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Empire BlueCross BlueShield – Controls Over Payments for Special Items
… identified implant overpayments totaling $894,315 (over 300 percent more than the $208,993 that Empire recovered). …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsManagement of Indoor Air Quality for Individuals With Asthma
… from April 2014 to January 2021. About the Program Asthma is a significant public health problem in the United States. It is one of this country’s most common and costly diseases, … often requires emergency care and hospital admission and is responsible for a high number of missed school and/or work …
https://www.osc.ny.gov/state-agencies/audits/2022/08/02/management-indoor-air-quality-individuals-asthmaImproper Medicaid Payments for Recipients in Hospice Care (Follow-Up)
… in Hospice Care ( 2017-S-76 ). About the Program Hospice is a program that provides care to terminally ill … all hospice services. However, if a Medicaid recipient is also enrolled in Medicare, Medicare is the primary payer and Medicaid is the secondary payer. In …
https://www.osc.ny.gov/state-agencies/audits/2020/10/15/improper-medicaid-payments-recipients-hospice-care-followMedicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
… 31, 2019. About the Program The State’s Medicaid program is administered by the Department of Health (Department). The … of admission and when the services ended. This information is used to calculate the payment made to the hospital. … may vary significantly depending on whether a patient is transferred or discharged. For example, a claim where a …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-dischargesBenefits Advisement Services for Individuals With Disabilities Seeking Employment
… 75 percent for people without disabilities. Further, ACS data shows that New Yorkers with disabilities are more than … this be achieved was by improving benefits advisement services to assist all individuals with disabilities in … entities as necessary. Capture historical notification data for analysis and assessment of the effectiveness of WINR …
https://www.osc.ny.gov/state-agencies/audits/2021/07/20/benefits-advisement-services-individuals-disabilities-seeking-employmentUse of Federal Funding for Election Technology and Security
… Objective To determine whether the Board of Elections utilized … the 2018 Help America Vote Act Election Security Grant to enhance the security of the State’s election technology … To determine whether the Board of Elections BOE utilized …
https://www.osc.ny.gov/state-agencies/audits/2021/09/17/use-federal-funding-election-technology-and-securityUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… Objectives To determine whether UnitedHealthcare (United) paid claims … correlate with the date of the service on the claims, and to calculate the corresponding financial impact. The audit … (Civil Service), provides health insurance coverage to over 1.2 million active and retired State, local …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsMaximizing Drug Rebates for Health and Recovery Plans (Follow-Up)
… Objective To determine the extent of implementation of the two recommendations made in our initial audit report, … Rebate Program, which allows states to recover a portion of their Medicaid prescription drug costs by requesting … To determine the extent of implementation of the two recommendations made in our …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/maximizing-drug-rebates-health-and-recovery-plans-followEmpire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… Special Items (Report 2016-S-57 ). About the Program The New York State Health Insurance Program (NYSHIP) covers active …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… could achieve cost savings by implementation of a rental cap on oxygen equipment. The audit covered the period from … caps. For example, one MCO established a 10-month rental cap on apnea monitors, yet for one recipient the MCO paid … 64 extra rental payments for a monitor beyond the 10-month cap. Furthermore, we estimated potential cost avoidance for …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsImproper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)
… of services for recipients and reimburse providers. When a hospital bills an MCO for an inpatient stay, the hospital reports certain information on its claims, including …
https://www.osc.ny.gov/state-agencies/audits/2023/12/06/improper-managed-care-payments-misclassified-patient-discharges-followAnnual Assessment of Market Orders for 2015 and 2016
… covered the period July 1, 2014 through June 30, 2016 for the Apple and Sour Cherry Market Orders and the period April 1, 2014 through March 31, 2016 for the Apple, Cabbage, and Onion Research and Development Programs. About the Program During the audit …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
… Purpose To determine whether Medicaid overpayments were made to hospitals for mechanical ventilation services reported on … To determine whether Medicaid overpayments were made to hospitals for mechanical ventilation services reported on …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-servicesMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… for services provided to enrollees. Generally, Medicaid is the secondary payer, and covers any financial balances … uses the CARCs to determine whether a billed service is eligible for payment as well as the correct payment … an incorrect CARC. Without the appropriate CARC, eMedNY is at risk of improperly adjudicating – and overpaying – …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesRestrictions on Consecutive Hours of Work for Nurses (Follow-Up)
… as health care disasters or a federal, State, or local declaration of an emergency. Our initial report, issued on …
https://www.osc.ny.gov/state-agencies/audits/2019/09/09/restrictions-consecutive-hours-work-nurses-followImplementation of the Dignity for All Students Act (Follow-Up)
… Objective To determine the extent of implementation of the three recommendations included in our initial audit report, Implementation of the Dignity for All Students Act (Report 2016-S-28 ). … To determine the extent of implementation of the three recommendations included in …
https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-followBrighter Choice Charter School for Boys - Payroll (2018M-139)
… paid 15 employees who were paid $123,754 over four payroll periods during the audit period. 1 We reviewed the … Brighter Choice Charter School for Boys Payroll 2018M139 …
https://www.osc.ny.gov/local-government/audits/charter-school/2018/10/12/brighter-choice-charter-school-boys-payroll-2018m-139Medicaid Program – Improper Payments for Certain Third-Party Cost-Sharing Claims
… Group codes include PR (patient responsibility) and CO (contractual obligation). CARC 45 occurs when the charge … configured to pay in eMedNY, while claims with a CARC CO 45 are not. All claims submitted for Medicaid members with …
https://www.osc.ny.gov/state-agencies/audits/2025/11/05/medicaid-program-improper-payments-certain-third-party-cost-sharing-claimsTown of Somerset – Budgeting for Sales Tax (2016M-419)
… of our audit was to review the Town's allocation of sales tax for the period January 1, 2015 through November 18, … million. Key Findings Town officials improperly budgeted sales tax revenue in the refuse district. Key Recommendations Allocate sales tax as allowed by statute. …
https://www.osc.ny.gov/local-government/audits/town/2017/11/22/town-somerset-budgeting-sales-tax-2016m-419DiNapoli: State Needs to Improve Services for Vulnerable Adults
… The State Office of Children and Family Services is not adequately overseeing adult protective service providers responsible for protecting vulnerable adults to ensure they are handling … for protecting them must do a better job.” Elder abuse is a problem nationwide, with 1 in 10 older adults subject to …
https://www.osc.ny.gov/press/releases/2021/11/dinapoli-state-needs-improve-services-vulnerable-adults