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

… through December 31, 2016. Background The New York State Health Insurance Program (NYSHIP), administered by the State … Department of Civil Service (Civil Service), provides health insurance coverage to active and retired State, … testing, outpatient surgery, physical therapy, and home care services. United processes and pays claims from …

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 our initial audit … Educators for Children, Youth and Families, Inc. - Use of Contract Funds (Report 2007-S-128). Background Our initial …

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

… The Department administers the State’s Medicaid program. For the State fiscal year ended March 31, 2017, New York’s … pays managed care organizations (MCOs) a monthly premium for each enrolled Medicaid recipient, and the MCOs arrange for the provision of services their members require. As of …

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

… Code 59 (Report 2013-S-82 ). Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, …

Changes in Federal Policies Pose Significant Risks for New York City's Budget

… Projected budget gaps for New York City in the coming years appear manageable, but tax … growth has come primarily in the business services, health care, and leisure and hospitality sectors, which have …

Medicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber

… the Department paid Joia more than $7.7 million for 50,060 claims on behalf of 706 recipients. The Doctor was listed as the prescriber on 31,351 (63 percent) of the 50,060 claims. Key Findings Based on a statistical projection of our … Department overpaid Joia $1,485,121 for improper pharmacy claims. Disallowances included: Claims billed for excess …

Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)

… Purpose To determine the extent of implementation of the three recommendations included in … work with the Nassau County District Attorney and the New York State Department of Financial Services. On December 10, …

Medicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care

… manner, in some cases taking more than six months to enter new enrollee eligibility data. Key Recommendations Review the …

DiNapoli Statement on Greenville Arrest for Alleged Theft of Taxpayer Funded Resources

… P. DiNapoli released the following statement regarding the arrest of Terry Williams for alleged theft of fuel from the … P DiNapoli released the following statement regarding the arrest of Terry Williams for alleged theft of fuel from the …

DiNapoli Announces Interim CIO for the New York State Common Retirement Fund

… New York State Comptroller Thomas P. DiNapoli today announced … is the third largest public pension fund in the United States, with an audited value of $207.4 billion as of March …

Special Plan for Suffolk County Park Police Officers (Sections 89-r and 603(n))

… and Local Retirement System (Return to Top) … Information for members about Special Plan for Suffolk County Park Police Officers Sections 89r and 603n …

Medicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease

… diagnosed with end stage renal disease who were eligible for, but not enrolled in, Medicare. The audit covered the … requires dialysis or a kidney transplant to stay alive. For the six-year period ended December 31, 2015, Medicaid paid $909 million for medical services (including inpatient, clinic, …

Oversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency

… of Health (DOH) are adequately ensuring that hotels and motels used for homeless and mixed-use temporary residency … report, of the more than 86,000 homeless people in New York State, almost 13,000 (15 percent) are located in areas outside of New York City (NYC). Counties throughout the State utilize hotels …

Lifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual

… program, and sufficiently documented pursuant to the State Education Department’s (SED) Reimbursable Cost Manual …

Brookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual

… determine whether the costs reported by Brookville Center for Children’s Services, Inc. (Brookville) on its … The audit included expenses claimed on Brookville’s CFR for the fiscal year ended June 30, 2014, and certain expenses claimed on its CFRs for the two fiscal years ended June 30, 2013. Background …

DiNapoli: Contractor Sentenced in Federal Court for Defrauding State of Over $360,000

… Comptroller Thomas P. DiNapoli and U.S. Attorney for the Southern District Preet Bharara, was sentenced today to a … Junkovic defrauded the state by billing for thousands of hours that he did not work while he took overseas vacations … went as far as billing the state for working over 24 hours a day on a few occasions. This is the latest example of …

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

… and Local Retirement System  (Return to Top) … Information for members about special 25 year retirement plan providing an alternative retirement benefit for institutional safety officers and safety and secur …