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Administration of Contract C007373 With the Institute for Community Living
… Purpose To determine whether the Office of Mental Health (OMH) is effectively administering its contract with the Institute … 22, 2015. Background The mission of OMH is to promote the mental health and well-being of all New Yorkers. OMH operates … To determine whether the Office of Mental Health OMH is effectively administering its contract …
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
… housing program, PCMH assigns clients to private apartments scattered throughout the local communities as well … manager contacts. However, our visits to certain client apartments identified what appeared to be ongoing conditions …
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
… SED. SED reimburses DoE and the other school districts for a portion of its payments to WSSC. For the four years ended … increased by 126 percent, from $38,000 to $86,000, over a 22-month period; and $40,638 in depreciation related to … Davidson dealer; $1,723 for lodging at the Majestic View Lodge near Zion National Park; $1,620 at a cigar store; and …
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
… Fiscal Reports (CFRs) of the Children’s Center for Early Learning (Center) were calculated properly, documented … Fiscal Reports CFRs of the Childrens Center for Early Learning Center were calculated proper …
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
… Purpose To determine whether the costs reported on the Consolidated Fiscal Reports (CFRs) of the Whitestone School for Child Development (Whitestone) were calculated properly, … To determine whether the costs reported on the Consolidated Fiscal Reports of the …
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
… waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare … PC waived Empire Plan members outofpocket costs and if so to quantify the overpayments made by United …
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
… sets (one each for professional, institutional, dental, and pharmacy encounters). The EIS then processes the …
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)
… 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 … (Department) remind nursing homes of the correct way of coding for standard nursing home days and bed reserve days. …
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)
… Purpose To determine the extent of implementation of the three … audit report, Excessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Report 2009-S-64). … the Department was correctly paying claims for services to Medicaid recipients who also have health insurance through …
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
… Purpose To determine whether Long Island Laparoscopic Surgery, PLLC waived Empire Plan members’ … Our audit focused on claims submitted to United by Long Island Laparoscopic Surgery, PLLC (Long Island Laparoscopic), a non-participating provider located in … To determine whether Long Island Laparoscopic Surgery PLLC waived Empire Plan members …
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
… To determine whether the costs reported by Astor Services for Children & Families (Astor) on its Consolidated Fiscal Report (CFR) were … fiscal year ended June 30, 2013. Background Astor, a not-for-profit organization located in Rhinebeck, New York, … To determine whether the costs reported by Astor Services for Children Families Astor on its Consolidated Fiscal Report …
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)
… extent of implementation of the six recommendations made in our audit report, Improper Payments for Controlled Substances That Exceed Allowed Dispensing … pharmacies $1,183,601 for 13,705 fee-for-service claims in which quantities of controlled substances exceeded the …
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)
… audit report, Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Report 2014-S-5 ). … Medicaid inappropriately paid 29,289 fee-for-services pharmacy claims totaling $978,251 on behalf of 18,010 Medicaid recipients whose pharmacy benefits were covered by managed care. We …
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) … (Manual). The audit included all expenses claimed on Starting Point’s CFR for the fiscal year ended June 30, 2013, …
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
… codes unless the provider includes a modifier code on the claim to further describe the services performed. Modifier 59 … Health Insurance Program: United HealthCare - Certain Claim Payments for Evaluation and Management Services …
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
… for program reimbursements. Key Recommendations Follow up on the unsupported and/or inappropriate expenses (totaling …
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
… claims for recipients who were transferred between merged or consolidated hospitals and whether corresponding … occur among hospitals or divisions that are part of a merged or consolidated facility. Under these circumstances, … a recipient is transferred from the first hospital to a merged or consolidated division or hospital, only the first …
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
… 2010. Background Medicaid recipients in need of inpatient hospital care are provided a full range of necessary … Department and IPRO to review a judgmental sample of 297 hospital stays that were billed by ten hospitals for patients … care for a patient hospitalized in 2008. Although the hospital provided acute care on the first day of the …
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
… three and five. The New York City Department of Education (DoE) paid All Services tuition and fees according to rates …
https://www.osc.ny.gov/state-agencies/audits/2014/02/25/all-services-kids-inc-compliance-reimbursable-cost-manual