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Medicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… Purpose To determine whether Medicaid inappropriately paid for recipients’ Medicare Part C … January 1, 2012 through December 31, 2016. Background Many Medicaid recipients are also enrolled in Medicare. Such … for services provided to enrollees. For dual-eligibles, Medicaid reimburses the plan providers for the enrollee’s …
https://www.osc.ny.gov/state-agencies/audits/2018/09/10/medicaid-program-medicaid-payments-medicare-advantage-plan-providersMedicaid Program – Claims Processing Activity April 1, 2023 Through September 30, 2023
… were submitted by approved providers, were processed in accordance with Medicaid requirements, and resulted in correct payments to providers. The audit covered the … 2023, eMedNY processed over 420 million claims, resulting in payments to providers of more than $47.1 billion. The …
https://www.osc.ny.gov/state-agencies/audits/2024/04/24/medicaid-program-claims-processing-activity-april-1-2023-through-september-30-2023Long Island Association for AIDS Care
… the reimbursement for employee health insurance (i.e., medical and dental expenses). As a result, we continued our examination of medical and dental expenses claimed for reimbursement by … LIAAC’s claims for payment totaling $120,293 for employee medical and dental expenses for the period February 2014 …
https://www.osc.ny.gov/state-agencies/audits/2017/11/10/long-island-association-aids-careAllocation, Billing, and Collection of Expenses of Administering the Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act
… persons they might injure or whose property they might damage as a result of an accident. Department activities …
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
… her employment anniversary date, allowing her to receive 29 hours of additional personal and floating holiday hours. … by FSS for more than 20 years, was terminated on December 27, 2018 once her actions were brought to light. She pleaded …
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)
… administers the Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act (collectively, “Acts”) pursuant to Articles VI and VII of the Vehicle and Traffic Law. These Acts help ensure that the operators of … included in our initial audit report Allocation Billing and Collection of Expenses of Administering the Motor Vehicle …
https://www.osc.ny.gov/state-agencies/audits/2021/05/27/allocation-billing-and-collection-expenses-administering-motor-vehicle-financial-securityNew York’s Economy and Finances in the COVID-19 Era (June 24, 2021)
… Growth of telehealth utilization in New York followed the national trend: CMS reported a 2,745 percent increase in … changes that included enhanced flexibility under Health Insurance Portability and Accountability Act (HIPAA) privacy … patient benefits and provider productivity, but does not find decreases in the cost of care. The extent to which …
https://www.osc.ny.gov/reports/new-yorks-economy-and-finances-covid-19-era-june-24-2021Crossroads Center for Children – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Crossroads Center for Children, (Crossroads) on its Consolidated Fiscal … To determine whether the costs reported by Crossroads Center for Children Crossroads on its Consolidated Fiscal …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/crossroads-center-children-compliance-reimbursable-cost-manualMedicaid Program - Medicaid Managed Care Organization Fraud and Abuse Detection
… to ineligible health care providers and whether these managed care organizations established and implemented … through December 31, 2014. Background Through its Medicaid managed care program, the Department contracts with managed care organizations (MCOs) to coordinate the care for …
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
… the administrative costs in determining MCO premium rates. Our audit covered the period January 1, 2011 through … expenses included, but were not limited to, legal fees, interest, marketing expenses, entertainment costs, and … current and future need. Other Related Audits/Reports of Interest Department of Health: Medicaid Managed Care …
https://www.osc.ny.gov/state-agencies/audits/2017/09/13/medicaid-program-administrative-costs-used-premium-rate-setting-mainstream-managed-careImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… Objective To assess the extent of implementation of the nine recommendations included in our initial audit … To assess the extent of implementation of the nine recommendations included in our …
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
… reported by Astor Services for Children & Families (Astor) on its Consolidated Fiscal Report (CFR) were properly … rates set by SED. These reimbursement rates are based on financial information, including costs, that Astor reports to SED on its annual CFR. To be eligible for reimbursement, reported …
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
… Objectives To determine whether UnitedHealthcare (United) paid claims using reasonable and customary (R&C) reimbursement rate schedules that did not correlate with the date of the … for certain out-of-network claims is 80 percent of the R&C rate for the service. R&C rates are updated every six months. …
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 … To determine whether payments made by the New York State Office For People With Developmental …
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)
… than $115,000. District officials did not obtain quotes for 16 of 21 purchases totaling approximately $56,000. The … may have improperly charged the District more than $14,000 for administrative fees and sales tax. Key Recommendations … legal counsel and, if appropriate, seek reimbursement for the improper charges. District officials generally agreed …
https://www.osc.ny.gov/local-government/audits/fire-district/2019/08/30/west-seneca-fire-district-2-purchasing-and-capital-project-management-2018mTown of Essex – Internal Controls Over Selected Financial Operations (2015M-60)
The purpose of our audit was to review the Towns internal controls over selected financial operations for the period January 1 2013 through October 31 2014
https://www.osc.ny.gov/local-government/audits/town/2015/08/07/town-essex-internal-controls-over-selected-financial-operations-2015m-60Retiree Annual Statement
… provides a year-end summary of your pension payments for the last calendar year, including the total amount you received and a breakdown of credits, … deductions and taxes. It also gives you an explanation of the pension payment option you chose at retirement. Mailed …
https://www.osc.ny.gov/retirement/retirees/retiree-annual-statementCenter for Disability Services – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by the Center for … York. CFDS provides preschool special education services to children with disabilities between the ages of three and … financial information, including costs, that CFDS reports to SED on its annual CFR. To be eligible for reimbursement, …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/center-disability-services-compliance-reimbursable-cost-manualCantalician Center for Learning – Compliance With the Reimbursable Cost Manual
… the Program Cantalician is an SED-approved, not-for-profit special education provider located in Depew, serving students … Erie, Genesee, and Niagara counties. Cantalician provides special education services to children with disabilities who are between the ages of 3 and 5 years. …
https://www.osc.ny.gov/state-agencies/audits/2023/01/26/cantalician-center-learning-compliance-reimbursable-cost-manual