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League for the Handicapped – Compliance With the Reimbursable Cost Manual
… Audits/Reports of Interest State Education Department: Summit Educational Resources - Compliance With the …
https://www.osc.ny.gov/state-agencies/audits/2016/06/03/league-handicapped-compliance-reimbursable-cost-manualEmpire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011
… which includes coverage for inpatient and outpatient hospital services. Empire processes Plan claims for hospital services in accordance with agreements they negotiate with member hospitals. Payments for hospital services are generally based on standard fee …
https://www.osc.ny.gov/state-agencies/audits/2013/05/09/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2011-throughState Comptroller DiNapoli Releases Audits
… Selected Aspects of the All-Agency Contractor Evaluation (ACE) System at Long Island Rail Road, Metro-North Railroad, … and Tunnel Authority (2019-S-52) MTA implemented the ACE performance evaluation system as a means for component … performance and share the results with each other. ACE ratings must be reviewed when determining whether to …
https://www.osc.ny.gov/press/releases/2022/12/state-comptroller-dinapoli-releases-auditsMedicaid Program – Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare
… About the Program Hospice is a coordinated program of home and/or inpatient care that treats terminally ill … Hospice programs provide palliative care, including nursing, physician, and counseling services; home health … Care (MLTC) plans, which serve people who require nursing home or long-term home health care. When a Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2020/12/28/medicaid-program-improper-medicaid-payments-individuals-receiving-hospice-services-coveredMedicaid Program – Claims Processing Activity April 1, 2023 Through September 30, 2023
… been paid by managed care; $985,786 was paid for newborn birth and maternity claims that contained inaccurate information, such as the newborn’s birth weight; $582,101 was paid for inpatient, clinic, …
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
… of motor vehicles registered in New York possess adequate insurance coverage, or are financially secure, to compensate … on insurance carriers in proportion to their reported premiums. Certain fees paid by self-insurers and for bonded … of not adjusting its billing to account for amended premiums reported by insurers. It also lacks a method for …
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
… Thomas P. DiNapoli announced that former Family Service Society (FSS) Chief Operating Officer Jennifer … Comptroller Thomas P DiNapoli announced that former Family Service Society FSS Chief Operating Officer Jennifer Thurber …
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)
… of motor vehicles registered in New York possess adequate insurance coverage, or are financially secure, to compensate … on insurance carriers in proportion to their reported premiums. The objective of our initial audit, issued December … of not adjusting its billing to account for amended premiums reported by insurance carriers. The Department also …
https://www.osc.ny.gov/state-agencies/audits/2021/05/27/allocation-billing-and-collection-expenses-administering-motor-vehicle-financial-securityLong Island Association for AIDS Care
… is self-insured for medical and dental insurance. The CEO of LIAAC also served as the CEO of LINCS. Each month, LINCS paid its third party …
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
… MCOs that offered 81 different plans; United HealthCare (UHC) and Amerigroup were among the largest plans. In 1998, … of fraud and abuse. Key Findings During our audit period, UHC and Amerigroup made improper and questionable payments … to excluded providers. Recoveries of improper payments by UHC’s and Amerigroup’s SIUs were very limited. For example, …
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
… whether mainstream managed care organizations (MCOs) are submitting accurate administrative costs to the … provides a wide range of medical services to those who are economically disadvantaged and/or have special health … sets the monthly managed care premium rates, which are based, in part, on allowable MCO administrative costs. …
https://www.osc.ny.gov/state-agencies/audits/2017/09/13/medicaid-program-administrative-costs-used-premium-rate-setting-mainstream-managed-careMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… to enrollees. For dual-eligibles, Medicaid reimburses the plan providers for the enrollee’s Part C cost-sharing … Key Findings We reviewed selected Medicare Advantage plan contracts offered by Fidelis and WellCare and, based on … claims for Medicare Part C cost-sharing liabilities. Other Related Audits/Reports of Interest Department of Health: …
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)
… Medicaid and Child Health Plus Beneficiaries in New York The COVID-19 pandemic prompted many changes in the ways New … across the country. The pandemic also spurred a change in how people sought and received medical care; rather than … The COVID19 pandemic prompted many changes in the ways New …
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
… determine whether the costs reported by Crossroads Center for Children, (Crossroads) on its Consolidated Fiscal Report … 30, 2014. Background Crossroads is an SED-approved, not-for-profit organization located in Schenectady, New York. … the ages of three and five years. Crossroads is reimbursed for preschool special education services through rates set by …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/crossroads-center-children-compliance-reimbursable-cost-manualImproper 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 … Hospice programs provide palliative care, including nursing, physician, and counseling services; home health … Care (MLTC) plans, which serve people who require nursing home or long-term home health care. When a Medicaid …
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
… CFR, of which $3.3 million was for the Preschool Special Class and the Preschool Integrated Special Class (Programs) we audited. Key Findings We identified …
https://www.osc.ny.gov/state-agencies/audits/2015/09/02/astor-services-children-families-compliance-reimbursable-cost-manualUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… 31, 2018. About the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance coverage to over 1.2 million active and retired … that occurred before those rates took effect. From a sample of 100 claims, we calculated a potential cost savings …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsChildren’s Unit for Treatment and Evaluation – Compliance With the Reimbursable Cost Manual
… million in reimbursable costs for the Preschool Special Class that it provided. Key Findings For the three fiscal … $232,464 in parent agency administrative costs and $142 in consultant travel expenses. Key Recommendations To SED: …
https://www.osc.ny.gov/state-agencies/audits/2019/07/15/childrens-unit-treatment-and-evaluation-compliance-reimbursable-cost-manualAssociation for the Advancement of the Blind and Retarded – Options for People Through Services Program
… 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)
… charged the District more than $14,000 for administrative fees and sales tax. Key Recommendations Solicit bids or … obligations and based on original invoices. Consult legal counsel and, if appropriate, seek reimbursement for the …
https://www.osc.ny.gov/local-government/audits/fire-district/2019/08/30/west-seneca-fire-district-2-purchasing-and-capital-project-management-2018m