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School for Language and Communication Development – Compliance With the Reimbursable Cost Manual
… SLCD is an SED-approved, not-for-profit special education provider located in Nassau County, New York. SLCD provides … employees that exceeded the benefits available to direct care preschool employees; $7,152 in costs for a teacher …
https://www.osc.ny.gov/state-agencies/audits/2018/04/16/school-language-and-communication-development-compliance-reimbursable-cost-manualBrookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Brookville Center for Children’s Services, Inc. (Brookville) on its … Audits/Reports of Interest Yeled v’Yalda Early Childhood Center: Compliance With the Reimbursable Cost Manual ( … Determine whether the costs reported by Brookville Center for Childrens Services Inc on its Consolidated Fiscal …
https://www.osc.ny.gov/state-agencies/audits/2017/10/04/brookville-center-childrens-services-inc-compliance-reimbursable-cost-manualLifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by Lifeline Center … (CFRs) were reasonable, necessary, directly related to the special education program, and sufficiently documented pursuant to the State Education Department’s (SED) Reimbursable Cost … To determine whether the costs reported by Lifeline Center …
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
… Purpose To determine whether Orthopedic Associates of Long Island, LLP waived Empire Plan members’ … audit focused on claims submitted to United by Orthopedic Associates of Long Island, LLP (Orthopedic Associates), a non-participating provider located in Long …
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
… Purpose To determine whether the Department of Health paid pharmacy providers for controlled substances in compliance … supply. During the audit period, the Medicaid program paid pharmacy providers through the fee-for-service method and the … managed care method. Under fee-for-service, Medicaid pays pharmacy providers directly for drugs dispensed to Medicaid …
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
… March 31, 2015. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating … services to Empire Plan members. Members pay a nominal co-payment to the participating provider for the services …
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 Funds … issued on August 20, 2010, examined whether Educators for Children, Youth and Families, Inc. (Educators) appropriately … the State Education Department (SED) and the Office of Children and Family Services (OCFS) under grant contracts for …
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
… 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 provided during a hospital admission are generally not reimbursable. In 2007, …
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
… prescriptions were missing or invalid; Claims in which the medication dispensing labels contained inaccurate …
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
… 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
… renal disease who were eligible for, but not enrolled in, Medicare. The audit covered the period January 1, 2010 … End stage renal disease (ESRD) is a medical condition in which a person has permanent kidney failure and requires … When Medicaid recipients with ESRD are also enrolled in Medicare, Medicare becomes the primary insurer (payer) and …
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
… Objective To determine whether the costs reported by St. Mary’s Hospital for Children, Inc. (St. Mary’s) on its Consolidated … (CFRs) were reasonable, necessary, directly related to the special education program, and sufficiently documented … To determine whether the costs reported by St Marys Hospital for Children Inc on …
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)
… that identify the services that plans must cover and pay for (benefit packages) in exchange for monthly premium … fee-for-service (FFS). The Medicaid program should not pay claims on a FFS basis for MLTC plan covered services. We …
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
… plans. MLTC plans provide long-term care services, such as home health care, nursing home care, and durable medical equipment, to people who are … operates a statewide enrollment center for public health insurance programs. Enrollment information is ultimately …
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
… Teacher (SEIT), full- and half-day Special Class (SC), and full- and half-day Special Class in an Integrated … of three and five years. For purposes of this report, the SC and SCIS programs for the three years ended June 30, 2017 …
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)
… Objective To determine the extent of implementation of the nine recommendations included in our initial audit report, Administration of the Contract With the Postgraduate Center for Mental Health ( … To determine the extent of implementation of the nine recommendations …
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)
… in our initial audit report, Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Report 2018-S-71 ). About the Program Hospice is a … to as dual-eligibles), Medicare is the primary payer for Medicare-covered hospice services, while Medicaid is the …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-follow