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Children's Development Group, PLLC – Compliance With the Reimbursable Cost Manual
… the Program CDG is an SED-approved, for-profit provider of preschool special education services to children with disabilities who are between three and five years of age. CDG is reimbursed for these services through rates … to CDG’s tuition reimbursement rates. Remind CDG officials of the pertinent SED guidelines that relate to the …
https://www.osc.ny.gov/state-agencies/audits/2019/12/11/childrens-development-group-pllc-compliance-reimbursable-cost-manualEmpire BlueCross – Improper Payments for Intraocular Lens Claims Billed by Hospitals
… Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital … schedules. Intraocular lenses are used in the treatment of cataracts – the clouding of the lens in the eye – which cause vision problems. A …
https://www.osc.ny.gov/state-agencies/audits/2019/12/20/empire-bluecross-improper-payments-intraocular-lens-claims-billed-hospitalsMinds in Motion, Inc. – Compliance With the Reimbursable Cost Manual
… Objective To determine whether the costs reported by Minds in Motion, Inc. (MIM) on its Consolidated Fiscal Reports … for-profit special education provider located in Newburgh. MIM provides preschool special education … the fiscal year ended June 30, 2015, MIM reported $571,094 in reimbursable costs for the one rate-based preschool …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/minds-motion-inc-compliance-reimbursable-cost-manualUnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services (Follow-Up)
… York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), covers …
https://www.osc.ny.gov/state-agencies/audits/2020/01/03/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesOversight of Nurse Hiring and Retention (Follow-Up)
… and Hospitals) is a public benefit corporation created by the New York City Health and Hospitals Corporation Act of …
https://www.osc.ny.gov/state-agencies/audits/2020/01/03/oversight-nurse-hiring-and-retention-followCompliance With Executive Order 88 – Energy Efficiency in State Buildings
… effectively meet its contributions toward Executive Order 88 (EO 88) and complied with EO 88 Guidelines. The audit covered the period from April 1, …
https://www.osc.ny.gov/state-agencies/audits/2020/01/30/compliance-executive-order-88-energy-efficiency-state-buildingsBehavior Analysts of New York, LLC – Compliance With the Reimbursable Cost Manual
… calculated, and adequately documented in accordance with applicable State Education Department (SED) … of preschool special education services to children with disabilities who are between three and five years of … in reimbursable costs for its Special Education Itinerant Teacher Program (Program), and provided these services to 18 …
https://www.osc.ny.gov/state-agencies/audits/2020/01/31/behavior-analysts-new-york-llc-compliance-reimbursable-cost-manualMedicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… in our initial audit report, Medicaid Overpayments for Medicare Advantage Plan Services (Report 2017-S-46 ). … is generally the secondary payer and reimburses providers for financial balances not covered by the Plan (typically … Department overpaid health care providers’ Medicaid claims for services also covered by Plans. The audit covered the …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followMedicaid Program – Improper Medicaid Payments for Terminated Drugs
… whether the Medicaid program made improper payments for drugs dispensed after their drug termination date. The … and is overseen at the federal level by the Centers for Medicare & Medicaid Services (CMS). The Medicaid program … Drugs may be removed from the market (i.e., terminated) for safety or commercial reasons. To ensure terminated drugs …
https://www.osc.ny.gov/state-agencies/audits/2020/09/17/medicaid-program-improper-medicaid-payments-terminated-drugsNational Directory of New Hires Data Security
… Objective To determine if the Office of Temporary and Disability Assistance has met federal requirements for securing National Directory of New Hires data. Our audit covered the … To determine if the Office of Temporary and Disability Assistance has met federal …
https://www.osc.ny.gov/state-agencies/audits/2024/05/08/national-directory-new-hires-data-securityMedicaid Program – Improper Payments for Brand Name Drugs
… To determine whether Medicaid made improper payments for brand name drugs. The audit covered the period from July … Findings We identified $1,102,823 in Medicaid overpayments for brand name prescription drugs where generic drugs were … Our review found: Overpayments of $739,446 on 16,261 fee-for-service (FFS) pharmacy claims for the period July 2016 …
https://www.osc.ny.gov/state-agencies/audits/2022/12/13/medicaid-program-improper-payments-brand-name-drugsImproper Medicaid Payments for Misclassified Patient Discharges (Follow-Up)
… in our initial audit report, Improper Medicaid Payments for Misclassified Patient Discharges (Report 2020-S-8 ). … Related Groups (DRG) methodology to reimburse hospitals for inpatient medical care. The DRG methodology classifies … and severity of illness, which provides the basis for calculating the reimbursement. When a hospital bills …
https://www.osc.ny.gov/state-agencies/audits/2023/01/18/improper-medicaid-payments-misclassified-patient-discharges-followNew York State Health Insurance Program – Payments by CVS Health for Pharmacy Services for Ineligible Members (Follow-Up)
… included in our initial audit report, Payments by CVS Health for Pharmacy Services for Ineligible Members … and their dependents. Civil Service contracts with CVS Health (CVS) to administer the Empire Plan’s pharmacy benefits. Civil … included in our initial audit report Payments by CVS Health for Pharmacy Services for Ineligible Members …
https://www.osc.ny.gov/state-agencies/audits/2023/01/04/new-york-state-health-insurance-program-payments-cvs-health-pharmacy-services-ineligibleCantalician Center for Learning – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Cantalician Center for Learning (Cantalician) on its Consolidated Fiscal Reports … Department’s (SED) guidelines, including the Reimbursable Cost Manual (RCM) and the Consolidated Fiscal Reporting and … To determine whether the costs reported by Cantalician Center for Learning on its Consolidated Fiscal Reports CFRs …
https://www.osc.ny.gov/state-agencies/audits/2023/01/26/cantalician-center-learning-compliance-reimbursable-cost-manualOffice of Temporary and Disability Assistance - SSP Payments Made to Deceased Individuals
… Purpose The objective of our examination was to determine the appropriateness of New York State Supplemental Program (SSP) Payments the Office of Temporary and Disability Assistance (OTDA) made to … The objective of our examination was to determine the appropriateness of …
https://www.osc.ny.gov/state-agencies/audits/2018/01/09/office-temporary-and-disability-assistance-ssp-payments-made-deceased-individualsCompliance With Requirements to Maintain Systems at Vendor-Supported Levels
… was complying with requirements to maintain its systems at vendor-supported levels. The audit covered the period … includes requirements for ensuring systems are maintained at vendor-supported levels (i.e., systems continue to be … determined that, generally, RGRTA maintained its systems at vendor-supported levels. However, we did identify …
https://www.osc.ny.gov/state-agencies/audits/2019/07/29/compliance-requirements-maintain-systems-vendor-supported-levelsSpringbrook NY, Inc. – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Springbrook NY, Inc. (Springbrook) on its Consolidated Fiscal Report … To determine whether the costs reported by Springbrook NY Inc on its Consolidated Fiscal Report were properly …
https://www.osc.ny.gov/state-agencies/audits/2019/09/06/springbrook-ny-inc-compliance-reimbursable-cost-manualProtection of Child Performers (Follow-Up)
… the Child Performers Unit (Unit) is responsible for monitoring compliance with Part 186 of the New York … system (System) and comprehensive permit requirements for child performers and certification of employers. System … created a sound and effective system of internal controls for the Unit, and did not have the necessary controls to …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/protection-child-performers-followCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… Purpose To determine if CVS Health invoiced and remitted commercial rebate revenue related to Empire Plan drug utilization in accordance with its contract with the Department of Civil … To determine if CVS Health invoiced and remitted commercial …
https://www.osc.ny.gov/state-agencies/audits/2019/01/28/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceSelected Safety and Security Equipment at Subway Stations (Follow-Up)
… Objective To determine the extent of implementation of the six recommendations included in our initial report, … To determine the extent of implementation of the six recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2019/09/18/selected-safety-and-security-equipment-subway-stations-follow