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New York State Health Insurance Program: Payments by Empire BlueCross for Hospital Services for Ineligible Members (Follow-Up) (2021-F-17) DCS 30-Day Response

To assess the extent of implementation of the five recommendations included in our initial audit report, Payments by Empire BlueCross for Hospital Services for Ineligible Members (Report 2019-S-32).

Improper Medicaid Payments to Hospitals for Outpatient Services Billed as Inpatient Services for Recipients Enrolled in Managed Care (2023-S-23) 180-Day Response

To determine whether Medicaid made improper payments to hospitals for outpatient services that were erroneously billed as inpatient services for recipients enrolled in managed care.

State Agencies Bulletin No. P-984

Payment of 4/1/98 Perf/Inc Advance for CSEA, PEF & RRSU Units & Longevity Pay for CSEA & RRSU Units

Nanuet Fire District - Credit and Gasoline Cards (2018M-193)

Determine if claims for credit card bills were audited and the purchases were for appropriate purposes.

Comptroller DiNapoli and Attorney General Underwood Announce Criminal Conviction and False Claims Act Settlement with Bottini Fuel for Diverting Customers' Credit Balances for Their Own Benefit

… substantial indications of knowingly fraudulent conduct on the part of the company and its principals. Thereafter, …

Children’s Unit for Treatment and Evaluation – Compliance With the Reimbursable Cost Manual

… To determine whether the costs reported by Children’s Unit for Treatment and Evaluation (CUTE) on its Consolidated … (RCM). The audit covered expenses reported on CUTE’s CFR for the fiscal year ended June 30, 2016 and certain costs reported on its CFRs for the two fiscal years ended June 30, 2015. About the …

Educators for Children, Youth and Families, Inc. – Use of Contract Funds (Follow-Up)

… Purpose To determine the extent of implementation of the three recommendations included in … received from the State Education Department (SED) and the Office of Children and Family Services (OCFS) under grant contracts for the period …

West Corners Fire Company – Accounting for Cash Receipts and Disbursements (2014M-215)

… ensured that the Treasurer was properly accounting for cash receipts and disbursements for the period January 1, 2013 through May 16, 2014. … that is located in, and provides fire protection services for, the Town of Union in Broome County. The Company’s …

Monitoring of Not-for-Profit Cemeteries for Fiscal Stability and Adequate Facility Maintenance (Follow-Up)

To determine the extent of implementation of the four recommendations included in our initial audit report Monitoring of NotforProfit Cemeteries for Fiscal Stability and Adequate Facility Maintenance 2016S79

Medicaid Program – Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program

… Purpose To determine if the Department of Health has taken sufficient steps to safeguard Medicaid … which began in the 1990s with the over-prescribing of opioid drugs for pain-related conditions. Opioid treatment … Tracking Over-Prescribing (I-STOP), which contains records of controlled substance prescriptions. I-STOP is a tool to …

Medicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY

… Purpose To determine whether Medicaid made improper payments to providers who submitted Part B cost-sharing claims …

School for Language and Communication Development – Compliance With the Reimbursable Cost Manual

… not-for-profit special education provider located in Nassau County, New York. SLCD provides preschool special … June 30, 2015, SLCD reported approximately $8.1 million in reimbursable costs on its CFRs for the three rate-based … fiscal years ended June 30, 2015, we identified $38,741 in ineligible costs that SLCD reported on its CFRs for the …

UnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers

… Purpose To determine whether UnitedHealthcare overpaid for … Surgery Centers that were contractually required to use in-network anesthesia providers. The audit covered the …

Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 3, 4, 5 and 6 Members – Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 3, 4, 5 and 6 Members

Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 1 and 2 Members – Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 1 and 2 Members

Medicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance

… Purpose To determine whether the Department of Health (Department) made Medicaid … 2012 to September 1, 2017. Background The Medicaid program is a federal, state, and locally funded program that provides … York State Social Services Law, the Department’s policy is to exclude Medicaid recipients from mainstream managed …

UnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)

… Service (Department) contracts with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to Empire Plan members. United’s payments to medical providers are based, in part, on … on January 8, 2015. Our objective was to determine whether United improperly paid for medical services designated with …

Special 25-Year Plan for Institutional Safety Officers (Sections 89-t and 604(q))

… (Return to Top) (Return to Top) (Return to Top) VO1873 (Rev. 7/11) © 2011, New York State and Local Retirement System  (Return to Top) … Information for members about special 25 year …

United HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center

… participating providers who agree to accept payments, at rates established by United, to furnish medical services … United reimburses claims from non-participating providers at amounts that are generally higher (and often significantly … This caused United to continue to make overpayments. At the time of our audit fieldwork, United was negotiating …

Medicaid 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 with the New York State Controlled Substances Act, which limits … that exceed supply limits allowed by the Act. There is considerable risk that other participating Medicaid MCOs …