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Empire BlueCross BlueShield – Controls Over Payments for Special Items

… identified implant overpayments totaling $894,315 (over 300 percent more than the $208,993 that Empire recovered). …

https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-items

Management of Indoor Air Quality for Individuals With Asthma

… from April 2014 to January 2021. About the Program Asthma is a significant public health problem in the United States. It is one of this country’s most common and costly diseases, … often requires emergency care and hospital admission and is responsible for a high number of missed school and/or work …

https://www.osc.ny.gov/state-agencies/audits/2022/08/02/management-indoor-air-quality-individuals-asthma

Improper Medicaid Payments for Recipients in Hospice Care (Follow-Up)

… in Hospice Care ( 2017-S-76 ). About the Program Hospice is a program that provides care to terminally ill … all hospice services. However, if a Medicaid recipient is also enrolled in Medicare, Medicare is the primary payer and Medicaid is the secondary payer. In …

https://www.osc.ny.gov/state-agencies/audits/2020/10/15/improper-medicaid-payments-recipients-hospice-care-follow

Medicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges

… 31, 2019. About the Program The State’s Medicaid program is administered by the Department of Health (Department). The … of admission and when the services ended. This information is used to calculate the payment made to the hospital. … may vary significantly depending on whether a patient is transferred or discharged. For example, a claim where a …

https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-discharges

Benefits Advisement Services for Individuals With Disabilities Seeking Employment

… 75 percent for people without disabilities. Further, ACS data shows that New Yorkers with disabilities are more than … this be achieved was by improving benefits advisement services to assist all individuals with disabilities in … entities as necessary. Capture historical notification data for analysis and assessment of the effectiveness of WINR …

https://www.osc.ny.gov/state-agencies/audits/2021/07/20/benefits-advisement-services-individuals-disabilities-seeking-employment

Use of Federal Funding for Election Technology and Security

… Objective To determine whether the Board of Elections utilized … the 2018 Help America Vote Act Election Security Grant to enhance the security of the State’s election technology … To determine whether the Board of Elections BOE utilized …

https://www.osc.ny.gov/state-agencies/audits/2021/09/17/use-federal-funding-election-technology-and-security

UnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims

… Objectives To determine whether UnitedHealthcare (United) paid claims … correlate with the date of the service on the claims, and to calculate the corresponding financial impact. The audit … (Civil Service), provides health insurance coverage to over 1.2 million active and retired State, local …

https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claims

Maximizing Drug Rebates for Health and Recovery Plans (Follow-Up)

… Objective To determine the extent of implementation of the two recommendations made in our initial audit report, … Rebate Program, which allows states to recover a portion of their Medicaid prescription drug costs by requesting … To determine the extent of implementation of the two recommendations made in our …

https://www.osc.ny.gov/state-agencies/audits/2020/01/17/maximizing-drug-rebates-health-and-recovery-plans-follow

Empire BlueCross – Controls Over Payments for Special Items (Follow-Up)

… plan for NYSHIP. Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital services according to contracts it negotiates with … rate schedules for the payment of inpatient and outpatient hospital services. Hospitals may be entitled to additional …

https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-follow

Medicaid Program – Excessive Payments for Durable Medical Equipment Rentals

… could achieve cost savings by implementation of a rental cap on oxygen equipment. The audit covered the period from … caps. For example, one MCO established a 10-month rental cap on apnea monitors, yet for one recipient the MCO paid … 64 extra rental payments for a monitor beyond the 10-month cap. Furthermore, we estimated potential cost avoidance for …

https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentals

Selected Aspects of Accommodations for Passengers With Disabilities (Follow-Up)

… in Manhattan (9th Street, 14th Street, 23rd Street, and Christopher Street) were not accessible for customers who are …

https://www.osc.ny.gov/state-agencies/audits/2023/05/12/selected-aspects-accommodations-passengers-disabilities-follow

Improper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)

… of services for recipients and reimburse providers. When a hospital bills an MCO for an inpatient stay, the hospital reports certain information on its claims, including …

https://www.osc.ny.gov/state-agencies/audits/2023/12/06/improper-managed-care-payments-misclassified-patient-discharges-follow

Annual Assessment of Market Orders for 2015 and 2016

… covered the period July 1, 2014 through June 30, 2016 for the Apple and Sour Cherry Market Orders and the period April 1, 2014 through March 31, 2016 for the Apple, Cabbage, and Onion Research and Development Programs. About the Program During the audit …

https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016

Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services

… Purpose To determine whether Medicaid overpayments were made to hospitals for mechanical ventilation services reported on … To determine whether Medicaid overpayments were made to hospitals for mechanical ventilation services reported on …

https://www.osc.ny.gov/state-agencies/audits/2019/05/16/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-services

Medicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services

… for services provided to enrollees. Generally, Medicaid is the secondary payer, and covers any financial balances … uses the CARCs to determine whether a billed service is eligible for payment as well as the correct payment … an incorrect CARC. Without the appropriate CARC, eMedNY is at risk of improperly adjudicating – and overpaying – …

https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-services

Restrictions on Consecutive Hours of Work for Nurses (Follow-Up)

… as health care disasters or a federal, State, or local declaration of an emergency. Our initial report, issued on …

https://www.osc.ny.gov/state-agencies/audits/2019/09/09/restrictions-consecutive-hours-work-nurses-follow

Implementation of the Dignity for All Students Act (Follow-Up)

… Objective To determine the extent of implementation of the three … New York State’s Dignity for All Students Act (DASA) seeks to provide students in New York with a safe and supportive … race, sexual orientation, weight) and required schools to designate a trained Dignity Act Coordinator (DAC). An …

https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-follow

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