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Empire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)
… of the three recommendations made in our audit report, New York State Health Insurance Program: Empire … for the Period January 1, 2012 Through June 30, 2012 (Report 2012-S-132). Background The New York State Health … for 38,381 claims for special items. Our initial audit report, which was issued on December 13, 2013, found that …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2012-throughEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period July 1, 2012 Through December 31, 2012 (Follow-Up)
… of the three recommendations made in our audit report, New York State Health Insurance Program: Empire … for the Period July 1, 2012 Through December 31, 2012 (Report 2013-S-28). Background The New York State Health … for 39,993 claims for special items. Our initial audit report, which was issued on January 16, 2014, found that …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-july-1-2012-throughUnited Healthcare – Empire Plan Drug Rebate Revenue (Follow-Up)
… of rebates offered by drug manufacturers. In 2012, Express Scripts Holding Company (Express Scripts) acquired Medco. Our initial audit report, … throughout the course of our initial audit, United and Express Scripts delayed access to information we requested …
https://www.osc.ny.gov/state-agencies/audits/2015/12/03/united-healthcare-empire-plan-drug-rebate-revenue-followOverpayments of Certain Medicare Crossover Claims (Follow-Up)
… made in our audit report, Overpayments of Certain Medicare Crossover Claims (2011-S-28). Background Many Medicaid recipients are also enrolled in Medicare, the federal health care program for people 65 years … programs are referred to as “dual-eligibles.” Generally, Medicare is the primary payer for medical services provided …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/overpayments-certain-medicare-crossover-claims-followControls and Accountability of Court, Trust and Bail Funds
… Department of Finance accurately accounts for Court, Trust and Bail funds. This audit covered from January 1, 2011 … Section 2601 of the New York State Civil Practice Law and Rules requires that all moneys paid into the New York … or no heirs able or willing to administer the estates), and other miscellaneous funds. Finance's Court Assets …
https://www.osc.ny.gov/state-agencies/audits/2014/04/16/controls-and-accountability-court-trust-and-bail-fundsSelected Procurement and Contracting Practices
… communicated these procedures to the campuses. Our tests at seven campuses and System Administration found they … SUNY’s requirements to manage cost and could serve as best practice examples if more widely shared among the campuses. …
https://www.osc.ny.gov/state-agencies/audits/2015/07/06/selected-procurement-and-contracting-practicesReStacking Occupancy Initiative
… Background One cost-saving initiative recommended by the State’s Savings and Government Efficiency (SAGE) Commission, … established by the Governor in January 2011 to streamline State government, was targeted at decreasing the amount of leased property occupied by State agencies. The Commission predicted this initiative …
https://www.osc.ny.gov/state-agencies/audits/2014/09/09/restacking-occupancy-initiativeMedicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… the new APR DRG-based hospital inpatient payment system for Medicaid services when patient deaths occur within one … a change to the Medicaid reimbursement methodology used to compensate hospitals for inpatient medical care. The new methodology, based on All Patient Refined Diagnosis Related Groups (APR DRG), was implemented to …
https://www.osc.ny.gov/state-agencies/audits/2013/08/15/medicaid-program-payments-death-related-one-day-inpatient-admissionsConservation Fund – Sources and Uses of Funds
… Department of Environmental Conservation's (Department) fish, wildlife, and marine resources program (Program), which includes activities such as operating fish hatcheries and game farms and managing fish and wildlife populations. The Fund's primary source of …
https://www.osc.ny.gov/state-agencies/audits/2013/10/09/conservation-fund-sources-and-uses-fundsSelected Aspects of Discretionary Spending
… for personal items and other questionable items, such as movie tickets to be sold to employees. Key Recommendations …
https://www.osc.ny.gov/state-agencies/audits/2014/09/30/selected-aspects-discretionary-spending-2Medicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance
… Objective To determine whether Medicaid overpayments for pharmacy services on behalf of managed care recipients who … Medicaid services their recipients require, which includes pharmacy services. Many recipients have other third-party … audit period, HMS’ third-party liability recoveries on MCO pharmacy payments totaled about $118 million. Key Findings We …
https://www.osc.ny.gov/state-agencies/audits/2022/07/13/medicaid-program-recovering-managed-care-overpayments-pharmacy-services-behalf-recipientsInternal Controls Over Selected Financial Operations (Follow-Up)
… and wholesale licenses, special event and brand label permits, and miscellaneous permits such as those for …
https://www.osc.ny.gov/state-agencies/audits/2022/08/19/internal-controls-over-selected-financial-operations-followTechnology Transfer Program and Royalty Payments (Follow-Up)
… ). About the Program As part of its duties, the Research Foundation for the State University of New York (Research Foundation) supports the State University of New York’s … process that requires efforts from the Research Foundation, IP creators, and industry partners to translate …
https://www.osc.ny.gov/state-agencies/audits/2021/02/08/technology-transfer-program-and-royalty-payments-followMedicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
… Objective To determine whether Medicaid made improper Supplemental Maternity Capitation Payments to … To determine whether Medicaid made improper Supplemental Maternity Capitation Payments to …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-supplemental-maternity-capitation-payments-managed-careInappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Follow-Up)
… extent of implementation of the five recommendations made in our initial audit report, Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Report … extent of implementation of the five recommendations made in our initial audit report Inappropriate Premium Payments …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/inappropriate-premium-payments-recipients-no-longer-enrolled-mainstream-managed-care-andOversight of Homeless Shelters
… Objective To determine if the Office of Temporary and Disability Assistance (Office) adequately oversees … are operating in compliance with applicable laws, rules, and regulations. Our audit covered the period from July 1, … the Program According to the U.S. Department of Housing and Urban Development’s 2018 Annual Homeless Assessment …
https://www.osc.ny.gov/state-agencies/audits/2020/03/10/oversight-homeless-sheltersOversight of Selected Fiscal Aspects of Homeless Shelter Services (Follow-Up)
… which the New York City Department of Homeless Services (DHS) implemented the recommendations in our initial audit … shelter to every eligible person who requests services. DHS, an administrative unit of the New York City Department … are operated by private providers through contracts with DHS. As part of the procurement process, contract proposals …
https://www.osc.ny.gov/state-agencies/audits/2020/05/06/oversight-selected-fiscal-aspects-homeless-shelter-services-followThrough Ages, Inc. – Compliance With the Reimbursable Cost Manual
… ended June 30, 2014. About the Program Through Ages is a New York City-based for-profit organization authorized by SED to provide preschool Special Education Itinerant Teacher (SEIT) services to children with disabilities who are … 2015, Through Ages reported approximately $13.7 million in reimbursable costs for the SEIT preschool cost-based …
https://www.osc.ny.gov/state-agencies/audits/2020/06/03/through-ages-inc-compliance-reimbursable-cost-manualRecovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance (Follow-Up)
… Medicaid Program: Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party … the Medicaid services their recipients require, such as pharmacy services. Many recipients have other third-party … 2022, was to determine whether Medicaid overpayments for pharmacy services on behalf of managed care recipients who …
https://www.osc.ny.gov/state-agencies/audits/2024/01/31/recovering-managed-care-overpayments-pharmacy-services-behalf-recipients-third-party-healthMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… For example, one MCO established a 10-month rental cap on apnea monitors, yet for one recipient the MCO paid $10,450 on …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentals