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UnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services
To determine whether UnitedHealthcare sufficiently monitors outofnetwork providers who routinely bill for higherlevel Evaluation and Management services and
https://www.osc.ny.gov/state-agencies/audits/2018/12/31/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesImproper Episodic Payments to Home Health Providers (Follow-Up)
… State's Medicaid program provides a wide range of health care services to individuals who are economically … to Medicaid recipients in the home. EPS is based on 60-day episodes of care. CHHAs can be paid for a full episode … were transferred into Managed Long Term Care during a 60-day episode of care. The CHHAs should not have received full …
https://www.osc.ny.gov/state-agencies/audits/2018/05/04/improper-episodic-payments-home-health-providers-followOversight of Persons Convicted of Driving While Intoxicated
… Key Findings Of the 2,166 IIDs ordered by courts, only 111 IIDs (5 percent) were actually installed, and the …
https://www.osc.ny.gov/state-agencies/audits/2015/10/07/oversight-persons-convicted-driving-while-intoxicatedMedicaid Program – Oversight of Localities' Efforts to Coordinate Veterans' Health Care Benefits Under Medicaid and the U.S. Department of Veterans Affairs
… Purpose To determine whether the Department of Health effectively oversaw localities' efforts to coordinate … veterans' health care benefits provided through Medicaid and the U.S. Department of Veterans Affairs (VA). The audit … To determine whether the Department of Health effectively oversaw localities efforts to coordinate …
https://www.osc.ny.gov/state-agencies/audits/2014/03/19/medicaid-program-oversight-localities-efforts-coordinate-veterans-health-care-benefitsExamination of Unemployment Insurance Benefits
… requests and payments made by the Department of Labor (DOL) were appropriate and in accordance with applicable Federal and State laws and regulations and DOL policies and procedures, and (ii) DOL took corrective action and recouped overpayments based on …
https://www.osc.ny.gov/state-agencies/audits/2015/10/07/examination-unemployment-insurance-benefitsComptroller DiNapoli Releases School Audits
… to provide taxpayers the assurance that their money is being spent appropriately and effectively.” Dryden Central … to $5.4 million in fiscal year 2012-13. The district is considered to be susceptible to fiscal stress due to three … 50,000 state contracts, visit http://www.openbooknewyork.com/ . The easy-to-use website was created by Comptroller …
https://www.osc.ny.gov/press/releases/2014/04/comptroller-dinapoli-releases-school-audits-1DiNapoli: Potsdam Audit Finds Missing Court Funds
… Mary Rain’s office. In February, the former clerk – Mary Jo Guyette – was charged by the St. Lawrence County District …
https://www.osc.ny.gov/press/releases/2014/04/dinapoli-potsdam-audit-finds-missing-court-fundsMedicaid Program – Overpayments to Managed Care Organizations and Hospitals for Low Birth Weight Newborns
… actual birth weight was 3,215 grams. Medicaid should have only paid the MCO $3,232 for a standard kick payment. As a …
https://www.osc.ny.gov/state-agencies/audits/2014/10/02/medicaid-program-overpayments-managed-care-organizations-and-hospitals-low-birth-weightCriminal History Background Checks of Unlicensed Health Care Employees
… safeguard patients through requests for required criminal history background checks when hiring unlicensed … March 3, 2017. Background The Department, through its Criminal History Record Check (CHRC) Legal Unit, is responsible for conducting …
https://www.osc.ny.gov/state-agencies/audits/2017/06/08/criminal-history-background-checks-unlicensed-health-care-employeesContract Participation of Minority- and Women-Owned Business Enterprises
… Purpose To determine whether the Dormitory Authority of the State of New York properly established annual contract … and accurately reported program results to the Department of Economic Development. The audit covered the period of … To determine whether the Dormitory Authority of the State of New York properly established annual contract …
https://www.osc.ny.gov/state-agencies/audits/2015/07/08/contract-participation-minority-and-women-owned-business-enterprisesTrash Can Free Stations Pilot Program
… “R” line and Flushing-Main Street on the number “7” line (Phase I). Subsequently, SEO expanded the Pilot Program twice. … in each of the Bronx, Manhattan, Brooklyn and Queens) as Phase II; and an additional 29 locations, on the “J” and “M” lines were added (Phase III) in July 2014. All 29 stations are elevated. Key …
https://www.osc.ny.gov/state-agencies/audits/2015/09/22/trash-can-free-stations-pilot-programMedicaid Program – Medicaid Drug Rebate Program Under Managed Care
… MCOs (referred to as encounter claims), including a drug’s National Drug Code (NDC). The NDC is a unique number that serves as a universal product identifier for each medication and is the basis for the Department’s manufacturer rebate requests. The Department’s Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2015/02/18/medicaid-program-medicaid-drug-rebate-program-under-managed-careState Comptroller DiNapoli Releases Municipal & School Audits
… were issued. Town of Lincoln – Disbursements (Madison County) The board and former supervisor did not ensure that … discharge. Raquette Lake Union Free School District – Business Office Operations (Hamilton County) The board and … officials did not provide effective oversight of the business office operations. Specifically, the board did not …
https://www.osc.ny.gov/press/releases/2024/04/state-comptroller-dinapoli-releases-municipal-school-audits-0DiNapoli: Local Governments Should Improve Enforcement of State Fire Code Regulations
… from across New York reveals gaps in the review of fire safety plans or evacuation procedures for public buildings … villages. “Local officials must do their part to keep fire safety a priority,” said DiNapoli. “By neglecting to properly … each year, while all other buildings requiring a fire safety and evacuation plan must have a fire safety inspection …
https://www.osc.ny.gov/press/releases/2015/05/dinapoli-local-governments-should-improve-enforcement-state-fire-code-regulationsAccounts Payable Advisory No. 29
… area of review for the certification due by April 30, 2027. For the certification due by April 30, 2026, in … requirement. For the certification due by April 30, 2027, in addition to the annual certification of internal …
https://www.osc.ny.gov/state-agencies/advisories/accounts-payable-advisory/29-internal-controls-certificationPatient Safety Center Activities and Handling of Revenues (Follow-Up)
… four recommendations included in our initial audit report, Patient Safety Center Activities and Handling of Revenues (Report 2019-S-15 ). About the Program The Patient Health Information and Quality Improvement Act of … by a physician with a history of negligence unknown to the patient. Pursuant to the Act’s amendments to the Public …
https://www.osc.ny.gov/state-agencies/audits/2024/01/03/patient-safety-center-activities-and-handling-revenues-followDiNapoli: Former Assistant Clerk Charged with Stealing Nearly $4,000 from Village of Horseheads
… the Village of Horseheads, for allegedly stealing nearly $4,000 from the Village. The arrest was the result of a joint … accepting payments from multiple residents who wished to pay their water bills. The joint investigation and forensic … determined that Miele paid her personal New York State Electric & Gas (NYSEG) bill with Village funds resulting in …
https://www.osc.ny.gov/press/releases/2023/08/dinapoli-former-assistant-clerk-charged-stealing-nearly-4000-village-horseheadsImproper Supplemental Maternity Capitation Payments to Managed Care Organizations (Follow-Up)
… Supplemental Maternity Capitation Payments to Managed Care Organizations (Report 2020-S-57 ). About the Program The … Medicaid recipients receive their services through managed care, whereby the Department pays managed care organizations (MCOs) a monthly premium for each enrolled …
https://www.osc.ny.gov/state-agencies/audits/2023/07/20/improper-supplemental-maternity-capitation-payments-managed-care-organizations-followAudit Finds Operational and Oversight Failures Led to Financial Instability in Mount Vernon
… The city of Mount Vernon faced financial uncertainty and problems because … to complete basic financial functions contributed to Mount Vernon’s fiscal crisis,” DiNapoli said. “It is time for … full responses are included in the audit. Audits City of Mount Vernon – Non-Payroll Disbursements (2021M-163) Audit …
https://www.osc.ny.gov/press/releases/2022/01/audit-finds-operational-and-oversight-failures-led-financial-instability-mount-vernonAdministration of Mitchell-Lama Waiting Lists (Follow-Up)
… of 269 State-supervised developments, with over 105,000 apartments, were built under the Program. In exchange for … out, they are no longer subject to DHCR supervision, and apartments do not need to be kept affordable for … Program developments with approximately 64,000 apartments. Apartments are rented or sold to applicants on …
https://www.osc.ny.gov/state-agencies/audits/2021/01/19/administration-mitchell-lama-waiting-lists-follow