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Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Follow-Up)
… what extent nursing home claims exceeded the bed reserve day limits. During the five year audit period ended March … for bed reserve claims that exceeded the bed reserve day limit. However, because reimbursement rates were the …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/monitoring-medicaid-payments-nursing-home-bed-reserve-days-followExcessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Follow-Up)
… Purpose To determine the extent of implementation of the three … audit report, Excessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Report 2009-S-64). … the Department was correctly paying claims for services to Medicaid recipients who also have health insurance through …
https://www.osc.ny.gov/state-agencies/audits/2013/04/26/excessive-medicaid-payments-services-recipients-receiving-medicare-benefits-followUnited HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… Members pay a nominal co-payment to the participating provider for the services rendered. Members may also choose … requirements, when United processes a non-participating provider’s claims, it is with the understanding that Empire … cost-sharing obligations. However, if a non-participating provider does not collect (i.e., waives) the member’s …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgeryAstor 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-manualImproper Payments for Controlled Substances That Exceed Allowed Dispensing Limits (Follow-Up)
… State’s Medicaid program provides a wide range of health care services, including prescription drugs, to individuals … are economically disadvantaged and/or have special health care needs. The New York State Controlled Substances Act … allowed by the Act. We further identified 3,323 managed care claims for controlled substances in which the quantities …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-payments-controlled-substances-exceed-allowed-dispensing-limits-followImproper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Follow-Up)
… Purpose To determine the extent of implementation of the three … We also recommended the Department take corrective action to help ensure managed care enrollment information is entered and update timely and to determine why certain fee-for-service claims were …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-fee-service-payments-pharmacy-services-covered-managed-care-followStarting Point Services for Children – Compliance With the Reimbursable Cost Manual
… Education Itinerant Teacher (SEIT) and Special Class Integrated Setting (SCIS) programs to disabled children … These ineligible costs included $2,228,711 in personal service costs and $356,743 in other than personal service costs. Among the disallowances we identified were: …
https://www.osc.ny.gov/state-agencies/audits/2015/12/11/starting-point-services-children-compliance-reimbursable-cost-manualUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59
… Interest New York State Health Insurance Program: United HealthCare - Certain Claim Payments for Evaluation and …
https://www.osc.ny.gov/state-agencies/audits/2015/01/08/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59Milestone School for Child Development – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by the Milestone School for Child Development (Milestone) on its … documented, program related, and allowable pursuant to the State Education Department’s (SED) Reimbursable Cost … Determine whether the costs reported by Milestone School for Child Development …
https://www.osc.ny.gov/state-agencies/audits/2015/07/17/milestone-school-child-development-compliance-reimbursable-cost-manualAdministration of the Contract With the Center for Urban Community Services
… Purpose We audited the New York City Department of Health and Mental Hygiene’s … increased to $28.7 million for expanded program services. The New York State Office of Mental Health funds about 75 … We audited the New York City Department of Health and Mental Hygienes …
https://www.osc.ny.gov/state-agencies/audits/2016/02/16/administration-contract-center-urban-community-servicesMedicaid Overpayments for Inpatient Transfer Claims Among Merged or Consolidated Facilities
… two separate payments are made: a payment for the first hospital’s claim and a payment for the second hospital’s claim. However, according to the Department’s … when a recipient is transferred from the first hospital to a merged or consolidated division or hospital, …
https://www.osc.ny.gov/state-agencies/audits/2015/12/08/medicaid-overpayments-inpatient-transfer-claims-among-merged-or-consolidated-facilitiesAll Services for Kids, Inc. – Compliance With the Reimbursable Cost Manual
… service expenses, including inappropriately allocated rental expenses, cell phones used by the Executive Director's minor children, unaccounted-for equipment items, and cable television. Key Recommendation SED …
https://www.osc.ny.gov/state-agencies/audits/2014/02/25/all-services-kids-inc-compliance-reimbursable-cost-manualMedicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients
… if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in … should not pay premiums for Buy-in Program coverage on behalf of individuals who do not have a benefit … made $31.7 million in improper Medicare premium payments on behalf of 42,586 individuals who did not have a benefit …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipientsOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… Objective To assess the extent of implementation of the three … Medicaid program provides a wide range of medical services to those who are economically disadvantaged and/or have … also enrolled in Medicare. Such individuals are referred to as “dual-eligibles.” The Medicare program covers physical, …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followEmpire BlueCross – Improper Payments for Intraocular Lens Claims Billed by Hospitals
… To determine whether Empire BlueCross properly paid hospital claims for intraocular procedures. The audit covered … million members. Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital services according to contracts it negotiates with …
https://www.osc.ny.gov/state-agencies/audits/2019/12/20/empire-bluecross-improper-payments-intraocular-lens-claims-billed-hospitalsManaged Care Premium Payments for Recipients With Comprehensive Third-Party Insurance (Follow-Up)
… Payments for Recipients With Comprehensive Third-Party Insurance (Report 2016-S-60 ). About the Program … care when they also have comprehensive TPHI. Recipients should, instead, be enrolled in Medicaid fee-for-service to avoid the expense of monthly managed care premiums (for instance, under fee-for-service, after the …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/managed-care-premium-payments-recipients-comprehensive-third-party-insurance-followOpioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Follow-Up)
… Objective To determine the extent of implementation of the three … an opioid use disorder. The State maintains a database to monitor controlled substance prescription drug use, known … of controlled substance prescriptions. I-STOP is a tool to assist prescribers in determining the most appropriate …
https://www.osc.ny.gov/state-agencies/audits/2020/05/07/opioid-prescriptions-medicaid-recipients-opioid-treatment-program-followMedicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY (Follow-Up)
… Objective To determine the extent of implementation of the five … Overpayments for Medicare Part B Services Billed Directly to eMedNY (Report 2017-S-36 ). About the Program The … To determine the extent of implementation of the five …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-part-b-services-billed-directly-emedny-followMedicaid Program – Improper Payments for Drugs Without a Federal Drug Rebate Agreement
… Objective To determine whether Medicaid inappropriately paid for drugs … program. The Medicaid Drug Rebate Program (MDRP) helps to offset the costs of most covered outpatient drugs dispensed to Medicaid patients. The MDRP requires drug manufacturers to … To determine whether Medicaid inappropriately paid for drugs …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreementCompliance With Special Education Regulations for the Provision of Services (Follow-Up)
… Objective To determine the extent of implementation of the five … providing special education and related services designed to meet students’ unique needs and to prepare them for further education, employment, and … To determine the extent of implementation of the five …
https://www.osc.ny.gov/state-agencies/audits/2023/03/15/compliance-special-education-regulations-provision-services-follow