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Starting Point Services for Children – Compliance With the Reimbursable Cost Manual
… services provided and the hourly fee charged, as otherwise required by the Manual; $173,539 in unsupported bonuses to … was not supported by performance evaluations, as required by the Manual; $70,078 in non-program (for Related … To SED: Review the recommended disallowances resulting from our audit and make the appropriate adjustments to …
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
… 1, 2012 to August 31, 2013. Background The New York State Health Insurance Program (NYSHIP) provides health insurance … the NYSHIP program and contracts 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 …
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 Reports (CFRs) were properly … The audit included all expenses claimed on Milestone’s CFR for the fiscal year 2012-13, and certain expenses claimed on …
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
… of Health and Mental Hygiene’s (DOHMH) administration of a contract (#113 225 01) with the Center for Urban Community … and ensured that CUCS was reimbursed only for appropriate contract expenses. Background DOHMH contracts with … awarded was with CUCS. In 2010, DOHMH signed a three-year contract with CUCS valued at $27.7 million for a variety of …
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
… two separate payments are made: a payment for the first hospital’s claim and a payment for the second hospital’s claim. However, according to the Department’s … mechanism to identify merged hospitals and, as a result, it cannot readily detect or prevent inappropriate payments …
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
… whether Medicaid overpaid hospitals by reimbursing for higher levels of medical care than those actually … rehabilitative and psychiatric care. When billing Medicaid for inpatient services, hospitals must indicate a patient's … of Care (ALC) setting, hospitals should not bill Medicaid for more intensive acute levels of care. To help ensure …
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
… Fiscal Reports CFRs are adequately documented and al …
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
… buy-in program. The audit covered Medicaid payments for individuals enrolled in the Medicare buy-in program for the period from January 1, 2015 through December 31, 2019 … program (Buy-in Program), administered by the Centers for Medicare & Medicaid Services (CMS), Medicaid pays …
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 Medicare … Medicare program covers physical, occupational, and speech therapy services as well as prescription drugs. When these … overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by …
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
… To determine whether Empire BlueCross properly paid hospital claims for intraocular procedures. The audit covered … million members. Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital services according to contracts it negotiates with …
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)
… Comprehensive Third-Party Insurance (Report 2016-S-60 ). About the Program Mainstream managed care (the managed …
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)
… Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Report 2017-S-66 ). About the Program Opioid treatment programs (Treatment Programs) provide medication-assisted treatment, … Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program Report 2017S66 …
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)
… in our initial audit report, Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY (Report … Program. Many Medicaid recipients are also enrolled in Medicare Part B (Part B), which provides supplemental … in our initial audit report Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY Report …
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
… 2017 through March 2023. About the Program The Department of Health (Department) administers New York’s Medicaid … Drug Rebate Program (MDRP) helps to offset the costs of most covered outpatient drugs dispensed to Medicaid … manufacturers to enter into an NDRA with the Department of Health and Human Services in exchange for state Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreementCompliance With Special Education Regulations for the Provision of Services (Follow-Up)
… and to prepare them for further education, employment, and independent living. They stipulate procedural requirements for the …
https://www.osc.ny.gov/state-agencies/audits/2023/03/15/compliance-special-education-regulations-provision-services-followMedicaid Program – Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition
… of another condition. Once malnutrition is identified, a hospital must use the appropriate International … malnutrition diagnosis increases, Medicaid’s payment to a hospital will increase. Medicaid will only pay for medical …
https://www.osc.ny.gov/state-agencies/audits/2019/04/08/medicaid-program-improper-medicaid-payments-recipients-diagnosed-severe-malnutritionNorthside Center for Child Development – Compliance With the Reimbursable Cost Manual
… determine whether the costs reported by Northside Center for Child Development (Northside) on its Consolidated Fiscal … disabilities who are between three and five years of age. For purposes of this report, these programs are collectively … in its cost-based programs. Northside is reimbursed for preschool special education services through rates …
https://www.osc.ny.gov/state-agencies/audits/2019/01/11/northside-center-child-development-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Managed Care
… Purpose To determine whether Medicaid made improper fee-for-service (FFS) payments for certain services covered by mainstream managed care … and payment system (eMedNY), pays providers directly for services rendered to Medicaid recipients. Under the … whether Medicaid made improper feeforservice payments for certain services covered by mainstream managed care plans …
https://www.osc.ny.gov/state-agencies/audits/2019/01/10/medicaid-program-improper-fee-service-payments-services-covered-managed-careMedicaid Payments for Pharmacy Claims – Joia Pharmacy and a Related Prescriber (Follow-Up)
… Purpose To determine the extent of implementation of the four recommendations made in our initial audit report, Medicaid Payments for Pharmacy Claims – Joia Pharmacy and a Related Prescriber … To determine the extent of implementation of the four recommendations made …
https://www.osc.ny.gov/state-agencies/audits/2018/12/27/medicaid-payments-pharmacy-claims-joia-pharmacy-and-related-prescriber-followYork College – Time and Attendance Practices for Public Safety Staff (Follow-Up)
… April 6, 2015, concluded that neither City University of New York (CUNY) nor York College had adequate internal controls over time and …
https://www.osc.ny.gov/state-agencies/audits/2018/12/28/york-college-time-and-attendance-practices-public-safety-staff-follow