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UnitedHealthcare – 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-agreementCompliance With Special Education Regulations for the Provision of Services (Follow-Up)
… education. The New York City Department of Education (DOE) – the nation’s largest school system – served … 192,000 of these students in the 2021-22 school year. The DOE is responsible for evaluating students to determine their … receive appropriate services. Toward this end, the DOE follows a multi-step evaluation and placement process. …
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 hospitals that improperly billed All Patient Refined Diagnosis Related Groups (APR-DRG) inpatient claims containing a severe malnutrition diagnosis . The audit covered the period from January 1, 2013 … to hospitals that improperly billed All Patient Refined Diagnosis Related Groups inpatient claims containing a severe …
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
… Purpose To determine whether the costs reported by Northside Center for Child Development … (CFR) were reasonable, necessary, directly related to the special education program, and sufficiently documented pursuant to the State Education Department’s (SED) guidelines including …
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
… ranging from hospital inpatient care to physician and dental services. Accordingly, Plans are responsible for … in improper FFS payments for inpatient, practitioner, and dental services that should have been covered by Plans. Many …
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)
… Medicaid Payments for Pharmacy Claims – Joia Pharmacy and a Related Prescriber (Report 2013-S-4 ). Background … on behalf of 706 Medicaid recipients. One particular doctor (herein referred to as “the Doctor”) was listed as the … the rules and policies set forth by the Department and the State Education Department. Our audit covered the period …
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)
… and/or excessive overtime costs. Additionally, video from surveillance cameras found that security officers …
https://www.osc.ny.gov/state-agencies/audits/2018/12/28/york-college-time-and-attendance-practices-public-safety-staff-followGASB Statement No. 33 "Accounting and Financial Reporting for Nonexchange Transactions"
… Account code 8015 should be used to reduce beginning fund balance on the Analysis of Changes in Fund Equity Statement …
https://www.osc.ny.gov/local-government/publications/gasb-statement-no-33-accounting-and-financial-reporting-nonexchange-transactions