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United HealthCare – Empire Plan Drug Rebate Revenue (Follow-Up)
… status of the recommendation made in our audit report, United HealthCare: Empire Plan Drug Rebate Revenue … Department of Civil Service (Department) contracted with United HealthCare (United) to administer the Empire Plan’s prescription drug … status of the recommendation made in our audit report United HealthCare Empire Plan Drug Rebate Revenue 2016S7 …
https://www.osc.ny.gov/state-agencies/audits/2017/05/15/united-healthcare-empire-plan-drug-rebate-revenue-followMedicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… payments to Medicaid mainstream managed care plans and Family Health Plus managed care plans (Plans) for recipients … to Medicaid managed care, during the audit period, Family Health Plus (FHP) was a publicly funded managed care … payments to Medicaid mainstream managed care plans and Family Health Plus …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamThe 80/20 Housing Program
… of AMI. These units are referred to as “deep rent skewed.” Under this option, if the income of a tenant in a low-income … four sampled developments, we concluded that the proper numbers of affordable apartment units were made available to … incomes, not all developments took this step. For 18 (42 percent) of the 43 tenants reviewed, applicant incomes …
https://www.osc.ny.gov/state-agencies/audits/2017/05/31/8020-housing-programWhitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… costs reported on the Consolidated Fiscal Reports (CFRs) of the Whitestone School for Child Development (Whitestone) were calculated properly, … education program to disabled children between the ages of three and five years. Whitestone, located in Queens, New …
https://www.osc.ny.gov/state-agencies/audits/2015/04/07/whitestone-school-child-development-compliance-reimbursable-cost-manualPractices Used by the Transit Adjudication Bureau to Collect and Account for Fines and Fees
… on summonses, such as bad addresses, false telephone numbers, and wrong Social Security numbers, contributes to collection difficulties. For example, … years later, during the week of February 13, 2015, only 25.18 percent of possible calls were made. This may, in part, be …
https://www.osc.ny.gov/state-agencies/audits/2016/08/11/practices-used-transit-adjudication-bureau-collect-and-account-fines-and-feesSelect Financial Management Practices
… are in compliance with the Commission’s procedures for the period January 1, 2013 through September 30, 2015. …
https://www.osc.ny.gov/state-agencies/audits/2015/11/05/select-financial-management-practicesMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
… Purpose To determine the readiness of all Medicaid managed care organizations (MCOs) to submit Medicaid encounter transactions to the new … To determine the readiness of all Medicaid managed care organizations to submit Medicaid encounter transactions to the new …
https://www.osc.ny.gov/state-agencies/audits/2016/03/29/medicaid-program-managed-care-organizations-readiness-encounter-intake-systemDriver Responsibility Assessment Program
… Purpose To determine whether the Department of Motor Vehicles (Department) has accurately assessed and … the licenses, or the privilege to obtain a license, of drivers who did not pay their assessed fees. Our audit … consumers. In an effort to prevent the repeated behavior of problem drivers and to improve traffic safety, in November …
https://www.osc.ny.gov/state-agencies/audits/2014/10/09/driver-responsibility-assessment-programFinancial Management Practices
… liquidated to cover significant liabilities resulting from litigation. Since September 2009, the District has had a … Continue to pursue acceptable outcomes in negotiations and litigation, in accordance with FERC’s Headwater Benefit …
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 Medicaid requirements, and resulted in correct payments to the providers. The audit covered the period … system processes Medicaid claims submitted by providers for services rendered to Medicaid-eligible recipients, and it … for inpatient claims that were either billed at a higher level of care than what was actually provided or …
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
… in Rego Park with additional instruction sites in Jackson Heights, Brooklyn and Jersey City. (Only students enrolled at …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/tuition-assistance-program-metropolitan-learning-instituteFuel Purchases
… the correct type of fuel, paying the proper amount for the fuel purchased, receiving the correct amount of fuel, … unleaded regular gas to the two subsidiaries that account for most of its fuel purchases. In addition, the Authority … we found the Authority purchased the correct type of fuel for buses, it spent approximately $11,000 more than necessary …
https://www.osc.ny.gov/state-agencies/audits/2015/02/27/fuel-purchasesAccountability for Traffic Ticket Surcharges
… (Department) accurately assessed, collected, accounted for, and reported all traffic ticket surcharge revenue … and one each in Rochester and Buffalo; each is responsible for processing and collecting fines and traffic ticket … $1 million in surcharge revenue that was reported twice for the same week during May 2013, the Department is …
https://www.osc.ny.gov/state-agencies/audits/2015/08/10/accountability-traffic-ticket-surchargesMedicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… services when patient deaths occur within one day of admission. The audit covers the period December 1, 2009 … claims when patient deaths occur within the first day of admission. For instance, Medicaid paid $153,329 on a claim … $9,685 for a patient who died within the first day of admission. The APR DRG-based methodology assigns additional …
https://www.osc.ny.gov/state-agencies/audits/2013/08/15/medicaid-program-payments-death-related-one-day-inpatient-admissionsMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… of Health's eMedNY system processes Medicaid claims for ancillary services in accordance with Medicaid … categories: diagnostic, therapeutic, and custodial. For example, laboratory, physical therapy, and home health … care are typical ancillary services. Medicaid claims for ancillary services are processed by eMedNY, the …
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
… The Department is required by the federal Centers for Medicare & Medicaid Services to create actuarially sound …
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
… times while serving a sentence for the same original crime. Key Findings We found the Department has appropriate …
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
… on the hospitals’ gross charges (i.e., no limit); and 16 did not allow for additional reimbursement of special items. During the four year audit period, Empire paid the hospitals $636 million for … limited the reimbursement of special items, and another 16 hospitals had contracts that only limited reimbursement …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsCompliance With Navigation Law
… Activity Reports and well other sources, such as boating accident reports from local law enforcement and Department of … enforcement activity, boating accidents, fatalities, and injuries by waterway for the year. In tandem with data from … and may distort Parks’ ability to reliably assess accident data and develop preventive measures. Key …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/compliance-navigation-lawSelected Wage Investigation Procedures (Follow-Up)
… Objective To determine the implementation status of the four recommendations included in our initial … To determine the implementation status of the four recommendations included in our initial …
https://www.osc.ny.gov/state-agencies/audits/2024/02/16/selected-wage-investigation-procedures-follow