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Medicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
… Medicaid’s reimbursement for services provided. Inpatient care generally requires recipients to stay overnight in the hospital and be monitored by the health care team at the hospital throughout treatment and recovery. … are medical procedures that can be performed in the same day. Medicaid uses the All Patient Refined Diagnosis Related …
https://www.osc.ny.gov/state-agencies/audits/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claimsImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Report 2018-S-71 ). About the … care, including nursing, physician, and counseling services; home health aides; physical and occupational … Medicare is the primary payer for Medicare-covered hospice services, while Medicaid is the payer of last resort. In …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-followDiNapoli: State Education Employment Program For New Yorkers With Disabilities Falling Short
… and keeping the jobs they want, and the pandemic has only made things harder,” DiNapoli said. “The State Education …
https://www.osc.ny.gov/press/releases/2022/03/dinapoli-state-education-employment-program-new-yorkers-disabilities-falling-shortDiNapoli: Lack of Oversight Hinders Home Meal Delivery Program for Vulnerable Seniors
… case managers to share clients’ complaints. English Only Client Surveys Among the city’s senior population, 28% … stated that when scoring proposals, they are limited to only considering the content submitted in the provider’s …
https://www.osc.ny.gov/press/releases/2022/01/dinapoli-lack-oversight-hinders-home-meal-delivery-program-vulnerable-seniorsDiNapoli: School District Tax Levy Cap Below 2 Percent for Second Straight Year
… with fiscal years starting July 1, 2021, including the “Big Four” cities of Buffalo, Rochester, Syracuse and Yonkers. …
https://www.osc.ny.gov/press/releases/2021/01/dinapoli-school-district-tax-levy-cap-below-2-percent-second-straight-yearContract Submission System Guide for the Office of the Attorney General Users
… the functions a user performs in an organization and only allows the user to complete tasks for which they have … containing contract transaction details. OAG View‐Only Role Allows user to view-only contracts that have been submitted to OSC for prior …
https://www.osc.ny.gov/state-agencies/contracts/contract-submission-system-guide-office-attorney-general-usersSt. Mary’s Hospital for Children, Inc. – Compliance With the Reimbursable Cost Manual
… Objective To determine whether the costs reported by St. Mary’s Hospital for Children, Inc. (St. Mary’s) on its Consolidated Fiscal Reports (CFRs) were … The audit focused primarily on expenses claimed on St. Mary’s CFR for the calendar year ended December 31, 2019 …
https://www.osc.ny.gov/state-agencies/audits/2022/11/09/st-marys-hospital-children-inc-compliance-reimbursable-cost-manualMedicaid 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-healthDiNapoli: Former Village of Sherman Treasurer Arrested for Alleged Theft of $20,000
… felony charges for the alleged theft of more than $20,000 in cash paid by residents from 2012 to 2016 for village … County Sheriff’s Office. Gilbert, 54, who now resides in Florida, was charged with grand larceny in the third degree. “Ms. Gilbert allegedly betrayed her …
https://www.osc.ny.gov/press/releases/2022/08/dinapoli-former-village-sherman-treasurer-arrested-alleged-theft-20000DiNapoli: State is Slow in Disbursing Some Federal Relief Funds for Housing
… to COVID-19 relief. For example, the audit found HCR had only committed about $98 million of the $127 million in CBDG …
https://www.osc.ny.gov/press/releases/2022/09/dinapoli-state-slow-disbursing-some-federal-relief-funds-housingDiNapoli: Orange County Resident Arrested for Stealing Her Late Mother’s Pension Benefits
… mother’s pension payments. “Ms. White thought she could get away with hiding her mother’s death from the retirement … wrong and now will be held accountable,” DiNapoli said. “I am grateful to Orange County District Attorney Hoovler and … the public to help fight fraud and abuse. New Yorkers can report allegations of fraud involving taxpayer money by …
https://www.osc.ny.gov/press/releases/2021/06/dinapoli-orange-county-resident-arrested-stealing-her-late-mothers-pension-benefitsDiNapoli Announces Nominee for the Commission on Ethics and Lobbying in Government
… Thomas P. DiNapoli today announced his nomination of Nancy G. Groenwegen to the Commission on Ethics and … and accountability. Nancy’s character, knowledge and depth of experience will help New York meet those challenges and … Groenwegen served as the commissioner and president of the New York Civil Service Commission and as an assistant …
https://www.osc.ny.gov/press/releases/2022/07/dinapoli-announces-nominee-commission-ethics-and-lobbying-governmentImproper 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-followDiNapoli: NYC Projects $3 Billion Surplus for 2015, Balanced Budget Next Year
… New York City is projecting a surplus of $3 billion for fiscal year (FY) 2015 and a balanced budget for FY 2016 with … New York City is projecting a surplus of $3 billion for fiscal year FY 2015 and a balanced budget for FY 2016 with …
https://www.osc.ny.gov/press/releases/2015/06/dinapoli-nyc-projects-3-billion-surplus-2015-balanced-budget-next-yearGlobal Investor Coalition Calls on Exxon to Prepare for a Lower Carbon Future
… by New York State Comptroller Thomas P. DiNapoli and the Church of England are urging ExxonMobil to disclose the … Edward Mason, the Head of Responsible Investment for the Church of England’s investment fund. “As responsible … shareholder proposal filed by Comptroller DiNapoli and the Church of England’s investment fund asks ExxonMobil to …
https://www.osc.ny.gov/press/releases/2016/01/global-investor-coalition-calls-exxon-prepare-lower-carbon-futureMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans
… such as home health care, nursing home care, and durable medical equipment, to people who are chronically ill or … or a contractor that operates a statewide enrollment center for public health insurance programs. Enrollment …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/medicaid-program-improper-fee-service-payments-services-covered-long-term-care-plansQuality Services for the Autism Community – Compliance With the Reimbursable Cost Manual
… rent because QSAC did not claim the actual rent only; instead, it claimed actual rent and added deferred …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/quality-services-autism-community-compliance-reimbursable-cost-manualMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by … drugs and January 1, 2012 to December 31, 2017 for therapy services. About the Program Many of the State’s … Medicare program covers physical, occupational, and speech therapy services, as well as prescription drugs. When these …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareAdministration of the Contract With the Postgraduate Center for Mental Health (Follow-Up)
… solely for PCMH’s Chief Executive Officer; parties and alcoholic beverages for staff; and unsupported professional … staff to follow up on recommendations to PCMH resulting from field visits, and excessive delays by OMH to recover $1.4 million in surplus advances from the 2011-12 through 2013-14 fiscal years. Key Findings …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/administration-contract-postgraduate-center-mental-health-followState Comptroller DiNapoli Statement on Arrest of Muge Ma for COVID-Related Scam
… New York State Comptroller Thomas P. DiNapoli released a statement today after the arrest of Muge Ma following a joint … Comptroller DiNapoli released a statement after the arrest of Muge Ma following an …
https://www.osc.ny.gov/press/releases/2020/05/state-comptroller-dinapoli-statement-arrest-muge-ma-covid-related-scam