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Medicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… Purpose To determine whether the Department of Health's eMedNY system processes Medicaid claims for … refer to health care services provided in the home, medical offices, clinics, and other freestanding sites. They … Department's Medicaid reimbursement policies. Some edits check various Department files to verify recipient …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… with applicable Medicaid laws and regulations as well as the rules and policies set forth by the Department of … of Medicaid’s payments to Joia were for patients who lived approximately one hour away (one way); and 134 of the …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/medicaid-program-medicaid-payments-pharmacy-claims-joia-pharmacy-and-related-prescriberOversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency
… the facility deficiencies we identified through our site visits, OTDA officials detailed organizational, legal, …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-hotels-and-motels-used-homeless-and-mixed-use-temporary-residencyMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… and qualified for Medicare based on his parent’s work credits. Had the child been enrolled in Medicare, the … based on their or a qualifying family member’s work credits, we identified 4,381 ESRD Medicaid recipients who did … [spouse, parent] and obtaining recipients’ qualifying work credits [“quarters of coverage,” or QCs] from SSA); and …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseSt. Mary’s Hospital for Children, Inc. – Compliance With the Reimbursable Cost Manual
… services to children with disabilities between the ages of 3 and 4 years. For the purposes of this report, the program we reviewed is referred to as the … information reported on CFRs. St. Mary’s is a subsidiary of St. Mary’s Healthcare System for Children, Inc., a …
https://www.osc.ny.gov/state-agencies/audits/2022/11/09/st-marys-hospital-children-inc-compliance-reimbursable-cost-manualImproper Fee-for-Service Payments for Services Covered by Managed Long-Term Care Plans (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Improper Fee-for-Service … who are chronically ill or disabled and who wish to stay in their homes and communities. MLTC plans offer a range of … that plans must cover and pay for (benefit packages) in exchange for monthly premium payments for each member …
https://www.osc.ny.gov/state-agencies/audits/2021/08/31/improper-fee-service-payments-services-covered-managed-long-term-care-plans-followQuality Services for the Autism Community – Compliance With the Reimbursable Cost Manual
… program, and sufficiently documented pursuant to the State Education Department’s (SED) Reimbursable Cost Manual … year ended June 30, 2015, QSAC received $3.7 million in State funding for the cost-based SC and SEIT programs. The …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/quality-services-autism-community-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans
… made improper fee-for-service (FFS) payments for certain services covered by managed long-term care (MLTC) plans. The audit covered the period January 1, … enrolled in MLTC plans. MLTC plans provide long-term care services, such as home health care, nursing home care, and …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/medicaid-program-improper-fee-service-payments-services-covered-long-term-care-plansHebrew Academy for Special Children, Inc. – Compliance With the Reimbursable Cost Manual
… operated several other programs, including SED-approved school-age programs, an Early Intervention program … a camp, and a day care program. During the 2016-17 school year, Hebrew Academy served approximately 539 students …
https://www.osc.ny.gov/state-agencies/audits/2020/02/04/hebrew-academy-special-children-inc-compliance-reimbursable-cost-manualAdministration of the Contract With the Postgraduate Center for Mental Health (Follow-Up)
… With the Postgraduate Center for Mental Health ( 2015-S-88 ). About the Program Our initial report, issued December …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/administration-contract-postgraduate-center-mental-health-followImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… Hospice is a coordinated program of home and/or inpatient care that treats terminally ill individuals and their … Hospice programs provide palliative care, including nursing, physician, and counseling services; home health … providers are responsible for developing a comprehensive plan of care and coordinating care and services needed by …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-followMedicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance
… have other third-party health insurance (TPHI) for pharmacy services in addition to Medicaid (e.g., … is considered the payer of last resort and, as such, FFS pharmacy providers are required to coordinate benefits with … period, Gainwell’s third-party liability recoveries on FFS pharmacy payments totaled almost $53 million. Key Findings We …
https://www.osc.ny.gov/state-agencies/audits/2023/05/11/medicaid-program-improper-fee-service-pharmacy-payments-recipients-third-party-healthMedicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
… codes, and each service provided could trigger a separate payment. Outpatient services are generally less expensive …
https://www.osc.ny.gov/state-agencies/audits/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claimsChildren’s Unit for Treatment and Evaluation – Compliance With the Reimbursable Cost Manual
… calculated, adequately documented, and allowable under the State Education Department’s (SED) guidelines, including the …
https://www.osc.ny.gov/state-agencies/audits/2019/07/15/childrens-unit-treatment-and-evaluation-compliance-reimbursable-cost-manualMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… from June 1, 2012 through May 31, 2017. Background Many of the State’s Medicaid recipients are also eligible for … supplementary medical insurance coverage for a range of outpatient medical services, physician services, and … of the automated crossover system was to minimize the need for providers to self-report Medicare claim data to …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyMedicaid Program – Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program
… Purpose To determine if the Department of Health has taken sufficient steps to safeguard Medicaid … use disorder treatment information among different health care providers is expected to continue. Key Findings … Other Related Audits/Reports of Interest Department of Health: Medicaid Managed Care Premiums for Recipients With …
https://www.osc.ny.gov/state-agencies/audits/2018/11/20/medicaid-program-opioid-prescriptions-medicaid-recipients-opioid-treatment-programMonitoring of Not-for-Profit Cemeteries for Fiscal Stability and Adequate Facility Maintenance (Follow-Up)
… Maintenance ( 2016-S-79 ). Background The Department of State’s (Department) Division of Cemeteries (Division) … all not-for-profit cemetery corporations (cemeteries) in New York State. As authorized by Article 15 of the Not-for-Profit …
https://www.osc.ny.gov/state-agencies/audits/2018/12/27/monitoring-not-profit-cemeteries-fiscal-stability-and-adequate-facility-maintenance-followMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… Many of the State’s Medicaid recipients are also enrolled in Medicare. Such individuals are referred to as … Medicaid. Key Findings The audit identified $20.1 million in Medicaid payments for services provided to dual-eligible … by Medicaid. Key Recommendations Review the $20.1 million in Medicaid payments for therapy services and prescription …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareState Comptroller DiNapoli Positions New York Pension Fund For Low Carbon Future
… risk to the Fund’s returns on investment. Additional funds can be added to the index as performance warrants. … Fund’s existing index holdings. “Forward-thinking pension funds like the New York State Common Retirement Fund know … Fund’s ongoing efforts — investing in clean technology and funds focused on ESG sustainability — are paying off. The …
https://www.osc.ny.gov/press/releases/2015/12/state-comptroller-dinapoli-positions-new-york-pension-fund-low-carbon-futureDiNapoli Audit Highlights Need for Better Compliance with School Violence Reporting Law
… to take steps toward providing a safe learning environment for students in pre-kindergarten through 12th grade. Under … failed to comply with provisions of the federal No Child Left Behind Act of 2001 that require it to notify local … DiNapoli’s auditors. DiNapoli recommended SED: Conduct and document a risk assessment related to compliance with the …
https://www.osc.ny.gov/press/releases/2015/01/dinapoli-audit-highlights-need-better-compliance-school-violence-reporting-law