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Medicaid Program – Medicaid Claims Processing Activity October 1, 2013 Through March 31, 2014
… Purpose To determine whether the Department of Health’s eMedNY system reasonably ensured that Medicaid claims were … administers the State’s Medicaid program. The Department’s eMedNY computer system processes Medicaid claims submitted by … claims. During the six-month period ended March 31, 2014, eMedNY processed about 112 million claims, resulting in …
https://www.osc.ny.gov/state-agencies/audits/2015/05/21/medicaid-program-medicaid-claims-processing-activity-october-1-2013-through-march-31-2014Medicaid Program – Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits
… Purpose To determine whether the Department of Health paid pharmacy providers for controlled substances in compliance … supply. During the audit period, the Medicaid program paid pharmacy providers through the fee-for-service method and the … managed care method. Under fee-for-service, Medicaid pays pharmacy providers directly for drugs dispensed to Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2015/02/06/medicaid-program-improper-payments-controlled-substances-exceed-allowed-dispensing-limitsSocial Adult Day Services
… Purpose To determine whether State agencies, particularly the New York State Office for the Aging (NYSOFA) and the Department of Health (DOH), are effectively overseeing Social Adult Day Services (SADS) programs to ensure that providers comply … Determine whether State agencies particularly the Office for the Aging and the Department of Health are …
https://www.osc.ny.gov/state-agencies/audits/2015/12/02/social-adult-day-servicesTuition Assistance Program – State Financial Aid Program at Barnard College
… Education’s Rules and Regulations when certifying students for State financial aid. Background Founded in 1889, Barnard … social sciences and natural sciences. Annual tuition for full-time students is approximately $44,300 per year. The … TAP is an entitlement program designed to provide funds for paying tuition costs to eligible students. Schools …
https://www.osc.ny.gov/state-agencies/audits/2015/08/03/tuition-assistance-program-state-financial-aid-program-barnard-collegeMedicaid Program – Medicaid Claims Processing Activity April 1, 2014 Through September 30, 2014
… were submitted by approved providers, were processed in accordance with Medicaid requirements, and resulted in correct payments to the providers. The audit covered the … 2014, eMedNY processed about 164 million claims, resulting in payments to providers of about $25 billion. The claims are …
https://www.osc.ny.gov/state-agencies/audits/2015/06/29/medicaid-program-medicaid-claims-processing-activity-april-1-2014-through-september-30-2014Assertive Community Treatment Program
… are licensed by the Office and operate throughout the State to provide services for up to 5,000 recipients. ACT … with the remainder being funded directly by the State. Key Findings The Office is not effectively overseeing …
https://www.osc.ny.gov/state-agencies/audits/2015/05/06/assertive-community-treatment-program2014 Year End Report
… Background The Board administered four sole custody funds in 2014 – the Uninsured Employers Fund, the Special Fund for … the claims: (i) were not properly supported, (ii) were not in compliance with mandated fee schedules, (iii) contained …
https://www.osc.ny.gov/state-agencies/audits/2015/03/30/2014-year-end-reportMedicaid Program – Eye Care Provider and Family Inappropriately Enroll as Recipients and Overcharge for Vision Services
… owner’s family, the State paid $68,483 in medical benefits on their behalf. The Provider received over $22,000 in … non-Medicaid-enrolled providers to render services, and on its claims to Medicaid identified a different, authorized, … claims system and bill over $700,000 in Medicaid claims on behalf of 55 providers. Further, we identified five …
https://www.osc.ny.gov/state-agencies/audits/2016/03/21/medicaid-program-eye-care-provider-and-family-inappropriately-enroll-recipients-andSelected Payments for Special Items Made to Stony Brook University Hospital from January 1, 2011 through March 31, 2011
… Plan. Empire processes Plan claims for hospital services in accordance with agreements they negotiate with member … from Stony Brook for the overpayments we identified in this audit. Develop and implement the controls necessary …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-stony-brook-university-hospital-january-1-2011-throughEmpire BlueCross BlueShield – Selected Payments for Special Items Made to Saratoga Hospital From January 1, 2011 Through March 31, 2011
… between Empire and Saratoga. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government and school district … Other Related Audits/Reports of Interest New York State Health Insurance Program: Payments Made to Stony Brook …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/empire-bluecross-blueshield-selected-payments-special-items-made-saratoga-hospital-januarySelected Payments for Special Items Made to Mary Imogene Bassett Hospital from January 1, 2011 through March 31, 2011
… Plan. Empire processes Plan claims for hospital services in accordance with agreements they negotiate with member … the $5,196 from Bassett for the overpayments we identified in this audit. Develop and implement the controls necessary …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mary-imogene-bassett-hospital-january-1-2011-throughCompliance With State Arts Education Requirements
… Purpose To determine whether New York City (NYC) Department of Education (DoE) students completed an Arts education … studies conclude that an Arts education reduces the risk of students dropping out of school and helps them develop … must: Be taught by individuals who are certified Arts teachers; Provide 180 minutes per week, or 108 hours of …
https://www.osc.ny.gov/state-agencies/audits/2014/02/28/compliance-state-arts-education-requirementsMedicaid Program – Medicaid Claims Processing Activity October 1, 2012 Through March 31, 2013
… system processes Medicaid claims submitted by providers for services rendered to Medicaid-eligible recipients, and it … pricing logic due to eMedNY's incorrect designation of the claim type being processed; $2,965,300 in overpayments for … for physician-administered drugs, hospital services, medical equipment, and dental services. By the end of the …
https://www.osc.ny.gov/state-agencies/audits/2014/05/22/medicaid-program-medicaid-claims-processing-activity-october-1-2012-through-march-31-2013Medicaid Claims Processing Activity April 1, 2012 Through September 30, 2012
… system processes Medicaid claims submitted by providers for services rendered to Medicaid-eligible recipients, and it generates payments to reimburse the providers for their claims. During the six-month period ended September … $675,265 in overpayments; Claims with incorrect billings for alternate levels of care, which caused $465,313 in …
https://www.osc.ny.gov/state-agencies/audits/2013/10/09/medicaid-claims-processing-activity-april-1-2012-through-september-30-2012Real Estate Portfolio
… market value for its property holdings. The Authority does not document the needs assessment it conducts to … Key Recommendations Ensure annual property reports include all Authority properties. Estimate and record current …
https://www.osc.ny.gov/state-agencies/audits/2014/03/27/real-estate-portfolioCourt Facilities Aid and Assistance Program
… and overseeing the administrative operations of all courts in the Unified Court System (UCS). UCS serves the State’s 62 … for municipalities and local justice courts that assist in the maintenance and improvement of court facilities. The … ending March 31, 2018, we identified a total of $301,000 in questionable expenses (out of $2.1 million reviewed) for …
https://www.osc.ny.gov/state-agencies/audits/2019/12/18/court-facilities-aid-and-assistance-programMedicaid Program – Maximizing Drug Rebates Under the Federal Medicaid Drug Rebate Program
… drug rebates under the federal Medicaid Drug Rebate Program (MDRP). The audit covered the period from April 2018 … and certain claims going back to January 2017. About the Program In 1990, Congress created the MDRP to reduce state … federal expenditures for Medicaid prescription drugs. The program was later expanded to require rebate collection for …
https://www.osc.ny.gov/state-agencies/audits/2023/04/05/medicaid-program-maximizing-drug-rebates-under-federal-medicaid-drug-rebate-programSUNY Bulletin No. SU-363
… if any, is expended up to the amounts described below. Full Payment Amount: The following employees may receive up to the full payment amount of $3,000 ($1,500 per year): Employees … employee’s taxable gross, and reported on the employee’s Form W-2. The adjustments (Earnings Code AOR) and retroactive …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-university-new-york/su-363-state-university-new-york-suny-managementconfidential-mcWest Seneca Fire District #6 – Financial Management (2013M-14)
… January 1, 2009, through November 28, 2012. Background The West Seneca Fire District #6 is a district corporation of the State, distinct and separate from the Town of West Seneca and the County of … a timely manner. Contact FEMA to determine if the District can submit reimbursement claims for the SAFER and AFG grants. …
https://www.osc.ny.gov/local-government/audits/fire-district/2013/09/27/west-seneca-fire-district-6-financial-management-2013m-14Wantagh Fire District – Payroll (2013M-176)
… Purpose of Audit The purpose of our audit was to examine the District’s internal controls … The Wantagh Fire District is a district corporation of the State, distinct and separate from the Town of Hempstead and Nassau County in which it is located. An … The purpose of our audit was to examine the Districts internal controls …
https://www.osc.ny.gov/local-government/audits/fire-district/2013/09/20/wantagh-fire-district-payroll-2013m-176