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Overpayments for Services Also Covered by Medicare Part B (Follow-Up)
… Covered by Medicare Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in … which would otherwise be the financial obligation of the patient (such as deductibles and coinsurance). Federally … implemented. Key Recommendation Officials are given 30 days after the issuance of the follow-up report to provide …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followSubway Service Diversions for Maintenance and Capital Projects (Follow-Up)
… in our initial audit report, Subway Service Diversions for Maintenance and Capital Projects ( 2010-S-34 ). … that while Transit has a number of policies and procedures for managing and controlling subway diversions, more needed … not planned using current ridership data, and the budget for diversion advertisements to communicate information about …
https://www.osc.ny.gov/state-agencies/audits/2015/09/16/subway-service-diversions-maintenance-and-capital-projects-followOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… report, Overpayments for Services Also Covered by Medicare Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for Medicare Part B, which provides supplementary medical insurance … health care providers' Medicaid claims for Medicare Part B deductibles and coinsurance. The audit covered the …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followUnnecessary Medicaid Payments for Children at Voluntary Agencies (Follow-Up)
… Purpose To determine the extent of implementation of the five recommendations made in our audit report, … To determine the extent of implementation of the five recommendations made in our …
https://www.osc.ny.gov/state-agencies/audits/2014/10/23/unnecessary-medicaid-payments-children-voluntary-agencies-followImproper Managed Care Payments for Certain Medicaid Recipients (Follow-Up)
… made in our audit report, Improper Managed Care Payments for Certain Medicaid Recipients (Report 2010-S-66). … which was issued on July 24, 2012, determined that, for the five years ended June 30, 2010, Medicaid made $15.6 … Department of Health: Improper Managed Care Payments for Certain Medicaid Recipients ( 2010-S-66 ) …
https://www.osc.ny.gov/state-agencies/audits/2015/01/20/improper-managed-care-payments-certain-medicaid-recipients-followStatus of the Board-Approved Capital Plan for 2005-2011 (Follow-Up)
… that completing the plan as approved would take longer and cost significantly more than was originally forecast. Key … (2008-S-48) New York State Thruway Authority: Proposed Toll Increases for July 2008 Through January 2010 (2008-S-6) …
https://www.osc.ny.gov/state-agencies/audits/2013/06/27/status-board-approved-capital-plan-2005-2011-followEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… of special items on the hospitals’ gross charges (i.e., no limit); and 16 did not allow for additional reimbursement …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsManagement of Indoor Air Quality for Individuals With Asthma
… asthma. The COVID-19 pandemic has had significant impacts on those living with chronic diseases such as asthma. … evaluate impacts in reducing the levels of asthma in the State. The Department has not conducted an overall evaluation … assess the impact of the HNP on the asthma burden in the State. Develop an evaluation to determine the overall …
https://www.osc.ny.gov/state-agencies/audits/2022/08/02/management-indoor-air-quality-individuals-asthmaImproper Medicaid Payments for Recipients in Hospice Care (Follow-Up)
… audit report, Improper Medicaid Payments for Recipients in Hospice Care ( 2017-S-76 ). About the Program Hospice is a program that provides care to terminally ill … Generally, when eligible Medicaid recipients elect hospice care, they waive their right to use Medicaid for …
https://www.osc.ny.gov/state-agencies/audits/2020/10/15/improper-medicaid-payments-recipients-hospice-care-followMedicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
… to reimburse hospitals for inpatient medical care. When a hospital bills Medicaid for an inpatient stay, the hospital … a patient was transferred to another facility may result in a lower payment than if a patient was simply discharged … status codes. Key Recommendations Review the $252,107 in overpayments and recover as appropriate. Review the …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-dischargesUse of Federal Funding for Election Technology and Security
… available funding from the 2018 Help America Vote Act Election Security Grant to enhance the security of the State’s election technology and infrastructure. The audit covered the … available funding from the 2018 Help America Vote Act Election Security Grant to enhance the security of the States …
https://www.osc.ny.gov/state-agencies/audits/2021/09/17/use-federal-funding-election-technology-and-securityUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… To determine whether UnitedHealthcare (United) paid claims using reasonable and customary (R&C) reimbursement … that did not correlate with the date of the service on the claims, and to calculate the corresponding financial impact. … United’s reimbursement for certain out-of-network claims is 80 percent of the R&C rate for the service. R&C …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsMaximizing Drug Rebates for Health and Recovery Plans (Follow-Up)
… in our initial audit report, Maximizing Drug Rebates for Health and Recovery Plans (Report 2017-S-61 ). About the … behavioral health needs began to be enrolled into Health and Recovery Plans (HARPs). HARPs are a type of … in our initial audit report Maximizing Drug Rebates for Health and Recovery Plans Report 2017S61 …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/maximizing-drug-rebates-health-and-recovery-plans-followEmpire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… of implementation of the two recommendations included in our initial audit report, Controls Over Payments for … Key Findings Empire officials made significant progress in addressing the problems we identified in the initial audit. In particular, Empire recovered $11.5 …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… Objectives To determine whether Medicaid managed care organizations … equipment. The audit covered the period from July 2016 to December 2021 for non-oxygen-related durable medical equipment rentals and September 2018 to December 2021 for oxygen-related durable medical equipment …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsSelected Aspects of Accommodations for Passengers With Disabilities (Follow-Up)
… PANYNJ staff. Four of the PATH stations, in Manhattan (9th Street, 14th Street, 23rd Street, and Christopher Street) were not accessible for …
https://www.osc.ny.gov/state-agencies/audits/2023/05/12/selected-aspects-accommodations-passengers-disabilities-followImproper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)
… Program The Department of Health (Department) administers New York’s Medicaid Program. Many Medicaid recipients receive …
https://www.osc.ny.gov/state-agencies/audits/2023/12/06/improper-managed-care-payments-misclassified-patient-discharges-followAnnual Assessment of Market Orders for 2015 and 2016
… Purpose To determine whether the Department of Agriculture and … had adequate procedures in place during the audit period to accurately report its assessable expenses related to its … To determine whether the Department of Agriculture and …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
… provides the force needed to deliver air to the lungs in a patient whose ability to breathe is diminished or lost. … ventilation services. Key Finding We identified $975,795 in overpayments on 32 inpatient claims that reported 96 …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-servicesMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… claims for services also covered by Medicare Advantage plans. The audit covered the period from January 1, 2013 to … Medicare benefits and offer different health care plans (referred to as Medicare Advantage plans) tailored to the specific needs of Medicare … claims for services also covered by Medicare Advantage plans …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-services