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Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Follow-Up)
… audit report, Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Report 2010-S-21). Background Our … was issued on December 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 day limits. During the …
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)
… of implementation of the three recommendations included in our initial audit report, Excessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits … ended June 30, 2009, we identified about $600 million in Medicaid payments that could have been avoided had the …
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 … claim. Our audit focused on claims submitted to United by Long Island Laparoscopic Surgery, PLLC (Long Island Laparoscopic), a non-participating provider … To determine whether Long Island Laparoscopic Surgery PLLC waived Empire Plan …
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
… for Children & Families (Astor) on its Consolidated Fiscal Report (CFR) were properly calculated, adequately documented … for Children Families Astor on its Consolidated Fiscal Report CFR were properly calculated adeq …
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)
… dispense when prescriptions are ordered by telephone or fax. Our initial audit report, which was issued on February …
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 … York-based not-for-profit organization that is authorized by SED to operate, among other SED-approved programs, the … and pays for their services using rates established by SED. The rates are based on the financial information that …
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
… modifier code 59 that were not distinct and independent from other services provided on the same day. The audit covered the period from September 1, 2012 to August 31, 2013. Background The New … performed a procedure that was distinct or independent from another procedure that was performed on the same day for …
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
… school year, Milestone serviced about 110 students. The New York City Department of Education (DoE) refers students to Milestone based on clinical …
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 … increased to $28.7 million for expanded program services. The New York State Office of Mental Health funds about 75 … We audited the New York City Department of Health and Mental Hygienes …
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
… overpayments occurred. The audit covered the period from December 1, 2009 through June 30, 2014. Background The … two separate payments are made: a payment for the first hospital’s claim and a payment for the second hospital’s … Under these circumstances, when a recipient is transferred from the first hospital to a merged or consolidated division …
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
… hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The audit … Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and therapeutic care, including but not limited to surgical, medical, …
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
… in reimbursable expenses. All Services' CFR for the fiscal year ended June 30, 2011 had not been prepared at the time of …
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
To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buyin program
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)
… recipients, health care providers are required to bill Medicare, which is generally the primary payer, before billing Medicaid. We issued our initial … therapists. As a result, the providers often did not bill Medicare for the services or incorrectly reported a …
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)
… extent of implementation of the seven recommendations made in our initial audit report, Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance … (the managed care program most Medicaid recipients enroll in) provides comprehensive medical services that range from …
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)
… guidance encourages Treatment Programs to coordinate care with patients’ other prescribers of controlled … did not check I-STOP and, where authorized, coordinate care with other prescribers – auditors noted 493 of the … the overdose. Based on a review of medical records for a sample of 25 recipients who received 1,065 opioid …
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
… Program The Department of Health (Department) administers New York’s Medicaid program. The Medicaid Drug Rebate Program … Department of Health and Human Services in exchange for state Medicaid coverage of most of the manufacturer’s drugs. …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreement