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DiNapoli and Ulster Co. DA Nneji: Owner of Ulster Co. Medical Transportation Company Pleads Guilty to Stealing $1.1 Million in Medicaid Fraud Scheme
… transportation service company today pleaded guilty to grand larceny in the first degree for stealing over $1.1 … Ulster County Court before Judge Brian Rounds. He faces up to 15 years in prison and will pay $1.1 million in restitution. Sentencing …
https://www.osc.ny.gov/press/releases/2026/03/dinapoli-and-ulster-co-da-nneji-owner-ulster-co-medical-transportation-company-pleads-guilty-stealingSelected Management and Operations Practices (Follow-Up)
… Purpose To determine the extent of implementation of the 12 … 60 (part CC) of the Laws of 2011 (Law). RNY power is to be allocated to businesses and not-for-profits that commit to retain or … To determine the extent of implementation of the 12 …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/selected-management-and-operations-practices-followMedicaid Program – Medicaid Drug Rebate Program Under Managed Care
… dispensed to individuals enrolled in Medicaid managed care. The audit covered the period from October 1, 2011 to … In 1990, Congress created the Medicaid Drug Rebate Program (Rebate Program) to reduce state and federal … requesting rebates from drug manufacturers. The Affordable Care Act, enacted in 2010, extended prescription drug rebates …
https://www.osc.ny.gov/state-agencies/audits/2015/02/18/medicaid-program-medicaid-drug-rebate-program-under-managed-careUnited Community Services, Inc. – Compliance With the Reimbursable Cost Manual
… the State Education Department’s (SED) Reimbursable Cost Manual (Manual). The audit covered expenses claimed on United’s CFRs … $207,295 in reported costs that did not comply with the Manual’s requirements and recommend such costs be disallowed. …
https://www.osc.ny.gov/state-agencies/audits/2015/12/30/united-community-services-inc-compliance-reimbursable-cost-manualContract Participation of Minority- and Women-Owned Business Enterprises
… comply with the Law. Key Findings The Law set the State’s MWBE participation target at 28.92 percent, and the Authority … years. However, the Authority did not explain why its MWBE participation goals were less than the goal established … required per DED regulation. The Authority overstated its MWBE contract participation when reporting to DED. A …
https://www.osc.ny.gov/state-agencies/audits/2015/07/08/contract-participation-minority-and-women-owned-business-enterprisesUnited HealthCare – Empire Plan Drug Rebates
… Purpose To determine if United HealthCare Insurance Company of New York (United) credited … rebates. Other Related Audits/Reports of Interest United HealthCare Insurance Company of New York: Empire Plan Drug Rebate Revenue (2013-S-41) United HealthCare: New York State Health Insurance Program - …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/united-healthcare-empire-plan-drug-rebatesCompliance With Payment Card Industry Standards
… DSS to protect against electronic security breaches and theft of payment card data. Entities that do not comply with … Services: Security and Effectiveness of Department of Motor Vehicles’ Licensing and Registration Systems …
https://www.osc.ny.gov/state-agencies/audits/2016/06/08/compliance-payment-card-industry-standardsUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy
… Pharmacy inappropriately billed United HealthCare for prescription medications under the State's employee health … the primary health benefits plan for NYSHIP and includes prescription drug coverage. The Department of Civil Service … with United HealthCare (United) to administer the prescription drug benefit portion of the Plan. Based on the …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyEmpire BlueCross BlueShield – Payments to John T. Mather Memorial Hospital (Follow-Up)
… Empire BlueCross BlueShield: Payments to John T. Mather Memorial Hospital (Report 2010-S-51), issued on April 23, … is comprised of ten hospitals, including John T. Mather Memorial Hospital (Mather). Empire’s agreement with the … Empire BlueCross Blue Shield - Payments to John T. Mather Memorial Hospital (2010-S-51) New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2013/06/04/empire-bluecross-blueshield-payments-john-t-mather-memorial-hospital-followMedicaid Program – Overpayments of Hospitals' Claims for Lengthy Acute Care Admissions
… hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The audit … Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and therapeutic care, including but not limited to surgical, medical, …
https://www.osc.ny.gov/state-agencies/audits/2013/07/25/medicaid-program-overpayments-hospitals-claims-lengthy-acute-care-admissionsDual Employment
… Purpose To determine whether Department of Corrections and Community Supervision (DOCCS) … DOCCS is responsible for the confinement and habilitation of approximately 56,000 offenders at 60 facilities across the State. As of September 1, 2012, DOCCS had 29,796 employees. To ensure …
https://www.osc.ny.gov/state-agencies/audits/2013/12/19/dual-employment-2Corcraft's Textile Procurement Practices
… to Corcraft textile operations. Production of textile products accounted for about 20 percent of Corcraft's sales. … Director of Operations, a Purchasing Supervisor, a Quality Control Analyst, and three Purchasing Agents. Key Findings … practices allow one person, the Purchasing Supervisor, to control almost all of the process for the procurement of …
https://www.osc.ny.gov/state-agencies/audits/2014/05/16/corcrafts-textile-procurement-practicesCriminal History Background Checks of Unlicensed Health Care Employees
… through its Criminal History Record Check (CHRC) Legal Unit, is responsible for conducting criminal history … If the person has been fingerprinted before, the CHRC Legal Unit reviews the case using information from its … approximately 17 percent with a criminal history, the CHRC Legal Unit conducted a review and made an employment …
https://www.osc.ny.gov/state-agencies/audits/2017/06/08/criminal-history-background-checks-unlicensed-health-care-employeesAccounts Payable Advisory No. 29
… of the New York Codes, Rules and Regulations requires the head of an agency to certify to the Comptroller annually, or at any time there is a new head of the agency, that the agency has sufficient internal … Section 110 of New York State Finance Law requires the head of the agency certify or approve vouchers for submission …
https://www.osc.ny.gov/state-agencies/advisories/accounts-payable-advisory/29-internal-controls-certificationCanarsie Childhood Center, Inc. – Compliance With the Reimbursable Cost Manual
… directly related to the special education program, and sufficiently documented pursuant to the State Education … Department’s (SED) Reimbursable Cost Manual (RCM) and the Consolidated Fiscal Reporting and Claiming Manual (CFR Manual). The audit focused primarily …
https://www.osc.ny.gov/state-agencies/audits/2022/02/01/canarsie-childhood-center-inc-compliance-reimbursable-cost-manualPurchasing and Procurement Practices
… New York Racing Association, Inc. (NYRA) procured goods and services competitively and in accordance with its policies and procedures. Our audit covered the period from January … the New York Racing Association Inc NYRA procured goods and services competitively and in accordance with its …
https://www.osc.ny.gov/state-agencies/audits/2022/03/16/purchasing-and-procurement-practicesMedicaid Program – Improper Overlapping Medicaid and Essential Plan Enrollments
… Review and correct the identified enrollment overlaps and recover overpayments, as warranted. Strengthen …
https://www.osc.ny.gov/state-agencies/audits/2022/10/11/medicaid-program-improper-overlapping-medicaid-and-essential-plan-enrollmentsOversight of Telemental Health Services (Follow-Up)
… that makes use of two-way, real-time interactive audio and video equipment to provide and support mental health services …
https://www.osc.ny.gov/state-agencies/audits/2022/12/06/oversight-telemental-health-services-followHousing Trust Fund Corporation – Oversight of the Residential Emergency Services to Offer Home Repairs to the Elderly Program
… in need of assistance. Specifically, we found: Inaccurate scoring on 7 of 30 LPA applications reviewed (23 percent) … to seniors. Key Recommendations Develop objective scoring guidelines to promote consistency and transparency in scoring and selecting LPA applications. Identify LPAs that …
https://www.osc.ny.gov/state-agencies/audits/2021/07/15/housing-trust-fund-corporation-oversight-residential-emergency-services-offer-home-repairsMedicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims
… by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with federal … deductibles, coinsurance, and copayments. Under Medicare Part C, private companies administer Medicare benefits by … Medicaid programs several options for paying the Medicare Part C cost-sharing. States can pay: the full Medicare …
https://www.osc.ny.gov/state-agencies/audits/2021/09/21/medicaid-program-cost-saving-opportunities-payments-medicare-part-c-claims