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Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits (Follow-Up)
… made in our audit report, Improper Payments for Controlled Substances That Exceed Allowed Dispensing … which was issued on February 6, 2015, determined that, for the period January 1, 2009 through December 31, 2013, Medicaid overpaid pharmacies $1,183,601 for 13,705 fee-for-service claims in which quantities of …
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
… (SCIS) programs to disabled children between the ages of three and five years. During the 2012-13 school year, … Point served 942 students. The New York City Department of Education (DoE) refers students to Starting Point based on … SED on its annual CFRs. SED reimburses DoE for a portion of its payments to Starting Point based on statutory rates. …
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
… To determine whether UnitedHealthcare improperly paid for medical services designated with modifier code 59 that were … 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 procedure codes …
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
… Reports (CFRs) were properly documented, program related, and allowable pursuant to the State Education Department’s … all expenses claimed on Milestone’s CFR for the fiscal year 2012-13, and certain expenses claimed on Milestone’s CFRs for 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
… Purpose We audited the New York City Department of Health and Mental Hygiene’s (DOHMH) administration of a contract (#113 … contracts with not-for-profit providers for a range of health and social services, including supportive housing. … We audited the New York City Department of Health and Mental Hygienes DOHMH administration of a contract …
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
… for their services. Generally, when a Medicaid recipient is transferred among different hospitals, two separate … facility. Under these circumstances, when a recipient is transferred from the first hospital to a merged or … Payments for Misclassified Patient Discharges (2009-S-26) Department of Health: Medicaid Claims Processing …
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
… overpaid hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The … March 31, 2010. Background Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and therapeutic care, …
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
… 2010. Background All Services, located in Fresh Meadows, New York, provided special education itinerant teacher … with disabilities between the ages of three and five. The New York City Department of Education (DoE) paid All Services …
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
… Objective To determine if Medicaid made improper Medicare premium … Medicare buy-in program credits from January 1, 2015 to November 30, 2020. About the Program The Department of … We found that the Department needs additional controls to ensure timely Buy-in Program eligibility determinations …
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 … overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered … covered the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, …
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
… Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital … schedules. Intraocular lenses are used in the treatment of cataracts – the clouding of the lens in the eye – which cause vision problems. A …
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)
… of implementation of the seven recommendations made in our initial audit report, Managed Care Premium Payments for … promptly disenrolling them from managed care. We issued our initial audit report on June 13, 2018. The audit … the period January 1, 2012 through September 1, 2017. Our audit identified $1.28 billion in premiums that were paid …
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)
… The audit objective was to determine if the Department of Health (Department) had taken sufficient steps to safeguard … dangerous prescriptions if Treatment Programs did not check I-STOP and, where authorized, coordinate care with … – auditors noted 493 of the 18,786 recipients required medical care as a result of opioid or narcotic overdoses that …
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 … included 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
… managed care organizations (MCOs) a monthly capitation payment for each Medicaid recipient enrolled in their plans. …
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)
… Objective To determine the extent of implementation of the five recommendations included in the initial audit report, … issues identified in the initial report. Of the report’s five recommendations, three were partially implemented and … To determine the extent of implementation of the five recommendations included in the initial audit report …
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
… to a hospital will increase. Medicaid will only pay for medical care and services that are medically necessary, whose necessity is evident from … assessments and Medicaid billing rules; and Properly document severe malnutrition in a patient’s medical record. …
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
… with disabilities who are between three and five years of age. For purposes of this report, these programs are collectively referred to … five employees worked for the program or the allocation of costs for one employee. The Manual requires that providers …
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
… for certain services covered by mainstream managed care plans. Our audit covered the period January 1, 2013 to April … the managed care method, the Department pays managed care plans a monthly premium for each Medicaid recipient enrolled in managed care, and the managed care plans pay providers for services rendered to their members. …
https://www.osc.ny.gov/state-agencies/audits/2019/01/10/medicaid-program-improper-fee-service-payments-services-covered-managed-care