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Administration of the Contract With the Center for Urban Community Services
… administration of a contract (#113 225 01) with the Center for Urban Community Services (CUCS) for the period July 1, 2010 through July 15, 2015. The audit … a review of costs claimed by CUCS and paid by DOHMH for the year ended June 30, 2013. Our objectives were to …
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
… for their services. Generally, when a Medicaid recipient is transferred among different hospitals, two separate … facility. Under these circumstances, when a recipient is transferred from the first hospital to a merged or …
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
… and therefore more expensive than others. When a patient is designated to a lower (and therefore less costly) … of overpayments from the sample that was reviewed, there is high risk that Medicaid overpaid many other inpatient …
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
… To determine whether the costs reported by All Services for Kids, Inc. (All Services) on its Consolidated Fiscal … presented in its annual CFRs. According to its CFRs for the two fiscal years ended June 30, 2010, All Services … $1.3 million in reimbursable expenses. All Services' CFR for the fiscal year ended June 30, 2011 had not been prepared …
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
… buy-in program. The audit covered Medicaid payments for individuals enrolled in the Medicare buy-in program for the period from January 1, 2015 through December 31, 2019 … program (Buy-in Program), administered by the Centers for Medicare & Medicaid Services (CMS), Medicaid pays …
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)
… included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by … overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered … covered the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, …
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
… district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, covering … lens in the eye – which cause vision problems. A cataract is corrected with surgery, which frequently involves removing …
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)
… employer. The Department of Health’s (Department) policy is to exclude Medicaid recipients from enrollment in … in the initial audit report; however, additional action is needed. For the one-year period ended September 30, 2019, … timely identification of recipients’ comprehensive TPHI is essential to preventing improper premium payments, OMIG’s …
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)
… included in our initial audit report, Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program … opioid medications and counseling and behavioral therapies for people diagnosed with an opioid use disorder. The State … prescription drug use, known as the Internet System for Tracking Over-Prescribing (I-STOP), which contains …
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 … B (Part B), which provides supplemental insurance coverage for outpatient medical services, physician services, and … B cost-sharing amounts (e.g., deductibles and coinsurance) for these dual-eligible individuals. Our initial audit …
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
… To determine whether Medicaid inappropriately paid for drugs from manufacturers that did not enter into a … the Department of Health and Human Services in exchange for state Medicaid coverage of most of the manufacturer’s … Manufacturers then pay states rebates on those drugs for which Medicaid payments were made. Covered outpatient …
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)
… report, Compliance With Special Education Regulations for the Provision of Services (Report 2018-N-5 ). About the … (Regulations). Generally, the Regulations set standards for providing special education and related services designed … to meet students’ unique needs and to prepare them for further education, employment, and independent living. …
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
… from the treatment of another condition. Once malnutrition is identified, a hospital must use the appropriate … and services that are medically necessary, whose necessity is evident from documentation in the patient’s medical …
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
… determine whether the costs reported by Northside Center for Child Development (Northside) on its Consolidated Fiscal … disabilities who are between three and five years of age. For purposes of this report, these programs are collectively … in its cost-based programs. Northside is reimbursed for preschool special education services through rates …
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
… Purpose To determine whether Medicaid made improper fee-for-service (FFS) payments for certain services covered by mainstream managed care … and payment system (eMedNY), pays providers directly for services rendered to Medicaid recipients. Under the … whether Medicaid made improper feeforservice payments for certain services covered by mainstream managed care plans …
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)
… made in our initial audit report, Medicaid Payments for Pharmacy Claims – Joia Pharmacy and a Related Prescriber … paid Joia Pharmacy, Inc. (Joia) more than $7.7 million for 50,060 claims on behalf of 706 Medicaid recipients. One … pertaining to the Doctor’s prescribing activity for the period January 1, 2013 through June 30, 2016. Our …
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)
… in our initial audit report, Time and Attendance Practices for Public Safety Staff ( 2013-S-65 ). Background Our initial … had adequate internal controls over time and attendance for Public Safety officers. No one was responsible for verifying the hours worked by Department of Public Safety …
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"
… for nonexchange transactions. A nonexchange transaction is one in which a government receives (or gives) value … giving (or receiving) equal value in exchange. There is no clear link between services provided and supporting … entered into voluntarily). The purpose of this bulletin is to discuss the Statement No. 33 impact on revenue …
https://www.osc.ny.gov/local-government/publications/gasb-statement-no-33-accounting-and-financial-reporting-nonexchange-transactionsImproper Medicaid Payments for Outpatient Services Billed as Inpatient Claims (Follow-Up)
… audit report, Medicaid Program: Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims (Report … program. The Medicaid program reimburses hospitals for inpatient and outpatient services. A recipient’s status … versus outpatient—affects Medicaid’s reimbursement for services provided. Inpatient care generally requires …
https://www.osc.ny.gov/state-agencies/audits/2025/03/12/improper-medicaid-payments-outpatient-services-billed-inpatient-claims-followImproper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance (Follow-Up)
… our initial audit report, Medicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance (Report … administers New York’s Medicaid program. Under the fee-for-service (FFS) payment method, DOH makes Medicaid payments …
https://www.osc.ny.gov/state-agencies/audits/2025/06/18/improper-fee-service-pharmacy-payments-recipients-third-party-health-insurance-follow