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DiNapoli Seeks Stronger Federal Safety Measures for Oil Trains to Protect New Yorkers
… associated with major rail accidents. “The potential for oil train accidents demands that we take every measure to … is self-insured at a level of $25 million per occurrence for what it terms as “non-catastrophic” property damage, such … contaminated sites. “Comptroller DiNapoli has shined a light on the troubling reality that railroads often are …
https://www.osc.ny.gov/press/releases/2016/04/dinapoli-seeks-stronger-federal-safety-measures-oil-trains-protect-new-yorkersState Comptroller DiNapoli Releases Audits
… and coinsurance that Medicaid would be obligated to pay under the fee-for-service (FFS) method of payment, the …
https://www.osc.ny.gov/press/releases/2022/12/state-comptroller-dinapoli-releases-auditsNew York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan
… the issue and develop a process to reconcile the data in their respective systems to reduce the risk of processing … To Civil Service and CVS Caremark: Review the $12,358,531 in claims identified in this report as incorrectly paid under the Commercial Plan …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/new-york-state-health-insurance-program-incorrect-payments-cvs-caremark-medicare-rx-drugMedicaid Program – Claims Processing Activity April 1, 2023 Through September 30, 2023
… by approved providers, were processed in accordance with Medicaid requirements, and resulted in correct payments … lab, and practitioner claims that did not comply with Medicaid policies; $167,098 was paid for claims where … We also identified 12 Medicaid providers who were charged with or found guilty of crimes that violated laws or …
https://www.osc.ny.gov/state-agencies/audits/2024/04/24/medicaid-program-claims-processing-activity-april-1-2023-through-september-30-2023Allocation, Billing, and Collection of Expenses of Administering the Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act
… on insurance carriers in proportion to their reported premiums. Certain fees paid by self-insurers and for bonded vehicles reduce the assessable expenses. Key … to administering the Acts. However, we identified areas for improvement. For example, the Department could better …
https://www.osc.ny.gov/state-agencies/audits/2019/12/13/allocation-billing-and-collection-expenses-administering-motor-vehicle-financial-securityDiNapoli: Former Non-Profit Executive Pleads Guilty to Falsifying Business Records
… today pleaded guilty to manipulating the organization’s payroll system to defraud the organization of over $5,500. Thurber altered the payroll system to increase her paid time off and lower her … to properly charge 42.25 paid time off hours within the payroll system. Thurber, who was employed by FSS for more …
https://www.osc.ny.gov/press/releases/2021/08/dinapoli-former-non-profit-executive-pleads-guilty-falsifying-business-recordsAllocation, Billing, and Collection of Expenses of Administering the Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act (Follow-Up)
… to its practice of not adjusting its billing to account for amended premiums reported by insurance carriers. The Department also lacked a method for carrying prior period balances forward to subsequent …
https://www.osc.ny.gov/state-agencies/audits/2021/05/27/allocation-billing-and-collection-expenses-administering-motor-vehicle-financial-securityMedicaid Program – Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare
… Objective To determine whether Medicaid made improper payments to … in actual and potential overpayments for services that are not allowed in conjunction with hospice (such as Assisted … equipment and supplies (totaling $4.1 million) that may have been eligible to be covered by the Medicare hospice …
https://www.osc.ny.gov/state-agencies/audits/2020/12/28/medicaid-program-improper-medicaid-payments-individuals-receiving-hospice-services-coveredLong Island Association for AIDS Care
… Inc. (LIAAC). Based on information obtained subsequent to that report, we questioned the authenticity of the documents LIAAC submitted to support the reimbursement for employee health insurance … Long Island Network of Community Services (LINCS), which is self-insured for medical and dental insurance. The CEO of …
https://www.osc.ny.gov/state-agencies/audits/2017/11/10/long-island-association-aids-careMedicaid Program - Medicaid Managed Care Organization Fraud and Abuse Detection
… coordinate the care for enrolled Medicaid beneficiaries. In exchange, MCOs receive a monthly premium payment for each enrollee. In 2014, New York State’s Medicaid claim costs totaled more … to 4.7 million members of the over 6 million enrolled in Medicaid. At the time of the audit, there were 53 MCOs …
https://www.osc.ny.gov/state-agencies/audits/2016/07/15/medicaid-program-medicaid-managed-care-organization-fraud-and-abuse-detectionMedicaid Program – Administrative Costs Used in Premium Rate Setting of Mainstream Managed Care Organizations
… (MMCORs). The Department issues MMCOR instructions to guide MCOs on how to report administrative expenses. Of the …
https://www.osc.ny.gov/state-agencies/audits/2017/09/13/medicaid-program-administrative-costs-used-premium-rate-setting-mainstream-managed-careCrossroads Center for Children – Compliance With the Reimbursable Cost Manual
… determine whether the costs reported by Crossroads Center for Children, (Crossroads) on its Consolidated Fiscal Report … special education services through rates set by SED. These reimbursement rates are based on financial information, … reports to SED on its annual CFR. To be eligible for reimbursement, reported costs must comply with the guidelines …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/crossroads-center-children-compliance-reimbursable-cost-manualMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… whether Medicaid inappropriately paid for recipients’ Medicare Part C cost-sharing liabilities. The audit covered … Background Many Medicaid recipients are also enrolled in Medicare. Such recipients are commonly referred to as …
https://www.osc.ny.gov/state-agencies/audits/2018/09/10/medicaid-program-medicaid-payments-medicare-advantage-plan-providersNew York’s Economy and Finances in the COVID-19 Era (June 24, 2021)
… services. Recent research by the Tufts University Center for Health Systems and Policy found that: “Evidence of …
https://www.osc.ny.gov/reports/new-yorks-economy-and-finances-covid-19-era-june-24-2021Improper 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 … to as dual-eligibles), Medicare is the primary payer for Medicare-covered hospice services, while Medicaid is the … to delivering services, hospice providers are responsible for developing a comprehensive plan of care and coordinating …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-followAstor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Astor Services for Children & Families (Astor) on its Consolidated Fiscal … fiscal year ended June 30, 2013. Background Astor, a not-for-profit organization located in Rhinebeck, New York, … the ages of three and five years. Astor is reimbursed for preschool special education services through rates set by …
https://www.osc.ny.gov/state-agencies/audits/2015/09/02/astor-services-children-families-compliance-reimbursable-cost-manualChildren’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 …
https://www.osc.ny.gov/state-agencies/audits/2019/07/15/childrens-unit-treatment-and-evaluation-compliance-reimbursable-cost-manualUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… (United) paid claims using reasonable and customary (R&C) reimbursement rate schedules that did not correlate with the … receive services from out-of-network providers. United’s reimbursement for certain out-of-network claims is 80 percent … uses only the two most recent R&C rate periods (i.e., reimbursement rates from the prior 12 months) to process all …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsAssociation for the Advancement of the Blind and Retarded – Options for People Through Services Program
… Purpose To determine whether payments made by the Office for People With Developmental Disabilities (OPWDD) to the Association for the Advancement of Blind and Retarded …
https://www.osc.ny.gov/state-agencies/audits/2013/07/26/association-advancement-blind-and-retarded-options-people-through-services-programWest Seneca Fire District #2 – Purchasing and Capital Project Management (2018M-241)
… to our audit. District officials did not competitively bid a public works contract totaling more than $115,000. …
https://www.osc.ny.gov/local-government/audits/fire-district/2019/08/30/west-seneca-fire-district-2-purchasing-and-capital-project-management-2018m