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United HealthCare – Empire Plan Drug Rebate Revenue (Follow-Up)
… of the recommendation made in our audit report, United HealthCare: Empire Plan Drug Rebate Revenue (2016-S-7). … of Civil Service (Department) contracted with United HealthCare (United) to administer the Empire Plan’s … Interest New York State Health Insurance Program: United HealthCare - Empire Plan Drug Rebate Revenue ( 2016-S-7 ) …
https://www.osc.ny.gov/state-agencies/audits/2017/05/15/united-healthcare-empire-plan-drug-rebate-revenue-followThe 80/20 Housing Program
… information. While the Program requires all applicants and adult family members to sign consent forms authorizing …
https://www.osc.ny.gov/state-agencies/audits/2017/05/31/8020-housing-programWhitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… SED: Review the recommended disallowances resulting from this audit and make the appropriate adjustments to …
https://www.osc.ny.gov/state-agencies/audits/2015/04/07/whitestone-school-child-development-compliance-reimbursable-cost-manualNursing Home Surveillance
… State regulations and procedures for conducting nursing home surveys and whether survey processes, including the … Complaint surveys investigate issues, and nursing home-reported incidents, that may involve non-compliance with … for severity and urgency to assess whether a nursing home has violated a federal or State regulation. If any …
https://www.osc.ny.gov/state-agencies/audits/2016/02/19/nursing-home-surveillancePractices Used by the Transit Adjudication Bureau to Collect and Account for Fines and Fees
… written on summonses, such as bad addresses, false telephone numbers, and wrong Social Security numbers, … calls based on probability of collection. Moreover, the number of calls made has decreased materially over the past … contract terms, which neither set expectations for the number of calls to be made nor provided incentives that could …
https://www.osc.ny.gov/state-agencies/audits/2016/08/11/practices-used-transit-adjudication-bureau-collect-and-account-fines-and-feesMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
… (one each for professional, institutional, dental, and pharmacy encounters). The EIS then processes the data and …
https://www.osc.ny.gov/state-agencies/audits/2016/03/29/medicaid-program-managed-care-organizations-readiness-encounter-intake-systemDriver Responsibility Assessment Program
… it suspended the licenses, or the privilege to obtain a license, of drivers who did not pay their assessed fees. Our … Department to assess and collect a fee of $250 per year for three years on drivers convicted of alcohol- or … or suspended the licenses or the privilege to obtain a license of drivers who did not pay. The Department needs to …
https://www.osc.ny.gov/state-agencies/audits/2014/10/09/driver-responsibility-assessment-programFinancial Management Practices
… (FERC) in 2007 for public safety reasons. The District has cut spending and taken other steps to balance its annual …
https://www.osc.ny.gov/state-agencies/audits/2014/11/25/financial-management-practicesMedicaid Program – Medicaid Claims Processing Activity October 1, 2014 Through March 31, 2015
… with improper payments for duplicate billings and for clinic and durable medical equipment services. By the end of the audit …
https://www.osc.ny.gov/state-agencies/audits/2015/12/08/medicaid-program-medicaid-claims-processing-activity-october-1-2014-through-march-31-2015Tuition Assistance Program – Metropolitan Learning Institute
… The Metropolitan Learning Institute (Metropolitan) is a licensed private career school headquartered in Rego Park … student’s enrollment agreement was not signed by an SED licensed agent. Additional incorrect certifications include …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/tuition-assistance-program-metropolitan-learning-instituteFuel Purchases
… had contracts with private fuel companies to supply diesel and unleaded regular gas to the two subsidiaries that …
https://www.osc.ny.gov/state-agencies/audits/2015/02/27/fuel-purchasesAccountability for Traffic Ticket Surcharges
… through its Traffic Violations Bureaus (TVBs). The audit covered the period April 1, 2012 through July 31, 2014. … cities with a population of 200,000 or more to adjudicate non-criminal traffic infractions through administrative … amount of surcharges that can be assessed as a result of any one traffic stop or incident. During our audit period, …
https://www.osc.ny.gov/state-agencies/audits/2015/08/10/accountability-traffic-ticket-surchargesMedicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… appropriately and effectively implemented and applied the new APR DRG-based hospital inpatient payment system for Medicaid services when … to compensate hospitals for inpatient medical care. The new methodology, based on All Patient Refined Diagnosis … appropriately and effectively implemented and applied the new APR DRGbased hospital inpatient paymen …
https://www.osc.ny.gov/state-agencies/audits/2013/08/15/medicaid-program-payments-death-related-one-day-inpatient-admissionsDual Employment
… DOCCS sometimes allows employees to work full-time at one facility and then work additional time at another facility (referred to as extra service), or may allow them to … they are being paid. Provide pertinent time and attendance training to dually employed staff and their supervisors, and …
https://www.osc.ny.gov/state-agencies/audits/2013/12/19/dual-employment-2Medicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… refer to health care services provided in the home, medical offices, clinics, and other freestanding sites. They … for review. Medicaid reimbursement rates for inpatient hospital claims include the costs of most medical care provided during a hospital admission. As such, claims for ancillary services …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Mainstream Managed Care Organizations: Administrative Costs Used in Premium Rate Setting
… based, in part, on allowable MCO administrative costs. For this purpose, the Department relies on financial data …
https://www.osc.ny.gov/state-agencies/audits/2016/10/13/medicaid-program-mainstream-managed-care-organizations-administrative-costs-used-premiumInmate Sentence Calculation and Release Practices
… were 83,475 inmate releases from Department facilities. This total includes 13,628 inmates who were released multiple …
https://www.osc.ny.gov/state-agencies/audits/2017/04/07/inmate-sentence-calculation-and-release-practicesEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… and recovery of overpayments made to hospitals for special medical items; and took sufficient steps to minimize the … range of services including, but not limited to, hospital services, office visits, home care, medical … rate schedules for the payment of inpatient and outpatient hospital services. Empire’s hospital contracts also allow …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsSelected Wage Investigation Procedures (Follow-Up)
… of its wage investigations during calendar years 2022, 2021, and 2020, respectively. The objective of our initial audit, issued on March 3, 2021, was to determine if DOL was following its wage … for 23 of 150 investigations we reviewed, there was no final report in WPM, although it was required. Our audit …
https://www.osc.ny.gov/state-agencies/audits/2024/02/16/selected-wage-investigation-procedures-followMedicaid Program – Claims Processing Activity October 1, 2018 Through March 31, 2019
… was paid for practitioner, pharmacy, inpatient, lab, and clinic claims that did not comply with Medicaid policies; …
https://www.osc.ny.gov/state-agencies/audits/2019/09/27/medicaid-program-claims-processing-activity-october-1-2018-through-march-31-2019