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Medicaid Program – Claims Processing Activity April 1, 2020 Through September 30, 2020
… were submitted by approved providers, were processed in accordance with Medicaid requirements, and resulted in correct payments to the providers. The audit covered the … 2020, eMedNY processed over 151 million claims, resulting in payments to providers of more than $38 billion. The claims …
https://www.osc.ny.gov/state-agencies/audits/2021/09/21/medicaid-program-claims-processing-activity-april-1-2020-through-september-30-2020Medicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
… through July 31, 2020. About the Program The Department of Health (Department) administers New York’s Medicaid program. Many of the State’s Medicaid recipients receive their services … center delivery costs associated with the maternity care of a recipient. However, MCOs are not eligible to receive …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-supplemental-maternity-capitation-payments-managed-careMedicaid Program – Improper Payments for Drugs Without a Federal Drug Rebate Agreement
… managed care organizations (MCOs) a monthly capitation payment for each Medicaid recipient enrolled in their plans. …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreementMedicaid Program – Claims Processing Activity April 1, 2023 Through September 30, 2023
… been paid by managed care; $985,786 was paid for newborn birth and maternity claims that contained inaccurate information, such as the newborn’s birth weight; $582,101 was paid for inpatient, clinic, …
https://www.osc.ny.gov/state-agencies/audits/2024/04/24/medicaid-program-claims-processing-activity-april-1-2023-through-september-30-2023Medicaid Program – Claims Processing Activity October 1, 2022 Through March 31, 2023
… Objective To determine whether the Department of Health’s eMedNY system … Medicaid requirements, and resulted in correct payments to providers. The audit covered the period October 2022 … To determine whether the Department of Healths eMedNY system …
https://www.osc.ny.gov/state-agencies/audits/2023/10/25/medicaid-program-claims-processing-activity-october-1-2022-through-march-31-2023Medicaid Program – Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition
… to a hospital will increase. Medicaid will only pay for medical care and services that are medically necessary, whose necessity is evident from … assessments and Medicaid billing rules; and Properly document severe malnutrition in a patient’s medical record. …
https://www.osc.ny.gov/state-agencies/audits/2019/04/08/medicaid-program-improper-medicaid-payments-recipients-diagnosed-severe-malnutritionMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Managed Care
… for certain services covered by mainstream managed care plans. Our audit covered the period January 1, 2013 to April … the managed care method, the Department pays managed care plans a monthly premium for each Medicaid recipient enrolled in managed care, and the managed care plans pay providers for services rendered to their members. …
https://www.osc.ny.gov/state-agencies/audits/2019/01/10/medicaid-program-improper-fee-service-payments-services-covered-managed-careDiNapoli: NYS Pension Fund Commits $1.3 Billion to Sustainable Investment Program
… equity, fixed income, private equity, infrastructure and real estate. DiNapoli also announced the Fund has completed …
https://www.osc.ny.gov/press/releases/2023/03/dinapoli-nys-pension-fund-commits-13-billion-sustainable-investment-programDiNapoli: After-School Provider Misused $194,320 in Public Funds
… expenses that were unnecessary, not allowable or unrelated to its programs, according to an audit released today by New York State Comptroller … DiNapoli said. “The State Education Department needs to step up and do a better job of making sure that taxpayers … expenses that were unnecessary not allowable or unrelated to its programs …
https://www.osc.ny.gov/press/releases/2014/02/dinapoli-after-school-provider-misused-194320-public-fundsState Agencies Bulletin No. 783
… Purpose To notify and provide instructions to agencies of a new PayServ Action/Reason code to use when processing certain Management Confidential employees … To notify and provide instructions to agencies of a new …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/783-new-workers-compensation-actionreason-code-management-confidentialJustice Court Fund: Advisories
… and Fee Increase VTL §1809 (1) New Surcharge VTL §1809-e January [pdf] - 2008 Legislative Update and Reporting to the … - Certification, No Activity, Term of Suspension Fee 2005 October [pdf] - 2005 Legislative Update and Reporting to the Justice Court …
https://www.osc.ny.gov/local-government/required-reporting/justice-court-fund-advisoriesTemporary Assistance – Federal Funding and New York
… Note: Temporary Assistance includes Family Assistance and Safety Net Assistance recipients. The count reflected in the … that are federally funded, and a small number of Safety Net Recipients that are TANF cases in the non-cash portion of the Safety Net program, as reported by OTDA. It does not include …
https://www.osc.ny.gov/reports/budget/fed-funding-ny/temporary-assistanceEmpire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011
… which includes coverage for inpatient and outpatient hospital services. Empire processes Plan claims for hospital services in accordance with agreements they … State Health Insurance Program: Payments to John T. Mather Memorial Hospital (2010-S-51) …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2011-throughMedicaid Claims Processing Activity October 1, 2011 Through March 31, 2012
… were processed in accordance with Medicaid requirements, and resulted in correct payments to the providers. The audit … for services rendered to Medicaid eligible recipients, and it generates payments to reimburse the providers for … providers of about $25 billion. The claims are processed and paid in weekly cycles which averaged about 9 million …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-claims-processing-activity-october-1-2011-through-march-31-2012Rebates and Discounts on Physician-Administered Drugs (Follow-Up)
… included in our initial audit report, Rebates and Discounts on Physician-Administered Drugs (2010-S-72). … Audit/Report of Interest Department of Health: Rebates and Discounts on Physician-Administered Drugs (2010-S-72) … included in our initial audit report Rebates and Discounts on PhysicianAdministered Drug …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/rebates-and-discounts-physician-administered-drugs-followAccuracy of Reported Cost Savings
… activities with various State agencies as well as Federal and local law enforcement agencies. These activities …
https://www.osc.ny.gov/state-agencies/audits/2014/07/11/accuracy-reported-cost-savingsAssessment of Costs to Administer the Workers’ Compensation Program for the Fiscal Year Ended March 31, 2014
… identifies and reports its assessable expenses in all material respects. The Board made minor payroll …
https://www.osc.ny.gov/state-agencies/audits/2016/10/26/assessment-costs-administer-workers-compensation-program-fiscal-year-ended-march-31-2014Kids First Evaluation & Advocacy Center – Compliance with the Reimbursable Cost Manual
… Objective To determine whether the costs reported by Kids First Evaluation & Advocacy Center (Kids First) on its Consolidated Fiscal Report (CFR) were … Department’s (SED) guidelines, including the Reimbursable Cost Manual (RCM) and the Consolidated Fiscal and Reporting …
https://www.osc.ny.gov/state-agencies/audits/2022/03/02/kids-first-evaluation-advocacy-center-compliance-reimbursable-cost-manualCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… Purpose To determine if CVS Health invoiced and remitted commercial rebate revenue related to Empire Plan drug utilization in accordance with its contract with the Department of Civil … To determine if CVS Health invoiced and remitted commercial …
https://www.osc.ny.gov/state-agencies/audits/2019/01/28/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCVS Health – Temporary Holding Account Rebate Revenue
… Objective To determine if CVS Health remitted to the State Department of Civil Service … to eligible prescription drug claims maintained in CVS Health’s temporary holding account. Our audit covered the … nearly 1.1 million members. Civil Service contracted with CVS Health to administer the Empire Plan’s prescription drug …
https://www.osc.ny.gov/state-agencies/audits/2019/10/17/cvs-health-temporary-holding-account-rebate-revenue