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Unnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… implement procedures to help ensure that Medicaid does not pay managed care premiums for enrollees of the Family Health …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followProcurement and Contracting Practices (Follow-Up)
… of implementation of the eight recommendations included in our initial audit report, Procurement and Contracting Practices (Report 2010-S-71). Background In our initial audit report, which was issued on February 28, … as the New York State Office for Technology, resulted in the best value for taxpayers, consistent with applicable …
https://www.osc.ny.gov/state-agencies/audits/2014/04/16/procurement-and-contracting-practices-followMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… Medicaid made improper fee-for-service claim payments for pharmacy services covered by recipients’ managed care plans. … provided to their enrollees. Prior to October 2011, pharmacy benefits were reimbursed through the fee-for-service … care coverage. However, beginning October 1, 2011, most pharmacy benefits were covered by managed care plans, and …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careSelected Employee Travel Expenses
… documentation to establish whether the official station of the selected employee was in the best interest of … Key Recommendations Ensure that each employee's official station is established in compliance with State travel rules …
https://www.osc.ny.gov/state-agencies/audits/2013/06/04/selected-employee-travel-expensesMedicaid Program – Medicaid Claims Processing Activity October 1, 2012 Through March 31, 2013
… cycles, which averaged about 6.4 million claims and $995 million in payments to providers. Key Findings Auditors …
https://www.osc.ny.gov/state-agencies/audits/2014/05/22/medicaid-program-medicaid-claims-processing-activity-october-1-2012-through-march-31-2013JCC of Mid-Westchester – Compliance With the Reimbursable Cost Manual
… Related Audits/Reports of Interest Kidz Therapy Services, PLLC: Compliance With the Reimbursable Cost Manual …
https://www.osc.ny.gov/state-agencies/audits/2016/12/30/jcc-mid-westchester-compliance-reimbursable-cost-manualHTA of New York, Inc. – Compliance With the Reimbursable Cost Manual
… Related Audits/Reports of Interest Kidz Therapy Services, PLLC: Compliance With the Reimbursable Cost Manual …
https://www.osc.ny.gov/state-agencies/audits/2016/12/15/hta-new-york-inc-compliance-reimbursable-cost-manualRFQual #22-03 – Independent Medical Examiner Services (Individual Physicians)
… 15, 2022 The New York State Comptroller (“Comptroller”), as Administrative Head of the New York State and Local … or the “System”) and as authorized by the Retirement and Social Security Law, is seeking to contract with physicians having general and specialized medical education, experience, and expertise. Physicians will …
https://www.osc.ny.gov/procurement/rfqual-22-03Cyber Incident Response Team
… Objective To determine whether the Cyber Incident Response Team at the Division of Homeland Security and Emergency … 26, 2021. About the Program The Cyber Incident Response Team (CIRT) is part of the State’s Division of Homeland … To determine whether the Cyber Incident Response Team at the Division of Homeland Security and Emergency …
https://www.osc.ny.gov/state-agencies/audits/2021/11/12/cyber-incident-response-teamCompliance With Executive Order 95 (Open Data) (Follow-Up)
… had published 155 data items including 76 data sets, 46 maps, 13 data lenses, 13 filtered views, six external links, …
https://www.osc.ny.gov/state-agencies/audits/2022/11/09/compliance-executive-order-95-open-data-followThe Arc Erie County New York – Compliance With the Reimbursable Cost Manual
… (CFRs) were properly calculated, adequately documented, and allowable under the State Education Department’s (SED) … guidelines, including the Reimbursable Cost Manual (RCM) and the Consolidated Fiscal Reporting and Claiming Manual (CFR Manual). The audit covered the …
https://www.osc.ny.gov/state-agencies/audits/2022/12/06/arc-erie-county-new-york-compliance-reimbursable-cost-manualMedicaid Program – Claims Processing Activity April 1, 2019 Through September 30, 2019
… pharmacy, inpatient, durable medical equipment, and dental claims that did not comply with Medicaid policies; … and was determining the program status of the remaining provider. Key Recommendations We made 12 recommendations to …
https://www.osc.ny.gov/state-agencies/audits/2020/09/02/medicaid-program-claims-processing-activity-april-1-2019-through-september-30-2019Medicaid Program – Claims Processing Activity October 1, 2019 Through March 31, 2020
… system processes Medicaid claims submitted by providers for services rendered to Medicaid-eligible recipients, and it generates payments to reimburse the providers for their claims. During the six-month period ended March 31, … prompt attention, including: $978,966 was paid for inpatient claims that were billed at a higher level of …
https://www.osc.ny.gov/state-agencies/audits/2020/10/20/medicaid-program-claims-processing-activity-october-1-2019-through-march-31-2020Use of Vendor-Supported Technology (Follow-Up)
… in Erie and Niagara counties, including the NFTA Metro Bus and Rail System, the Buffalo-Niagara International …
https://www.osc.ny.gov/state-agencies/audits/2021/01/19/use-vendor-supported-technology-followNational Directory of New Hires Data Security
… Enforcement), a subdivision of the U.S. Department of Health and Human Services (Health and Human Services). The … Every four years, the Office must submit a copy of an independent security assessment to Child Support Enforcement. … At the request of Office officials, we performed an independent security assessment of the Directory system …
https://www.osc.ny.gov/state-agencies/audits/2020/05/20/national-directory-new-hires-data-securityMedicaid Program – Accuracy of Medicaid Eligibility Determined by NY State of Health
… premium for each enrolled recipient and, in turn, the MCOs pay health care providers for services their members require. …
https://www.osc.ny.gov/state-agencies/audits/2020/09/17/medicaid-program-accuracy-medicaid-eligibility-determined-ny-state-healthMedicaid Program – Claims Processing Activity October 1, 2021 Through March 31, 2022
… Objective To determine whether the Department of Health’s (Department’s) eMedNY system reasonably ensured that … system processes claims submitted by providers for services rendered to Medicaid-eligible recipients, and it … Medicaid payments, as follows: $11.5 million was paid for managed care premiums on behalf of Medicaid recipients who …
https://www.osc.ny.gov/state-agencies/audits/2022/12/13/medicaid-program-claims-processing-activity-october-1-2021-through-march-31-2022Medicaid Program – Improper Medicaid Payments During Permissible Overlapping Medicaid and Essential Plan Coverage
… covered the period from January 2017 through November 2022. About the Program The Department of Health (Department) … the primary payer and Medicaid, as secondary payer, should pay any remaining liabilities, such as deductibles and …
https://www.osc.ny.gov/state-agencies/audits/2023/09/14/medicaid-program-improper-medicaid-payments-during-permissible-overlapping-medicaid-andEmpire BlueCross – Overpayments for Physician-Administered Drugs
… Drug Program. However, both programs should not pay for the same physician-administered drug for the same … were not in compliance with guidelines. As of June 21, 2023, Empire had started recoveries for $116,287 of the …
https://www.osc.ny.gov/state-agencies/audits/2023/09/27/empire-bluecross-overpayments-physician-administered-drugsMedicaid Program – Claims Processing Activity October 1, 2022 Through March 31, 2023
… Objective To determine whether the Department of Health’s eMedNY system reasonably ensured that Medicaid … system processes claims submitted by providers for services rendered to Medicaid-eligible recipients and … Medicaid payments, as follows: $12.2 million was paid for managed care premiums on behalf of Medicaid recipients who …
https://www.osc.ny.gov/state-agencies/audits/2023/10/25/medicaid-program-claims-processing-activity-october-1-2022-through-march-31-2023