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UnitedHealthcare Insurance Company of New York – Overpayments for Physician-Administered Drugs
… whether UnitedHealthcare Insurance Company of New York appropriately reimbursed physician-administered drugs. … 2017 through December 2021. About the Program The New York State Health Insurance Program (NYSHIP), administered by …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/unitedhealthcare-insurance-company-new-york-overpayments-physician-administered-drugsMedicaid Program – Impact of Rejected Encounters on the Collection of Drug Rebates
To determine whether the Department of Health did not collect Medicaid drug rebates due to encounter system rejections of pharmacy encounter claims
https://www.osc.ny.gov/state-agencies/audits/2024/12/23/medicaid-program-impact-rejected-encounters-collection-drug-rebatesCVS Caremark – Accuracy of Empire Plan Commercial Rebate Revenue Remitted to the Department of Civil Service
… 2019 through December 2022. About the Program The New York State Health Insurance Program (NYSHIP), administered by the … Civil Service received over $2 billion in Empire Plan commercial drug rebates (rebates exclusive of Medicare Part D … drug manufacturers for rebates or collect and remit all rebate revenue to Civil Service. Based on judgmental …
https://www.osc.ny.gov/state-agencies/audits/2025/03/18/cvs-caremark-accuracy-empire-plan-commercial-rebate-revenue-remitted-department-civilHomeless Outreach Program at the Long Island Rail Road
… of Interest Homeless Shelters and Homelessness in New York State – An Overview, Exclusive of New York City ( 2016-D-3 ) …
https://www.osc.ny.gov/state-agencies/audits/2019/01/16/homeless-outreach-program-long-island-rail-roadDiNapoli: MTA'S Homeless Outreach Program Didn't Do Much Outreach
… hired to provide outreach services at Penn Station, Grand Central and elsewhere, according to an audit released … informed that outreach efforts at LIRR stations within NYC were only taking place on overnight shifts Sunday through … and 25 outreach specialists (18 for Penn Station/LIRR and seven Grand Central/Metro North). The audit found that for …
https://www.osc.ny.gov/press/releases/2019/07/dinapoli-mtas-homeless-outreach-program-didnt-do-much-outreachMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… of Health overpaid health care providers’ Medicaid claims for services also covered by Medicare Advantage plans. The … plans (Plans) also offer supplemental insurance benefits for services that are not covered by original Medicare (e.g., … dental services). Plans reimburse health care providers for services provided to enrollees. Generally, Medicaid is …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesTuition Assistance Program – New York College of Health Professions
… Purpose To determine whether New York College of Health Professions complied with the … of Health Professions (College of Health) was established in 1981 as the New Center for Holistic Health Education and Research. The school operates five locations – a campus in Syosset, Long Island; three locations …
https://www.osc.ny.gov/state-agencies/audits/2017/10/31/tuition-assistance-program-new-york-college-health-professionsMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… Purpose To determine whether Medicaid inappropriately paid for … in Medicare. Such recipients are commonly referred to as “dual-eligibles.” In 1997, Congress established …
https://www.osc.ny.gov/state-agencies/audits/2018/09/10/medicaid-program-medicaid-payments-medicare-advantage-plan-providersMedicaid Program – Managed Care Organizations: Payments to Ineligible Providers
… 198,515 claims paid to pharmacies where the prescribing physician was excluded from the Medicaid program or otherwise …
https://www.osc.ny.gov/state-agencies/audits/2018/02/26/medicaid-program-managed-care-organizations-payments-ineligible-providersHomeless Housing and Assistance Program – Project Selection and Maintenance
… employees. HHAP was created in 1983 to provide funding for the establishment of homeless projects in the form of … to acquire, construct, or rehabilitate supportive housing for the homeless. Financial assistance is provided through direct contracts with municipalities, not-for-profits, charitable organizations, or public …
https://www.osc.ny.gov/state-agencies/audits/2019/01/10/homeless-housing-and-assistance-program-project-selection-and-maintenanceMedicaid Program – Managed Long Term Care Premium Rate Setting
… Purpose To determine whether managed care organizations (MCOs) provided the Department of Health (Department) with complete and accurate Medicaid cost … MLTC. The MLTC MCOs provide long term care services (e.g., home health care, adult day care, nursing home care) …
https://www.osc.ny.gov/state-agencies/audits/2017/09/27/medicaid-program-managed-long-term-care-premium-rate-settingUniversal Pre-Kindergarten Program – Monitoring of Health and Safety Requirements
… and safety requirements. There is a wide disparity in the way UPK providers are monitored for health and safety. Some …
https://www.osc.ny.gov/state-agencies/audits/2016/12/20/universal-pre-kindergarten-program-monitoring-health-and-safety-requirementsMedicaid Program – Overpayments of Ambulatory Patient Group Claims (Follow-Up)
… methodology (known as Ambulatory Patient Groups [or APG]) for clinic and ambulatory surgery services as well as … $933,399 in duplicate payments that were made to providers for the same services under both the old and the new (APG) …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/medicaid-program-overpayments-ambulatory-patient-group-claims-followDiNapoli: Audit Reveals Problems with Volunteer Firefighters’ Benefit Program
… fire districts are not accurately calculating credits for Length of Service Awards Programs (LOSAP) and as a result … and municipalities across the state have established LOSAP for their volunteers. “The men and women who volunteer their … and the maximum number of points that can be earned for performing each activity over the course of a year. …
https://www.osc.ny.gov/press/releases/2015/02/dinapoli-audit-reveals-problems-volunteer-firefighters-benefit-programMedicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… established Medicare Part C, the Medicare managed care program also known as Medicare Advantage. Under Medicare Part …
https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claimsProject Tracking Systems and Economic Assistance Program Evaluations (Follow-Up)
… State Development (ESD) is the chief agency responsible for the coordination of the State’s economic development … determine if ESD maintained adequate information systems for the collection of relevant data to effectively manage and …
https://www.osc.ny.gov/state-agencies/audits/2024/02/14/project-tracking-systems-and-economic-assistance-program-evaluations-followDiNapoli: Shift in MTA's Paratransit Program Generates Cost Savings
… Costs for the Metropolitan Transportation Authority’s (MTA) program to provide transportation services for people … every 1,000 scheduled rides, while brokers had a failure rate of 3.89 per 1,000. Still, complaints regarding … over 30,000 users could access the MTA’s bus fleet and may benefit from further investment in ADA accessible subway …
https://www.osc.ny.gov/press/releases/2023/11/dinapoli-shift-mtas-paratransit-program-generates-cost-savingsLake Placid Central School District – Investment Program (2023M-94)
… investment program. The Assistant Superintendent for Business, Finance and Support Services (Assistant …
https://www.osc.ny.gov/local-government/audits/school-district/2023/10/20/lake-placid-central-school-district-investment-program-2023m-94Medicaid Program – Oversight of Managed Long-Term Care Member Eligibility
… Objective To determine whether the Department of Health (Department) made improper Medicaid managed long-term … MLTC plans, which provide long-term care services, such as home health care and nursing home care, for people who are …
https://www.osc.ny.gov/state-agencies/audits/2022/08/05/medicaid-program-oversight-managed-long-term-care-member-eligibilityMedicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
… Objective To determine whether the Medicaid program made inappropriate fee-for-service (FFS) payments to … 1, 2015 to December 31, 2019. About the Program The State’s Medicaid program is administered by the Department of …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-discharges