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Reducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)
… Purpose To determine the implementation status of the five recommendations made in our initial audit report, … aid them in applying for Medicare. Of the initial report’s five audit recommendations, one was implemented, three were … To determine the implementation status of the five recommendations made in our initial audit report …
https://www.osc.ny.gov/state-agencies/audits/2018/09/05/reducing-medicaid-costs-recipients-end-stage-renal-disease-followMonitoring of Not-for-Profit Cemeteries for Fiscal Stability and Adequate Facility Maintenance
… Division of Cemeteries sufficiently monitors not-forprofit cemetery corporations to ensure fiscal stability and adequate … and preservation of burial grounds for all not-for-profit cemetery corporations (cemeteries) in New York State. As … Law (Law), and under the supervision of the State’s Cemetery Board (Board), the Division works with cemetery …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/monitoring-not-profit-cemeteries-fiscal-stability-and-adequate-facility-maintenanceAdministration of Contract C007373 With the Institute for Community Living
… Fiscal Report (CFR) for the contract year ended June 30, 2014. We also performed on-site observations of ICL staff, … of about $21.5 million for the fiscal year ended June 30, 2014. Key Findings We found that ICL provided the required … the Contract With the Center for Urban Community Services (2014-N-5) Office of Mental Health: Sky Light Center Inc. - …
https://www.osc.ny.gov/state-agencies/audits/2016/12/30/administration-contract-c007373-institute-community-livingAdministration of the Contract With the Postgraduate Center for Mental Health
… PCMH must file an annual Consolidated Fiscal Report (CFR) with OMH. The CFR categorizes and summarizes all … million for its supportive housing program during the 2013-14 contract year. Key Findings We found that the sampled … million in surplus advances from the 2011-12 through 2013-14 fiscal years. Key Recommendations Require PCMH case …
https://www.osc.ny.gov/state-agencies/audits/2016/12/30/administration-contract-postgraduate-center-mental-healthWestchester School for Special Children – Compliance With the Reimbursable Cost Manual
… whether the costs reported by the Westchester School for Special Children (WSSC) on its Consolidated Fiscal … SED. SED reimburses DoE and the other school districts for a portion of its payments to WSSC. For the four years ended June 30, 2011, WSSC claimed … whether the costs reported by the Westchester School for Special Children WSSC on its Consolidated Fiscal Reports …
https://www.osc.ny.gov/state-agencies/audits/2013/07/02/westchester-school-special-children-compliance-reimbursable-cost-manualChildren’s Center for Early Learning – Compliance With the Reimbursable Cost Manual
… reported on the Consolidated Fiscal Reports CFRs of the Childrens Center for Early Learning Center were calculated …
https://www.osc.ny.gov/state-agencies/audits/2014/12/29/childrens-center-early-learning-compliance-reimbursable-cost-manualWhitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… costs reported on the Consolidated Fiscal Reports (CFRs) of the Whitestone School for Child Development (Whitestone) … education program to disabled children between the ages of three and five years. Whitestone, located in Queens, New … Whitestone officials to help ensure their proper reporting of reimbursable costs. To Whitestone: Ensure that costs …
https://www.osc.ny.gov/state-agencies/audits/2015/04/07/whitestone-school-child-development-compliance-reimbursable-cost-manualUnited HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
… claims from non-participating providers at amounts that are generally higher (and often significantly higher) than … it is with the understanding that Empire Plan members are liable for a portion of the claimed amount, representing …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialistsMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
… Purpose To determine the readiness of all Medicaid managed care organizations (MCOs) to submit … Encounter Intake System. We conducted an early assessment of the readiness of Medicaid MCOs as of September 30, 2015. We did not review … To determine the readiness of all Medicaid managed care organizations to submit Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2016/03/29/medicaid-program-managed-care-organizations-readiness-encounter-intake-systemMonitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Follow-Up)
… Purpose To determine the extent of implementation of the three … 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 …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/monitoring-medicaid-payments-nursing-home-bed-reserve-days-followExcessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Follow-Up)
… in our initial audit report, Excessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits … whether the Department was correctly paying claims for services to Medicaid recipients who also have health … and proactive steps to administer Medicaid reimbursements for services provided to dual eligible individuals. About …
https://www.osc.ny.gov/state-agencies/audits/2013/04/26/excessive-medicaid-payments-services-recipients-receiving-medicare-benefits-followUnited HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… claims from non-participating providers at amounts that are generally higher (and often significantly higher) than … it is with the understanding that Empire Plan members are liable for a portion of the claimed amount, representing …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgeryAstor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… CFR, of which $3.3 million was for the Preschool Special Class and the Preschool Integrated Special Class (Programs) we audited. Key Findings We identified …
https://www.osc.ny.gov/state-agencies/audits/2015/09/02/astor-services-children-families-compliance-reimbursable-cost-manualImproper Payments for Controlled Substances That Exceed Allowed Dispensing Limits (Follow-Up)
… report. This included implementing controls to prevent the payment of pharmacy claims for quantities of controlled …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-payments-controlled-substances-exceed-allowed-dispensing-limits-followImproper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Follow-Up)
… included in our initial audit report, Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Report … which was issued on January 5, 2015, determined that, for the 27-month period October 1, 2011 through December 31, … our initial audit report Improper FeeforService Payments for Pharmacy Services …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-fee-service-payments-pharmacy-services-covered-managed-care-followStarting Point Services for Children – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by Starting Point Services for Children (Starting Point) on its Consolidated Fiscal Reports (CFRs) were … The audit included all expenses claimed on Starting Point’s CFR for the fiscal year ended June 30, 2013, and …
https://www.osc.ny.gov/state-agencies/audits/2015/12/11/starting-point-services-children-compliance-reimbursable-cost-manualUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59
… To determine whether UnitedHealthcare improperly paid for medical services designated with modifier code 59 that were … with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to Empire Plan members. United’s payments to medical providers are based, in part, on procedure codes …
https://www.osc.ny.gov/state-agencies/audits/2015/01/08/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59Milestone School for Child Development – Compliance With the Reimbursable Cost Manual
… integrated programs to disabled children between the ages of three and five years. During the 2012-13 school year, … serviced about 110 students. The New York City Department of Education (DoE) refers students to Milestone based on … and properly documented. SED reimburses DoE for a portion of its payments to Milestone based on statutory rates. For …
https://www.osc.ny.gov/state-agencies/audits/2015/07/17/milestone-school-child-development-compliance-reimbursable-cost-manualAdministration of the Contract With the Center for Urban Community Services
… Purpose We audited the New York City Department of Health and Mental Hygiene’s (DOHMH) administration of a contract (#113 … contracts with not-for-profit providers for a range of health and social services, including supportive housing. … We audited the New York City Department of Health and Mental Hygienes DOHMH administration of a contract …
https://www.osc.ny.gov/state-agencies/audits/2016/02/16/administration-contract-center-urban-community-servicesMedicaid Overpayments for Inpatient Transfer Claims Among Merged or Consolidated Facilities
… for their services. Generally, when a Medicaid recipient is transferred among different hospitals, two separate … facility. Under these circumstances, when a recipient is transferred from the first hospital to a merged or … Payments for Misclassified Patient Discharges (2009-S-26) Department of Health: Medicaid Claims Processing …
https://www.osc.ny.gov/state-agencies/audits/2015/12/08/medicaid-overpayments-inpatient-transfer-claims-among-merged-or-consolidated-facilities