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Medicaid 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 … risk of drugs ordered in this manner being diverted for inappropriate or unauthorized use. The supply limits that … Medicaid program paid pharmacy providers through the fee-for-service method and the managed care method. Under …
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
… waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare … LLC waived Empire Plan members outofpocket costs and if so to quantify the overpayments made …
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)
… Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (2012-S-11). Background Our initial audit report, … made improper payments totaling $94,460 to Davis Ethical Pharmacy. Based on information obtained from the prescribers … Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (2012-S-11) United HealthCare Insurance Program: …
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
… Medicaid made improper fee-for-service claim payments for pharmacy services covered by recipients’ managed care plans. … provided to their enrollees. Prior to October 2011, pharmacy benefits were reimbursed through the fee-for-service … care coverage. However, beginning October 1, 2011, most pharmacy benefits were covered by managed care plans, and …
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
… freestanding sites. They can be classified into three general categories: diagnostic, therapeutic, and custodial. … for review. Medicaid reimbursement rates for inpatient hospital claims include the costs of most medical care provided during a hospital admission. As such, claims for ancillary services …
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
… and a related prescriber (herein referred to as “the Doctor”) in compliance with applicable Medicaid laws and … audit findings pertaining to matters addressing the Doctor’s prescribing activity for the period January 1, 2013 … funded program that provides a wide range of medical services to those who are economically disadvantaged and/or …
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
… shelter facility. OTDA has assigned responsibility for the inspection of hotels and motels housing the homeless to local … across SSDs, and confusion still exists regarding the inspection process. Additionally, OTDA has not yet provided … unsatisfactory conditions. Material aspects of OTDA’s inspection program are similar to activities performed by …
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
… costs of recipients diagnosed with end stage renal disease who were eligible for, but not enrolled in, Medicare. The … services) on behalf of 10,906 Medicaid recipients who were diagnosed with ESRD. Medicaid recipients with ESRD … or (3) are the spouse or dependent child of a person who meets either of the aforementioned requirements. When …
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
… To determine whether the costs reported by St. Mary’s Hospital for Children, Inc. (St. Mary’s) on its Consolidated … To determine whether the costs reported by St Marys Hospital for Children Inc on its Consolidated Fiscal Reports …
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)
… Objective To determine the extent of implementation of the three … program offers managed long-term care (MLTC) coverage to people who are chronically ill or disabled and who wish to stay in their homes and communities. MLTC plans offer a … To determine the extent of implementation of the three …
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
… is approved by SED to provide Preschool Special Education (SC) and Special Education Itinerant Teacher (SEIT) program … with autism between three and five years of age. Both the SC and SEIT programs are located in Douglaston, Queens. For … 2015, QSAC served 164 students, which consisted of 140 in SC and 32 in SEIT, with 8 children enrolled in both Programs. …
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
… payments for certain services covered by managed long-term care (MLTC) plans. The audit covered the period January 1, … are enrolled in MLTC plans. MLTC plans provide long-term care services, such as home health care, nursing home care, and durable medical equipment, to …
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
… Class in an Integrated Setting (SCIS) programs to children with disabilities who are between the ages of three and five … of Health, programs funded through the Office for People With Developmental Disabilities, a camp, and a day care … $2,873,898 in reported costs that did not comply with the requirements in the RCM and the Consolidated Fiscal …
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)
… to the program via the proper authorities and that client case files contained required documentation. However, our visits to certain client apartments identified what appeared to be ongoing …
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)
… ). About the Program Hospice is a coordinated program of home and/or inpatient care that treats terminally ill individuals and their … including nursing, physician, and counseling services; home health aides; physical and occupational therapy; medical …
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 … Department of Health (Department) 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 …
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 inpatient … Medicaid program reimburses hospitals for inpatient and outpatient services. A recipient’s status in a hospital – inpatient versus outpatient – affects Medicaid’s reimbursement for services …
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
To determine whether the costs reported by Childrens Unit for Treatment and Evaluation on its Consolidated Fiscal Reports were properly calculated
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
… to minimize the need for providers to self-report Medicare claim data to eMedNY and thereby improve the accuracy of … appropriate. Formally advise providers to report accurate claim information when billing Medicaid for Part B …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emedny