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Optimizing Medicaid Drug Rebates (Follow-Up)
… made in our initial audit report, Optimizing Medicaid Drug Rebates (Report 2015-S-1 ). Background The State’s … able to recover a portion of the Medicaid prescription drug costs by requesting rebates from drug manufacturers. We issued our initial audit report on …
https://www.osc.ny.gov/state-agencies/audits/2017/12/20/optimizing-medicaid-drug-rebates-followMedicaid Program – Medicaid Claims Processing Activity April 1, 2017 Through September 30, 2017
… were submitted by approved providers, were processed in accordance with Medicaid requirements, and resulted in correct payments to the providers. The audit covered the … 2017, eMedNY processed over 193 million claims, resulting in payments to providers of more than $31 billion. The claims …
https://www.osc.ny.gov/state-agencies/audits/2018/08/03/medicaid-program-medicaid-claims-processing-activity-april-1-2017-through-september-30-2017Medicaid Program – Maximizing Drug Rebates for Health and Recovery Plans
… drugs, to Medicaid recipients age 21 or older with serious mental illness and/or substance use disorders. Beginning on October …
https://www.osc.ny.gov/state-agencies/audits/2018/06/22/medicaid-program-maximizing-drug-rebates-health-and-recovery-plansUnited HealthCare – Empire Plan Drug Rebate Revenue (Follow-Up)
… of the recommendation made in our audit report, United HealthCare: Empire Plan Drug Rebate Revenue (2016-S-7). … of Civil Service (Department) contracted with United HealthCare (United) to administer the Empire Plan’s … Interest New York State Health Insurance Program: United HealthCare - Empire Plan Drug Rebate Revenue ( 2016-S-7 ) …
https://www.osc.ny.gov/state-agencies/audits/2017/05/15/united-healthcare-empire-plan-drug-rebate-revenue-followMedicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… Medicaid mainstream managed care plans and Family Health Plus managed care plans (Plans) for recipients who were no … managed care, during the audit period, Family Health Plus (FHP) was a publicly funded managed care program for … Medicaid mainstream managed care plans and Family Health Plus …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamThe 80/20 Housing Program
… Purpose To determine whether housing developers participating in the Housing Finance Agency’s … provides low-interest financing to multifamily rental developers who commit to designating at least 20 percent of a … provide real estate tax abatements, as incentives to developers. In New York City, participating Program …
https://www.osc.ny.gov/state-agencies/audits/2017/05/31/8020-housing-programWhitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… the ages of three and five years. Whitestone, located in Queens, New York, provides preschool services throughout … 30, 2013, Whitestone reported approximately $2.3 million in reimbursable costs for the programs. Key Findings For the … fiscal years ended June 30, 2013, we identified $154,563 in reported costs that did not comply with Manual …
https://www.osc.ny.gov/state-agencies/audits/2015/04/07/whitestone-school-child-development-compliance-reimbursable-cost-manualNursing Home Surveillance
… State regulations and procedures for conducting nursing home surveys and whether survey processes, including the … Complaint surveys investigate issues, and nursing home-reported incidents, that may involve non-compliance with … for severity and urgency to assess whether a nursing home has violated a federal or State regulation. If any …
https://www.osc.ny.gov/state-agencies/audits/2016/02/19/nursing-home-surveillancePractices Used by the Transit Adjudication Bureau to Collect and Account for Fines and Fees
… and efficient manner. Specifically, we determined whether: fines and fees were collected timely; appropriate actions were taken to collect fines and fees that were overdue; and fines and fees …
https://www.osc.ny.gov/state-agencies/audits/2016/08/11/practices-used-transit-adjudication-bureau-collect-and-account-fines-and-feesSelect Financial Management Practices
… To determine if the Albany Port District Commissions Commission capital planning process and …
https://www.osc.ny.gov/state-agencies/audits/2015/11/05/select-financial-management-practicesMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
… Purpose To determine the readiness of all Medicaid managed care organizations (MCOs) to submit Medicaid encounter … quality assurance, various research and analytics, managed care rate setting, and drug rebate collections. On September … have fewer enrollees than mainstream Medicaid managed care plans. According to DOH officials, the specialized plans …
https://www.osc.ny.gov/state-agencies/audits/2016/03/29/medicaid-program-managed-care-organizations-readiness-encounter-intake-systemDriver Responsibility Assessment Program
… all Driver Responsibility Assessment Program fees due from violators and that it suspended the licenses, or the … the repeated behavior of problem drivers and to improve traffic safety, in November 2004, the State Legislature … a fee of $100 per year for the first six points and $25 for each additional point, for a three-year period, on …
https://www.osc.ny.gov/state-agencies/audits/2014/10/09/driver-responsibility-assessment-programFinancial Management Practices
… Purpose To determine if the Hudson River-Black River Regulating District’s (District) financial management … Background The District regulates the flow of the Hudson River and the Black River to reduce flooding caused by excess … To determine if the Hudson RiverBlack River Regulating Districts District financial management …
https://www.osc.ny.gov/state-agencies/audits/2014/11/25/financial-management-practicesMedicaid Program – Medicaid Claims Processing Activity October 1, 2014 Through March 31, 2015
… with improper payments for duplicate billings and for clinic and durable medical equipment services. By the end of …
https://www.osc.ny.gov/state-agencies/audits/2015/12/08/medicaid-program-medicaid-claims-processing-activity-october-1-2014-through-march-31-2015Tuition Assistance Program – Metropolitan Learning Institute
… students for State-funded Tuition Assistance program (TAP) awards and other State financial aid. Background TAP is an entitlement program designed to provide funds for … academic years ended June 30, 2012, the school certified 4,605 TAP awards totaling almost $8.7 million that were paid …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/tuition-assistance-program-metropolitan-learning-instituteFuel Purchases
… Authority (Authority) is purchasing the correct type of fuel, paying the proper amount for the fuel purchased, receiving the correct amount of fuel, and keeping accurate records of the supply and … Authority Authority is purchasing the correct type of fuel paying the proper a …
https://www.osc.ny.gov/state-agencies/audits/2015/02/27/fuel-purchasesMedicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… effectively implemented and applied the new APR DRG-based hospital inpatient payment system for Medicaid services when … implemented to provide a more equitable payment method for hospital inpatient services and to better reflect the … For instance, Medicaid paid $153,329 on a claim with hospital charges totaling $9,685 for a patient who died …
https://www.osc.ny.gov/state-agencies/audits/2013/08/15/medicaid-program-payments-death-related-one-day-inpatient-admissionsDual Employment
… 1, 2012, DOCCS had 29,796 employees. To ensure adequate staffing at its facilities, DOCCS sometimes allows employees …
https://www.osc.ny.gov/state-agencies/audits/2013/12/19/dual-employment-2Medicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… for review. Medicaid reimbursement rates for inpatient hospital claims include the costs of most medical care provided during a hospital admission. As such, claims for ancillary services provided during a hospital admission are generally not reimbursable. In 2007, …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Mainstream Managed Care Organizations: Administrative Costs Used in Premium Rate Setting
… costs in determining mainstream managed care premium rates. Our audit covered the period January 1, 2011 … monthly managed care premium rates, which are based, in part, on allowable MCO administrative costs. For this … The Department is required by the federal Centers for Medicare & Medicaid Services to create actuarially sound …
https://www.osc.ny.gov/state-agencies/audits/2016/10/13/medicaid-program-mainstream-managed-care-organizations-administrative-costs-used-premium