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Overpayments of Hospitals’ Claims for Lengthy Acute Care Admissions (Follow-Up)
… of the three recommendations made in our audit report, Overpayments of Hospitals’ Claims for Lengthy Acute Care Admissions (2010-S-30). Background … (IPRO), to review inpatient claims. Our initial audit report, which was issued on July 25, 2013, identified $7.8 …
https://www.osc.ny.gov/state-agencies/audits/2015/07/07/overpayments-hospitals-claims-lengthy-acute-care-admissions-followUnited HealthCare – Overpayments for Services Provided by Dr. John Gomes
… through September 30, 2014. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, … gynecology practice operated by Dr. John Gomes, located on Franklin Avenue in Garden City, New York. With respect to the …
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
… To determine whether the costs reported by the League for the Handicapped (LFH) on its Consolidated Fiscal Report … the fiscal year ended June 30, 2014. Background LFH, a not-for-profit organization located in Springville, New York, is … that LFH reports to SED on its annual CFR. To be eligible for reimbursement, reported costs must comply with the …
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
… To Crossroads: Ensure that costs reported on annual CFRs fully comply with SED’s requirements, and communicate …
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
… services to children with disabilities between the ages of three and five years. CFDS is reimbursed for preschool … included: $64,954 in personal service costs that consisted of ineligible bonuses and executive compensation above the … reimbursement rates, as appropriate. Remind CFDS officials of the pertinent SED guidelines that relate to the …
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)
… of implementation of the six recommendations included in our initial audit report, Unnecessary Managed Care … Medicare deductibles and coinsurance for the recipients in question, the net savings to Medicaid would have been … Medicaid managed care premiums occurred because of delays in posting recipients' Medicare data to eMedNY (Medicaid's …
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
… to support expenses, such as vehicle cost allocations, contractor bidding, and sole source justification …
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
… overpaid health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period January 1, 2009 … the elderly and disabled. It consists of several parts. Medicare Part B helps pay for medical care provided in … overpaid health care providers for Medicaid claims for Medicare Part B coinsurance …
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
… most recent incident of sexual harassment or retaliation. You do not need an attorney to file a complaint with DHR, and …
https://www.osc.ny.gov/sexual-harassment-policyMedicaid Program – Improper Managed Care Payments for Misclassified Patient Discharges
… codes on inpatient claims. The audit covered the period from January 1, 2016 through December 31, 2021. About the … to reimburse hospitals for inpatient medical care. When a hospital bills an MCO for an inpatient stay, the hospital … payment than if the patient was simply discharged home from the hospital. Key Findings The audit identified 2,808 …
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
… To determine if the New York City Department of Education (DOE) arranged for eligible students to be placed in special … students in special education. In New York City (NYC), the DOE is responsible for determining eligibility for and … such students. Specifically, the Regulations require that DOE arrange for the placement of eligible students in special …
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)
… Fee-for-Service Payments for Services Covered by Managed Care (Report 2017-S-74 ). About the Program The Department of … providers using the fee-for-service (FFS) or managed care method. Under the FFS method, the Department, through … rendered to Medicaid recipients. Under the managed care method, the Department pays managed care plans a monthly …
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
… (DOF) identifies and collects fines and fees that are due for parking violations. This audit covered 262,765 cases … and mailing notices of violations, collecting the amounts due, and adjudicating summonses that are disputed by the … Division is responsible for collecting all amounts due from summonses that are in judgment (i.e., a vehicle …
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)
… in our initial audit report, Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition (Report … contained in our audit report Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition Report …
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)
… made in our initial audit report, Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services … whether Medicaid overpayments were made to hospitals for mechanical ventilation services reported on APR-DRG (All … contained in our audit report Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services …
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
… by two subscriber plans under the New York State Dental Insurance Program. The audit covered the period from January … 2022. About the Program New York State provides dental insurance benefits to certain State employees and their … claims for services on behalf of the New York State Dental Insurance Program (Dental Program). Coordination of benefits …
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
… Findings ORES was intended, in part, to reduce the time to site major renewable energy projects and bring them online … the feasibility of meeting Climate Act goals, all site permit process time frames should be accounted for, as … A realistic accounting of the total time it can take to site major renewable energy projects would provide important …
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
… calculated, adequately documented, and allowable under the State Education Department’s (SED) guidelines, including the … calculated adequately documented and allowable under the State Education Departments SED guidelines including the …
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)
… by the Centers for Medicare & Medicaid Services (CMS), Medicaid pays Medicare premiums for individuals who … and process enrollment in the Buy-in Program. In addition, CMS automatically enrolls certain individuals. Medicaid … who were automatically added to the Buy-in Program by CMS with coverage beginning more than 2 years retroactively, …
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-follow