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Empire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)
… recommendations made in our audit report, New York State Health Insurance Program: Empire BlueCross BlueShield … 2012 (Report 2012-S-132). Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, …
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)
… Payments for hospital services are generally based on standard fee schedules that are negotiated between Empire … special items. Our initial audit report, which was issued on January 16, 2014, found that Empire did not have adequate … 31, 2012, Empire made a net overpayment of $898,541 on 96 claims from hospitals that had contracts with Empire …
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)
… Purpose To determine the extent of implementation of the three … Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, … (Department) contracted with United HealthCare (United) to administer the Plan’s prescription drug program between …
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)
… the Medicare/Medicaid claim crossover system. Under this system, providers submit medical claims for … the problems we identified in the initial audit report. This included the recovery of $977,343 in Medicaid … are planned to address the unresolved issues discussed in this report. Other Related Audits/Reports of Interest …
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
… accurately accounts for Court, Trust and Bail funds. This audit covered from January 1, 2011 through March 7, …
https://www.osc.ny.gov/state-agencies/audits/2014/04/16/controls-and-accountability-court-trust-and-bail-fundsSelected Procurement and Contracting Practices
… (SUNY) internal controls over procurement ensure goods and services are obtained competitively and at reasonable prices. … Administration) located in Albany. SUNY’s non-personal services expenditures are more than $3 billion annually. … grants SUNY increased flexibility in obtaining goods and services, both through less stringent purchasing and …
https://www.osc.ny.gov/state-agencies/audits/2015/07/06/selected-procurement-and-contracting-practicesReStacking Occupancy Initiative
… occupied by State agencies. The Commission predicted this initiative could save the State more than $21 million, … million in savings expected by March 31, 2014. To achieve this cost-savings goal, the Division of Budget (DOB) entered … agency office space. DOB commissioned OGS to implement this initiative. In 2011, OGS created the NYS Real Estate …
https://www.osc.ny.gov/state-agencies/audits/2014/09/09/restacking-occupancy-initiativeMedicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… of Health (Department) appropriately and effectively implemented and applied the new APR DRG-based hospital … changes enacted by the Legislature, the Department implemented a change to the Medicaid reimbursement … Patient Refined Diagnosis Related Groups (APR DRG), was implemented to provide a more equitable payment method for …
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
… ranged between $109 million and $121 million. During this period, the Fund provided annual Program support ranging …
https://www.osc.ny.gov/state-agencies/audits/2013/10/09/conservation-fund-sources-and-uses-fundsSelected Aspects of Discretionary Spending
New York State Energy Research and Development Authority
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
… paying for Medicaid services. The Office of the Medicaid Inspector General (OMIG) contracts with Health Management …
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)
… found that the controls were generally adequate to provide this assurance. We also identified six travel card charges …
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)
… included in our initial audit report, Technology Transfer Program and Royalty Payments (Report 2019-S-10 ). About the … included in our initial audit report Technology Transfer Program and Royalty Payments Report 2019S10 …
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
… premium for each enrolled recipient and, in turn, the MCOs pay for services their members require. In addition to the …
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)
… by the end of the audit. We also found the New York City Human Resources Administration misinterpreted guidelines, leaving …
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
… individuals. New York also had the largest increase in this population – 46.8 percent – between 2007 and 2018. The …
https://www.osc.ny.gov/state-agencies/audits/2020/03/10/oversight-homeless-sheltersOversight of Selected Fiscal Aspects of Homeless Shelter Services (Follow-Up)
… Objective To determine the extent to which the New York City Department of Homeless Services … To determine the extent to which the New York City Department of Homeless Services …
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
… the State Education Department’s (SED) Reimbursable Cost Manual (RCM) and the Consolidated Fiscal Reporting and Claiming Manual (CFR Manual). The audit focused primarily on expenses claimed on … to the State Education Departments Reimbursable Cost Manual and the Consolidated …
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
… whether the Medicaid program could achieve cost savings by implementation of a rental cap on oxygen equipment. The … that can withstand repeated use and have been ordered by a practitioner in the treatment of a specific medical … has no limit on the number of rental payments allowed. By comparison, under Medicare, oxygen equipment rentals are …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentals