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Medicaid Program – Improper Fee-for-Service Payments for Services Covered by Managed Care
… a monthly premium for each Medicaid recipient enrolled in managed care, and the managed care plans pay providers for … types of managed care. Most recipients are enrolled in mainstream managed care plans (Plans), which provide … eMedNY edits determine whether recipients are enrolled in Plans and will deny FFS claim payments unless the services …
https://www.osc.ny.gov/state-agencies/audits/2019/01/10/medicaid-program-improper-fee-service-payments-services-covered-managed-careDiNapoli: Clerk Admits Writing Nearly $5,000 in Village Checks for Herself
… Barnes pleaded guilty on Thursday after pocketing $4,788 in public funds for her personal use. Her thefts were brought … office. Barnes, 44, admitted before Judge Richard Gumo in Delhi Town Court that she issued four checks to herself … $500 to cover the village of Delhi’s insurance deductible in lieu of three years’ probation plus one year conditional …
https://www.osc.ny.gov/press/releases/2019/12/dinapoli-clerk-admits-writing-nearly-5000-village-checks-herselfImproper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance (Follow-Up)
… Objective To assess the extent of implementation of the eight recommendations included in our initial audit … (Report 2021-S-20 ). About the Program The Department of Health (DOH) administers New York’s Medicaid program. … To assess the extent of implementation of the eight recommendations included in …
https://www.osc.ny.gov/state-agencies/audits/2025/06/18/improper-fee-service-pharmacy-payments-recipients-third-party-health-insurance-followMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
… Intake System (EIS) began accepting encounter transactions from MCOs. (Prior to the EIS, MCOs submitted encounter … to submit encounter transactions to the EIS increased from 10 to 43 (of 52) by November 20, 2015. Key …
https://www.osc.ny.gov/state-agencies/audits/2016/03/29/medicaid-program-managed-care-organizations-readiness-encounter-intake-systemDiNapoli Urges Parents to Open a College Savings Account for Their Children
… helped New York residents pay for more than $230 million in college-related expenses in 2014, New York State Comptroller Thomas P. DiNapoli said today in recognition of 529 College Savings Day. The investment … helped New York residents pay for more than $230 million in collegerelated expenses in 2014 New York State Comptroller …
https://www.osc.ny.gov/press/releases/2014/05/dinapoli-urges-parents-open-college-savings-account-their-childrenManaged Care Premium Payments for Recipients With Comprehensive Third-Party Insurance (Follow-Up)
… in) provides comprehensive medical services that range from hospital care and physician services to dental and … (Department) policy is to exclude Medicaid recipients from enrollment in mainstream managed care when they also … with comprehensive TPHI and promptly disenrolling them from managed care. We issued our initial audit report on June …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/managed-care-premium-payments-recipients-comprehensive-third-party-insurance-followDiNapoli: Local Sales Tax Collections Drop for Second Quarter of 2020
… Sales tax revenue for local governments in New York state dropped 27.1 percent in the second quarter compared to the same period last year, … Collections for the month of June showed some improvement in most regions. Total collections were down 25.4 percent … Sales tax revenue for local governments in New York state dropped 271 percent in the second quarter …
https://www.osc.ny.gov/press/releases/2020/07/dinapoli-local-sales-tax-collections-drop-second-quarter-2020Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Report 2017-S-66 ). About the … prescriptions. I-STOP is a tool to assist prescribers in determining the most appropriate treatment for an …
https://www.osc.ny.gov/state-agencies/audits/2020/05/07/opioid-prescriptions-medicaid-recipients-opioid-treatment-program-followMonitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Follow-Up)
… audit report, Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Report 2010-S-21). Background Our … was issued on December 9, 2010, examined whether nursing home claims submitted to Medicaid for hospital bed reserve … days were appropriate, and if not, to what extent nursing home claims exceeded the bed reserve day limits. During the …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/monitoring-medicaid-payments-nursing-home-bed-reserve-days-followMedicaid Program – Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition
… necessary, whose necessity is evident from documentation in the patient’s medical record, and that meet existing … malnutrition diagnosis. Key Finding We identified $416,237 in overpayments on inpatient claims that certain hospitals … billing rules; and Properly document severe malnutrition in a patient’s medical record. Other Related Audits/Reports …
https://www.osc.ny.gov/state-agencies/audits/2019/04/08/medicaid-program-improper-medicaid-payments-recipients-diagnosed-severe-malnutritionMedicaid Program – Improper Payments for Drugs Without a Federal Drug Rebate Agreement
… an NDRA with the Department of Health and Human Services in exchange for state Medicaid coverage of most of the … capitation payment for each Medicaid recipient enrolled in their plans. MCOs then arrange for the provision of health … NDRA at the time of service. Additionally, we found flaws in the Department’s managed care capitation rate adjustment …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreementImproper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Improper Fee-for-Service … Key Finding Department officials have made some progress in addressing the problems we identified in the initial audit report. However, further actions are …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-fee-service-payments-pharmacy-services-covered-managed-care-followMedicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients
… Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program. The audit covered Medicaid payments for individuals enrolled in the Medicare buy-in program for the period from January 1, … Medicare premium payments on behalf of recipients enrolled in the Medicare buyin program …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipientsDirect Deposit Program
… to your direct deposit is effective, contact us . Use Retirement Online to Update Your Direct Deposit Information Retirement Online is the fastest and most convenient way to … applied to your next month’s pension payment. Sign in to Retirement Online. From Account Homepage, click Update Direct …
https://www.osc.ny.gov/retirement/retirees/direct-deposit-programMedicaid Program – Overpayments of Hospitals' Claims for Lengthy Acute Care Admissions
… 2010. Background Medicaid recipients in need of inpatient hospital care are provided a full range of necessary … laboratory, rehabilitative and psychiatric care. When billing Medicaid for inpatient services, hospitals must … of care. To help ensure Medicaid payments are correct, the Department uses a contractor, the Island Peer Review …
https://www.osc.ny.gov/state-agencies/audits/2013/07/25/medicaid-program-overpayments-hospitals-claims-lengthy-acute-care-admissionsDiNapoli: As State Tax Check-Off Options Increase, Spending Lags for Most
… the highest number of personal income tax (PIT) check-offs in the nation, but an analysis by State Comptroller Thomas P. … than one-third of the tax check-off funds has been spent in the last six years,” DiNapoli said. “Donors expect their … clarity on why spending from the funds is lagging.” In State Fiscal Year (SFY) 2022-23, contributions to the …
https://www.osc.ny.gov/press/releases/2024/01/dinapoli-state-tax-check-off-options-increase-spending-lags-mostMinority- and Women-Owned Business Enterprises (MWBEs)
… intent to increase our annual participation. Get Certified In order to take advantage of the State’s MWBE program, you … The Emerging Manager Program helps ensure that MWBEs in the financial arena have opportunities to do business with … andor womenowned businesses through a variety of programs In fact in some cases state agen …
https://www.osc.ny.gov/state-vendors/resources/minority-and-women-owned-business-enterprises-mwbesAstor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… Background Astor, a not-for-profit organization located in Rhinebeck, New York, provides preschool special education … reported costs must comply with the guidelines specified in the RCM. For the fiscal year ended June 30, 2013, Astor reported a total of $6.4 million in reimbursable costs on its CFR, of which $3.3 million was …
https://www.osc.ny.gov/state-agencies/audits/2015/09/02/astor-services-children-families-compliance-reimbursable-cost-manualExcessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Follow-Up)
… more proactive culture that seeks to ensure that Medicaid is the payer of last resort for services provided to dual …
https://www.osc.ny.gov/state-agencies/audits/2013/04/26/excessive-medicaid-payments-services-recipients-receiving-medicare-benefits-follow