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Lifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual
… resulted from Lifeline exceeding the approved staff-to-student ratios specified in the program approval letters … staff uniforms, $250 in food for Board meetings, $228 for student clothing, a $122 plaque for a retiring employee, and …
https://www.osc.ny.gov/state-agencies/audits/2017/10/12/lifeline-center-child-development-inc-compliance-reimbursable-cost-manualUnited HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… and if so, to quantify the overpayments made by United HealthCare resulting from this practice. The audit covered … State Department of Civil Service contracts with United HealthCare (United) to process and pay medical claims from … for Services at the Capital Region Ambulatory Surgery Center (2007-S-72) New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandMedicaid Program – Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits
… whether the Department of Health paid pharmacy providers for controlled substances in compliance with the New York State Controlled Substances … risk of drugs ordered in this manner being diverted for inappropriate or unauthorized use. The supply limits that … whether the Department of Health paid pharmacy providers for controlled substances in compliance with the New York …
https://www.osc.ny.gov/state-agencies/audits/2015/02/06/medicaid-program-improper-payments-controlled-substances-exceed-allowed-dispensing-limitsUnited HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… costs, and if so, to quantify the overpayments made by United HealthCare resulting from this practice. The audit … 2011 through March 31, 2015. Background The New York State Health Insurance Program (NYSHIP) provides health insurance … New York State Department of Civil Service contracts with United HealthCare (United) to process and pay medical claims …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-eastern-orange-ambulatory-surgery-centerPayments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… included in our initial audit report, Payments for Fraudulent and Improper Claims Submitted by Davis Ethical … which was issued on August 13, 2013, determined that, for the period January 1, 2008 through December 13, 2011, … fraudulent claims to Medicaid and received payments for those claims. We coordinated our audit and investigative …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy-followMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… Purpose To determine whether Medicaid made improper fee-for-service claim payments for pharmacy services covered by recipients’ managed care … program pays medical providers through either the fee-for-service method or the managed care plan method. Under the … Medicaid made improper feeforservice claim payments for pharmacy services covered by recipients managed care plans …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careEducators for Children, Youth and Families, Inc. – Use of Contract Funds (Follow-Up)
… included in our initial audit report, Educators for Children, Youth and Families, Inc. - Use of Contract … was issued on August 20, 2010, examined whether Educators for Children, Youth and Families, Inc. (Educators) … Children and Family Services (OCFS) under grant contracts for the period July 1, 2002 through June 4, 2008. New York …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/educators-children-youth-and-families-inc-use-contract-funds-followMedicaid 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 – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… to matters addressing the Doctor’s prescribing activity for the period January 1, 2013 through June 30, 2016. Background The Department is responsible for administering New York State’s Medicaid program. Medicaid … disadvantaged and/or have special health care needs. For the State fiscal year ended March 31, 2016, New York’s …
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
… 16, 2016. Background According to a 2016 Department of Housing and Urban Development report, of the more than 86,000 … Counties throughout the State utilize hotels and motels to house a substantial portion of their homeless populations. In … use of resources to inspect temporary residences to house the homeless. Agency Comments In responding to the …
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
… Purpose To determine whether the Department of Health took sufficient steps to control the Medicaid costs of recipients diagnosed with end stage … who were eligible for, but not enrolled in, Medicare. The audit covered the period January 1, 2010 through December …
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
… directly related to the special education program, and sufficiently documented under the State Education … guidelines, including the Reimbursable Cost Manual (RCM) and the Consolidated Fiscal Reporting and Claiming Manual (CFR Manual). The audit focused primarily …
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)
… coverage to people who are chronically ill or disabled and who wish to stay in their homes and communities. MLTC … such as home health care, nursing home care, dentistry, vision care, and durable medical equipment. The Department of … plan. The remaining $877,000 was improperly paid because, at the time eMedNY adjudicated the claim, the recipient was …
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
… QSAC’s administrative office for all programs is located in Manhattan. QSAC was established in 1978 and is approved by SED to provide Preschool Special … and $3,025 in administration rent because QSAC did not claim the actual rent only; instead, it claimed actual rent …
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
… the Department of Health (Department) made improper fee-for-service (FFS) payments for certain services covered by managed long-term care (MLTC) … managed care premiums and, in return, MLTC plans pay for all MLTC covered services. The Medicaid program should … of Health DOH made improper feeforservice FFS payments for certain services covered by managed longterm care plans …
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
… the Office for People With Developmental Disabilities, a camp, and a day care program. During the 2016-17 school year, …
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)
… of the Contract With the Postgraduate Center for Mental Health ( 2015-S-88 ). About the Program Our … Supportive Housing Contract with the Postgraduate Center for Mental Health (PCMH). The audit found sampled clients … negatively affect the health and/or safety of clients. For example, three apartments had significantly damaged …
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)
… were appropriate for dual-eligibles receiving care under the Medicare-funded hospice benefit. As a result, the …
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
… Objective To determine if Medicaid made inappropriate fee-for-service payments to pharmacies on behalf of recipients … administers New York’s Medicaid program. Under the fee-for-service (FFS) payment method, the Department makes Medicaid payments directly to health care providers for services rendered to Medicaid recipients. Many recipients …
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
… whether Medicaid made improper payments to hospitals for outpatient services that were erroneously billed as … (Department). 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/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claims