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United HealthCare – Overpayments for Services Provided by Dr. John Gomes
… Purpose To determine whether the practice of Dr. John Gomes routinely waived Empire Plan members’ … an obstetrics and gynecology practice operated by Dr. John Gomes, located on Franklin Avenue in Garden City, New … September 30, 2014. Key Recommendations Recover from Dr. John Gomes $1,258,855 in overpayments funded by the State. …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-dr-john-gomesLeague for the Handicapped – Compliance With the Reimbursable Cost Manual
… Fiscal Report CFR were properly calculated adequately doc …
https://www.osc.ny.gov/state-agencies/audits/2016/06/03/league-handicapped-compliance-reimbursable-cost-manualCrossroads Center for Children – Compliance With the Reimbursable Cost Manual
… determine whether the costs reported by Crossroads Center for Children, (Crossroads) on its Consolidated Fiscal Report … 30, 2014. Background Crossroads is an SED-approved, not-for-profit organization located in Schenectady, New York. … the ages of three and five years. Crossroads is reimbursed for preschool special education services through rates set by …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/crossroads-center-children-compliance-reimbursable-cost-manualCenter for Disability Services – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by the Center for Disability Services (CFDS) on its Consolidated Fiscal … December 31, 2013. Background CFDS is an SED-approved not-for-profit special education provider located in Albany, New … the ages of three and five years. CFDS is reimbursed for preschool special education program services through …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/center-disability-services-compliance-reimbursable-cost-manualUnnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… managed care premiums for enrollees of the Family Health Plus program who also have Medicare. Key Finding Department …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followAnnual Assessment of Market Orders for 2012, 2013, and 2014
… and Markets (Department) has adequate procedures in place to accurately report its assessable expenses related to … Key Findings The Department has adequate procedures in place to ensure that it accurately reports its assessable … of Agriculture and Markets has adequate procedures in place to accurately report its assessable expenses related to …
https://www.osc.ny.gov/state-agencies/audits/2015/05/07/annual-assessment-market-orders-2012-2013-and-2014Medicaid Program – Overpayments for Services Also Covered by Medicare Part B
… health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period January 1, … and disabled. It consists of several parts. Medicare Part B helps pay for medical care provided in outpatient … Medicare pays 80 percent of the charges for approved Part B services, and Medicaid pays the remaining balances …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bSexual Harassment Policy for the Office of the State Comptroller
… Introduction The Office of the State Comptroller (OSC) is committed to maintaining a … if the complaining individual is not the intended target of the sexual harassment; Such conduct is made either … The Office of the State Comptroller is committed to maintaining a …
https://www.osc.ny.gov/sexual-harassment-policyMedicaid Program – Improper Managed Care Payments for Misclassified Patient Discharges
… to reimburse hospitals for inpatient medical care. When a hospital bills an MCO for an inpatient stay, the hospital reports certain information on its claims, such as … than if the patient was simply discharged home from the hospital. Key Findings The audit identified 2,808 managed …
https://www.osc.ny.gov/state-agencies/audits/2022/08/19/medicaid-program-improper-managed-care-payments-misclassified-patient-dischargesCompliance With Special Education Regulations for the Provision of Services
… ranged from 32 percent in District 9 (located in the South Bronx) to 4 percent in District 11 (Northeast Bronx). DOE deprives itself of critical performance data by …
https://www.osc.ny.gov/state-agencies/audits/2020/09/30/compliance-special-education-regulations-provision-servicesImproper Fee-for-Service Payments for Services Covered by Managed Care (Follow-Up)
… Objective To determine the extent of implementation of the six recommendations included in our initial audit report, Improper Fee-for-Service … system, pays providers directly for services rendered to Medicaid recipients. Under the managed care method, the … To determine the extent of implementation of the six …
https://www.osc.ny.gov/state-agencies/audits/2021/02/11/improper-fee-service-payments-services-covered-managed-care-followSelected Aspects of Collecting Outstanding Amounts Due for Parking Violations
… that can issue parking summonses within New York City (NYC). During fiscal years 2017 through 2019, DOF processed … for collecting fines and fees for violations issued within NYC, and also the Outside Collection Agency/External Inquiry … from respondents who have New York plates and live within NYC. DOF refers other cases to the NYC Law Department, which …
https://www.osc.ny.gov/state-agencies/audits/2021/03/23/selected-aspects-collecting-outstanding-amounts-due-parking-violationsImproper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition (Follow-Up)
… improperly billed All Patient Refined-Diagnosis Related Group inpatient claims containing a severe malnutrition … that contained a severe malnutrition diagnosis that the medical records did not appear to support. We made two …
https://www.osc.ny.gov/state-agencies/audits/2020/09/02/improper-medicaid-payments-recipients-diagnosed-severe-malnutrition-followMedicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services (Follow-Up)
… Hospitals use International Classification of Diseases (ICD) procedure codes on their claims to report mechanical … ventilation services. When hospitals use a specific ICD procedure code to report a patient received 96 … we identified; remind hospitals to use the proper ICD procedure code that represents the duration of time the …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-services-followEmblemHealth Plan, Inc.: Overpayments for Services Requiring Coordination of Benefits
To determine whether EmblemHealth Plan Inc overpaid dental claims for members covered by two subscriber plans under the New York State Dental Insurance Program
https://www.osc.ny.gov/state-agencies/audits/2024/01/08/emblemhealth-plan-inc-overpayments-services-requiring-coordination-benefitsApplication Review and Site Permitting for Major Renewable Energy Projects
… Objective To determine whether the Office of Renewable Energy Siting is fulfilling its obligations under State law to issue siting permits for major renewable energy projects within the required time frames. This audit … To determine whether the Office of Renewable Energy Siting is fulfilling its obligations under State law …
https://www.osc.ny.gov/state-agencies/audits/2024/04/24/application-review-and-site-permitting-major-renewable-energy-projectsCantalician Center for Learning – Compliance With the Reimbursable Cost Manual
… it operated: Preschool Special Class – over 2.5 hours per day and Preschool Integrated Special Class – over 2.5 hours per day (collectively referred to as the Programs). Key Findings …
https://www.osc.ny.gov/state-agencies/audits/2023/01/26/cantalician-center-learning-compliance-reimbursable-cost-manualImproper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
… included in our initial audit report, Improper Payments of Medicare Buy-In Premiums for Ineligible Recipients (Report … program. Many Medicaid recipients are also enrolled in Medicare. Under the Medicare buy-in program (Buy-in Program), administered by the … included in our initial audit report Improper Payments of Medicare BuyIn Premiums for Ineligible Recipients Report …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/improper-payments-medicare-buy-premiums-ineligible-recipients-followUse of Federal Funding for Election Technology and Security (Follow-Up)
… in our initial audit report, Use of Federal Funding for Election Technology and Security (Report 2020-S-18 ). About … (BOE) is responsible for administering and enforcing election laws in the State. To fulfill these … the nation’s voting process. HAVA established minimum election administration standards and created the U.S. …
https://www.osc.ny.gov/state-agencies/audits/2023/06/22/use-federal-funding-election-technology-and-security-followBenefits Advisement Services for Individuals With Disabilities Seeking Employment (Follow-Up)
… in our initial audit report, Benefits Advisement Services for Individuals With Disabilities Seeking Employment ( … with disabilities was about 37% compared to about 75% for people without disabilities. Further, ACS data shows that … 2015. The Report established an Employment First Policy for New York State with the main goal of increasing the …
https://www.osc.ny.gov/state-agencies/audits/2023/06/22/benefits-advisement-services-individuals-disabilities-seeking-employment-follow