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Medicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… Purpose To determine whether the Department of Health (Department) made inappropriate premium payments to … In return, managed care plans arrange for the provision of health care services their members require. The State’s Medicaid program offers different types of managed care. Most Medicaid recipients are enrolled in …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamThe 80/20 Housing Program
… in the building, of comparable size (whether affordable or market rate), must be rented to a low-income tenant to …
https://www.osc.ny.gov/state-agencies/audits/2017/05/31/8020-housing-programWhitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… the State Education Department’s (SED) Reimbursable Cost Manual (Manual). The audit included all expenses claimed for the … $154,563 in reported costs that did not comply with Manual requirements and recommend such costs be disallowed. …
https://www.osc.ny.gov/state-agencies/audits/2015/04/07/whitestone-school-child-development-compliance-reimbursable-cost-manualNursing Home Surveillance
… State regulations and procedures for conducting nursing home surveys and whether survey processes, including the … Complaint surveys investigate issues, and nursing home-reported incidents, that may involve non-compliance with … for severity and urgency to assess whether a nursing home has violated a federal or State regulation. If any …
https://www.osc.ny.gov/state-agencies/audits/2016/02/19/nursing-home-surveillancePractices Used by the Transit Adjudication Bureau to Collect and Account for Fines and Fees
… To determine whether the Transit Adjudication Bureau of New York City Transit performs its responsibilities in an … for processing and adjudicating summonses for violations of NYC Transit (Transit) rules governing public use of the transit system. TAB offers a respondent the …
https://www.osc.ny.gov/state-agencies/audits/2016/08/11/practices-used-transit-adjudication-bureau-collect-and-account-fines-and-feesSelect Financial Management Practices
… capital planning process and collection and reporting of delinquent accounts receivable are in compliance with the … In 1925, the Commission was established through an act of the New York State Legislature. The enabling legislation … and effectively manage the publicly owned maritime Port of Albany-Rensselaer, contributing to the economy of the …
https://www.osc.ny.gov/state-agencies/audits/2015/11/05/select-financial-management-practicesMedicaid 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-systemDriver Responsibility Assessment Program
… driving record within an 18-month period. The Program database is maintained by the Office of Information … controls over manual adjustments made to the Program database by ITS staff. Several ITS employees have unrestricted access to the database and its contents. Although ITS has a procedure in …
https://www.osc.ny.gov/state-agencies/audits/2014/10/09/driver-responsibility-assessment-programFinancial Management Practices
… (District) financial management practices in the areas of revenue collection, payroll, procurement, asset and … March 15, 2014. Background The District regulates the flow of the Hudson River and the Black River to reduce flooding … by excess run-off and to augment river flow at times of drought. Organized as a public benefit corporation, it has …
https://www.osc.ny.gov/state-agencies/audits/2014/11/25/financial-management-practicesMedicaid Program – Medicaid Claims Processing Activity October 1, 2014 Through March 31, 2015
… Purpose To determine whether the Department of Health’s eMedNY system reasonably ensured that Medicaid … 1, 2014 through March 31, 2015. Background The Department of Health (Department) administers the State’s Medicaid … 264 million claims, resulting in payments to providers of about $28.5 billion. The claims are processed and paid in …
https://www.osc.ny.gov/state-agencies/audits/2015/12/08/medicaid-program-medicaid-claims-processing-activity-october-1-2014-through-march-31-2015Tuition Assistance Program – Metropolitan Learning Institute
… complied with the Education Law and the Commissioner of Education’s Rules and Regulations when certifying students … totaling almost $8.7 million that were paid on behalf of 1,890 students. At the time of our audit, Metropolitan served about 550 students. Tuition …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/tuition-assistance-program-metropolitan-learning-instituteFuel Purchases
… Authority (Authority) is purchasing the correct type of fuel, paying the proper amount for the fuel purchased, receiving the correct amount of fuel, and keeping accurate records of the supply and distribution of fuel. The audit covers the … Authority Authority is purchasing the correct type of fuel paying the proper a …
https://www.osc.ny.gov/state-agencies/audits/2015/02/27/fuel-purchasesAccountability for Traffic Ticket Surcharges
… York State Vehicle and Traffic Law authorizes cities with a population of 200,000 or more to adjudicate non-criminal … adjudication function. There are currently ten TVBs, eight in New York City and one each in Rochester and Buffalo; each is responsible for processing …
https://www.osc.ny.gov/state-agencies/audits/2015/08/10/accountability-traffic-ticket-surchargesMedicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… services when patient deaths occur within one day of admission. The audit covers the period December 1, 2009 … claims when patient deaths occur within the first day of admission. For instance, Medicaid paid $153,329 on a claim … $9,685 for a patient who died within the first day of admission. The APR DRG-based methodology assigns additional …
https://www.osc.ny.gov/state-agencies/audits/2013/08/15/medicaid-program-payments-death-related-one-day-inpatient-admissionsDual Employment
… Purpose To determine whether Department of Corrections and Community Supervision (DOCCS) … DOCCS is responsible for the confinement and habilitation of approximately 56,000 offenders at 60 facilities across the State. As of September 1, 2012, DOCCS had 29,796 employees. To ensure …
https://www.osc.ny.gov/state-agencies/audits/2013/12/19/dual-employment-2Medicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… the costs of most medical care provided during a hospital admission. As such, claims for ancillary services provided during a hospital admission are generally not reimbursable. In 2007, the …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Mainstream Managed Care Organizations: Administrative Costs Used in Premium Rate Setting
… submitting accurate administrative costs to the Department of Health (Department) and whether the Department is … and locally funded program that provides a wide range of medical services to those who are economically … and Medicaid claim costs totaled about $53 billion. Most of the State’s Medicaid recipients receive their services …
https://www.osc.ny.gov/state-agencies/audits/2016/10/13/medicaid-program-mainstream-managed-care-organizations-administrative-costs-used-premiumInmate Sentence Calculation and Release Practices
… Purpose To determine whether the Department of Corrections and Community Supervision (Department) follows … times in accordance with all laws and regulations. The audit covered the period January 1, 2013 through October … To determine whether the Department of Corrections and Community Supervision …
https://www.osc.ny.gov/state-agencies/audits/2017/04/07/inmate-sentence-calculation-and-release-practicesEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… generated surpluses totaling $885,680 for the items (or a 385 percent profit margin). Key Recommendations Enhance …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsCompliance With Navigation Law
… Objective To determine if the Office of Parks, Recreation and Historic Preservation (Parks) is … requirements to ensure boaters’ safety and quality of life on State waters in accordance with New York State … October 31, 2019. About the Program With its vast network of waterways, including about 70,000 miles of rivers and …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/compliance-navigation-law