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Monitoring 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
… whether the costs reported by the Milestone School for Child Development (Milestone) on its Consolidated Fiscal … The audit included all expenses claimed on Milestone’s CFR for the fiscal year 2012-13, and certain expenses claimed on Milestone’s CFRs for the two fiscal years ended June 30, 2012. Background The …
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-facilitiesMedicaid Program – Overpayments of Hospitals' Claims for Lengthy Acute Care Admissions
… overpaid hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The … March 31, 2010. Background Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and therapeutic care, …
https://www.osc.ny.gov/state-agencies/audits/2013/07/25/medicaid-program-overpayments-hospitals-claims-lengthy-acute-care-admissionsAll Services for Kids, Inc. – Compliance With the Reimbursable Cost Manual
… 2010. Background All Services, located in Fresh Meadows, New York, provided special education itinerant teacher … with disabilities between the ages of three and five. The New York City Department of Education (DoE) paid All Services …
https://www.osc.ny.gov/state-agencies/audits/2014/02/25/all-services-kids-inc-compliance-reimbursable-cost-manualMedicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients
… Objective To determine if Medicaid made improper Medicare premium … Medicare buy-in program credits from January 1, 2015 to November 30, 2020. About the Program The Department of … We found that the Department needs additional controls to ensure timely Buy-in Program eligibility determinations …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipientsOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by … overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered … covered the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followEmpire BlueCross – Improper Payments for Intraocular Lens Claims Billed by Hospitals
… Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital … schedules. Intraocular lenses are used in the treatment of cataracts – the clouding of the lens in the eye – which cause vision problems. A …
https://www.osc.ny.gov/state-agencies/audits/2019/12/20/empire-bluecross-improper-payments-intraocular-lens-claims-billed-hospitalsManaged Care Premium Payments for Recipients With Comprehensive Third-Party Insurance (Follow-Up)
… of implementation of the seven recommendations made in our initial audit report, Managed Care Premium Payments for … promptly disenrolling them from managed care. We issued our initial audit report on June 13, 2018. The audit … the period January 1, 2012 through September 1, 2017. Our audit identified $1.28 billion in premiums that were paid …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/managed-care-premium-payments-recipients-comprehensive-third-party-insurance-followOpioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Follow-Up)
… The audit objective was to determine if the Department of Health (Department) had taken sufficient steps to safeguard … dangerous prescriptions if Treatment Programs did not check I-STOP and, where authorized, coordinate care with … – auditors noted 493 of the 18,786 recipients required medical care as a result of opioid or narcotic overdoses that …
https://www.osc.ny.gov/state-agencies/audits/2020/05/07/opioid-prescriptions-medicaid-recipients-opioid-treatment-program-followMedicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY (Follow-Up)
… of implementation of the five recommendations included in our initial audit report, Medicaid Overpayments for … Program. Many Medicaid recipients are also enrolled in Medicare Part B (Part B), which provides supplemental … through May 31, 2017 and identified up to $8.7 million in improper payments for Part B deductibles and coinsurance. …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-part-b-services-billed-directly-emedny-followMedicaid Program – Improper Payments for Drugs Without a Federal Drug Rebate Agreement
… managed care organizations (MCOs) a monthly capitation payment for each Medicaid recipient enrolled in their plans. …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreement