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Medicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… with applicable Medicaid laws and regulations as well as the rules and policies set forth by the Department of … of Medicaid’s payments to Joia were for patients who lived approximately one hour away (one way); and 134 of the …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/medicaid-program-medicaid-payments-pharmacy-claims-joia-pharmacy-and-related-prescriberOversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency
… the facility deficiencies we identified through our site visits, OTDA officials detailed organizational, legal, …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-hotels-and-motels-used-homeless-and-mixed-use-temporary-residencyMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… and qualified for Medicare based on his parent’s work credits. Had the child been enrolled in Medicare, the … based on their or a qualifying family member’s work credits, we identified 4,381 ESRD Medicaid recipients who did … [spouse, parent] and obtaining recipients’ qualifying work credits [“quarters of coverage,” or QCs] from SSA); and …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseSt. Mary’s Hospital for Children, Inc. – Compliance With the Reimbursable Cost Manual
… services to children with disabilities between the ages of 3 and 4 years. For the purposes of this report, the program we reviewed is referred to as the … information reported on CFRs. St. Mary’s is a subsidiary of St. Mary’s Healthcare System for Children, Inc., a …
https://www.osc.ny.gov/state-agencies/audits/2022/11/09/st-marys-hospital-children-inc-compliance-reimbursable-cost-manualImproper Fee-for-Service Payments for Services Covered by Managed Long-Term Care Plans (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Improper Fee-for-Service … who are chronically ill or disabled and who wish to stay in their homes and communities. MLTC plans offer a range of … that plans must cover and pay for (benefit packages) in exchange for monthly premium payments for each member …
https://www.osc.ny.gov/state-agencies/audits/2021/08/31/improper-fee-service-payments-services-covered-managed-long-term-care-plans-followQuality Services for the Autism Community – Compliance With the Reimbursable Cost Manual
… program, and sufficiently documented pursuant to the State Education Department’s (SED) Reimbursable Cost Manual … year ended June 30, 2015, QSAC received $3.7 million in State funding for the cost-based SC and SEIT programs. The …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/quality-services-autism-community-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans
… made improper fee-for-service (FFS) payments for certain services covered by managed long-term care (MLTC) plans. The audit covered the period January 1, … enrolled in MLTC plans. MLTC plans provide long-term care services, such as home health care, nursing home care, and …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/medicaid-program-improper-fee-service-payments-services-covered-long-term-care-plansHebrew Academy for Special Children, Inc. – Compliance With the Reimbursable Cost Manual
… operated several other programs, including SED-approved school-age programs, an Early Intervention program … a camp, and a day care program. During the 2016-17 school year, Hebrew Academy served approximately 539 students …
https://www.osc.ny.gov/state-agencies/audits/2020/02/04/hebrew-academy-special-children-inc-compliance-reimbursable-cost-manualAdministration of the Contract With the Postgraduate Center for Mental Health (Follow-Up)
… With the Postgraduate Center for Mental Health ( 2015-S-88 ). About the Program Our initial report, issued December …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/administration-contract-postgraduate-center-mental-health-followImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… Hospice is a coordinated program of home and/or inpatient care that treats terminally ill individuals and their … Hospice programs provide palliative care, including nursing, physician, and counseling services; home health … providers are responsible for developing a comprehensive plan of care and coordinating care and services needed by …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-followMedicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance
… have other third-party health insurance (TPHI) for pharmacy services in addition to Medicaid (e.g., … is considered the payer of last resort and, as such, FFS pharmacy providers are required to coordinate benefits with … period, Gainwell’s third-party liability recoveries on FFS pharmacy payments totaled almost $53 million. Key Findings We …
https://www.osc.ny.gov/state-agencies/audits/2023/05/11/medicaid-program-improper-fee-service-pharmacy-payments-recipients-third-party-healthMedicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
… codes, and each service provided could trigger a separate payment. Outpatient services are generally less expensive …
https://www.osc.ny.gov/state-agencies/audits/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claimsChildren’s Unit for Treatment and Evaluation – Compliance With the Reimbursable Cost Manual
… calculated, adequately documented, and allowable under the State Education Department’s (SED) guidelines, including the …
https://www.osc.ny.gov/state-agencies/audits/2019/07/15/childrens-unit-treatment-and-evaluation-compliance-reimbursable-cost-manualMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… from June 1, 2012 through May 31, 2017. Background Many of the State’s Medicaid recipients are also eligible for … supplementary medical insurance coverage for a range of outpatient medical services, physician services, and … of the automated crossover system was to minimize the need for providers to self-report Medicare claim data to …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyMedicaid Program – Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program
… Purpose To determine if the Department of Health has taken sufficient steps to safeguard Medicaid … use disorder treatment information among different health care providers is expected to continue. Key Findings … Other Related Audits/Reports of Interest Department of Health: Medicaid Managed Care Premiums for Recipients With …
https://www.osc.ny.gov/state-agencies/audits/2018/11/20/medicaid-program-opioid-prescriptions-medicaid-recipients-opioid-treatment-programMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… Many of the State’s Medicaid recipients are also enrolled in Medicare. Such individuals are referred to as … Medicaid. Key Findings The audit identified $20.1 million in Medicaid payments for services provided to dual-eligible … by Medicaid. Key Recommendations Review the $20.1 million in Medicaid payments for therapy services and prescription …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareGlobal Investor Coalition Calls on Exxon to Prepare for a Lower Carbon Future
… is doing what is needed to prepare for a future with lower carbon emissions. The future success of the company, and its … we are committed to supporting the transition to a low carbon economy. We need more transparency and reporting from … to the risks and opportunities presented by the low carbon transition.” “These resolutions are especially …
https://www.osc.ny.gov/press/releases/2016/01/global-investor-coalition-calls-exxon-prepare-lower-carbon-futureDiNapoli Warns Changing Fiscal Landscape Could Increase Budget Challenges for Local Governments
… with state aid that has not kept pace with inflation and slower growth in local revenue may push some local … The report provides an overview of these revenue sources and how they have affected local budgets in recent years. “With pandemic aid coming to an end and uncertainty coming out of Washington, local governments …
https://www.osc.ny.gov/press/releases/2025/02/dinapoli-warns-changing-fiscal-landscape-could-increase-budget-challenges-local-governmentsDiNapoli: Improved Guidance Needed for State Agencies Using AI To Avoid Risks
… New York state’s centralized guidance and oversight of agencies’ use of Artificial Intelligence (AI) is inadequate and creates a risk that the technology could be used irresponsibly, according to an … New York states centralized guidance and oversight of agencies use of Artificial Intelligence AI is inadequate …
https://www.osc.ny.gov/press/releases/2025/04/dinapoli-improved-guidance-needed-state-agencies-using-ai-avoid-risksDiNapoli: State Needs to Help Addiction Support Providers Better Prepare for Emergencies
… the period from 2019 to 2022, found the state’s Office of Addiction Services and Supports (OASAS) must improve its oversight and monitoring of nearly 400 certified providers that offer vital programs … result, OASAS doesn’t have a clear picture if patients in need of care or who should be prioritized are getting …
https://www.osc.ny.gov/press/releases/2023/11/dinapoli-state-needs-help-addiction-support-providers-better-prepare-emergencies