Search
Medicaid Program – Improper Managed Care Payments for Recipients With Duplicate Client Identification Numbers
… To determine whether improper Medicaid managed care premiums were paid on behalf of recipients with duplicate … pays managed care organizations (MCOs) a monthly premium for each enrolled recipient and, in turn, the MCOs pay for services their members require. Each individual who …
https://www.osc.ny.gov/state-agencies/audits/2019/07/29/medicaid-program-improper-managed-care-payments-recipients-duplicate-client-identificationMedicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… the new APR DRG-based hospital inpatient payment system for Medicaid services when patient deaths occur within one … the Department implemented a change to the Medicaid reimbursement methodology used to compensate hospitals for … Usually, the more severe the illness, the higher the reimbursement factor. Because patient deaths can result from …
https://www.osc.ny.gov/state-agencies/audits/2013/08/15/medicaid-program-payments-death-related-one-day-inpatient-admissionsNew York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan
… The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. Civil Service … (CVS Caremark) to administer the prescription drug program for the Empire Plan. This program includes the Empire Plan Medicare Rx drug plan (Medicare Rx Plan) for retired members …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/new-york-state-health-insurance-program-incorrect-payments-cvs-caremark-medicare-rx-drugState Comptroller DiNapoli Releases State Audits and Examinations
… address to improve Centro’s information security program for cardholder data and to help ensure it meets PCI … officials incorrectly certified some students as eligible for state financial aid awards. Incorrect certifications … practices when calculating $245.9 million in combined premiums and providing $125.3 million in combined discounts …
https://www.osc.ny.gov/press/releases/2017/02/state-comptroller-dinapoli-releases-state-audits-and-examinationsState Comptroller DiNapoli Releases Audits
… in the acquisition process. OGS is also responsible for tracking data on state agencies’ food purchases and for … than $18.9 million in mainstream Medicaid managed care premiums for the state fiscal year 2014-15 due to a flaw in … $7,958 in ineligible costs that HSOR reported for reimbursement. State Education Department: Developmental …
https://www.osc.ny.gov/press/releases/2019/01/state-comptroller-dinapoli-releases-auditsMedicaid Program – Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare
… Objective To determine whether Medicaid made improper payments to providers on behalf of … hospice care covered by Medicare. This audit covered the period January 1, 2015 through July 31, 2019. About the … appliances and supplies; and drugs. When individuals are enrolled in both Medicaid and Medicare (referred to as …
https://www.osc.ny.gov/state-agencies/audits/2020/12/28/medicaid-program-improper-medicaid-payments-individuals-receiving-hospice-services-coveredKidz Therapy Services, PLLC – Compliance With the Reimbursable Cost Manual
… The audit covered expenses claimed on Kidz Therapy’s CFR for fiscal year 2011-12 and certain expenses claimed on Kidz … employees of a related entity, $2,149 in life insurance premiums, and $651 in health insurance expenses for a former … the appropriate adjustments to Kidz Therapy’s CFRs and reimbursement rates. Work with Kidz Therapy officials to help …
https://www.osc.ny.gov/state-agencies/audits/2016/09/15/kidz-therapy-services-pllc-compliance-reimbursable-cost-manualSmall Wonder Preschool, Inc. – Compliance With the Reimbursable Cost Manual
… primarily on expenses claimed on Small Wonder’s CFR for the fiscal year ended June 30, 2021 and certain expenses … direct care costs; $1,281 in personal vehicle insurance premiums; $824 in costs that were claimed in the incorrect … on Small Wonder’s CFRs and to Small Wonder’s tuition reimbursement rates, as warranted. Remind Small Wonder …
https://www.osc.ny.gov/state-agencies/audits/2024/09/05/small-wonder-preschool-inc-compliance-reimbursable-cost-manualState Comptroller DiNapoli Releases Audits
… whether OASAS has sufficient treatment programs available for those in need. Department of Health: Medicaid Claims … including $107.7 million in Medicaid managed care premiums were paid on behalf of recipients with concurrent … $263,196 in ineligible costs that ABC reported for reimbursement and recommend such costs be disallowed. These …
https://www.osc.ny.gov/press/releases/2019/03/state-comptroller-dinapoli-releases-auditsState Comptroller DiNapoli Releases State Audits
… leaves granted to CUNY instructional staff were awarded for authorized purposes and in compliance with requirements. … but CUNY did not have the required notification forms for one. Auditors identified two accounts that were not on … State Insurance Fund (NYSIF): Examination of Outstanding Premiums (2016-SIF-01) New York state businesses pay NYSIF …
https://www.osc.ny.gov/press/releases/2016/08/state-comptroller-dinapoli-releases-state-audits-0DiNapoli: Managed Care Companies Wasting Millions in State Medicaid Dollars
… period, including almost $60,000 in payments to pharmacies for medications that were prescribed by deceased doctors, … wasted.” DOH contracts with MCOs to coordinate the care for enrolled Medicaid beneficiaries. In exchange, MCOs … costs totaled more than $51 billion, of which managed care premiums comprised nearly $27 billion. At the time of …
https://www.osc.ny.gov/press/releases/2016/07/dinapoli-managed-care-companies-wasting-millions-state-medicaid-dollarsMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… Purpose To determine whether Medicaid inappropriately paid for recipients’ Medicare Part C cost-sharing liabilities. The audit covered …
https://www.osc.ny.gov/state-agencies/audits/2018/09/10/medicaid-program-medicaid-payments-medicare-advantage-plan-providersLeague for the Handicapped – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by the League for the Handicapped (LFH) on its Consolidated Fiscal Report … LFH offers a range of services and programs to children with disabilities from birth through eight years of age. In …
https://www.osc.ny.gov/state-agencies/audits/2016/06/03/league-handicapped-compliance-reimbursable-cost-manualXII.6.I Paying a Non-State Employee – XII. Expenditures
… to the State. Paying non-employee travel Paying expenses for employment interviews Paying expenses of non-salaried … more than his or her proper share of Social Security and Medicare tax liabilities. The worker will not receive pension … will process these payments through the Employee Expense Reimbursement Module in the Statewide Financial System (SFS), …
https://www.osc.ny.gov/state-agencies/gfo/chapter-xii/xii6i-paying-non-state-employeeEmpire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011
… the period from July through December 2011. Background The New York State Health Insurance Program (NYSHIP) provides health … district employees and their dependents. The Department of Civil Service contracts with Empire to administer the …
https://www.osc.ny.gov/state-agencies/audits/2013/05/09/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2011-throughCUNY Bulletin No. CU-547
… repayment plans, using Deduction Code 582 CUNY (SS/Medicare Deficiency), will have a deduction rate of ten … maintain the deduction rate of three percent of gross pay for the existing FICA repayment obligation. A new FICA … the State consistently makes reasonable efforts to obtain reimbursement of the employee's share of the corrected FICA …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/city-university-new-york/cu-547-new-repayment-rate-deduction-code-582-cuny-ssmedicareState Agencies Bulletin No. 1493
… repayment plans using Deduction Code 502 NYS (SS/Medicare Deficiency) will have a deduction rate of ten … maintain the deduction rate of three percent of gross pay for the existing FICA repayment obligation. A new FICA … the State consistently makes reasonable efforts to obtain reimbursement of the employee's share of the corrected FICA …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1493-new-repayment-rate-deduction-code-502-nys-ssmedicare-deficiencyImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… Objective To assess the extent of implementation of the nine recommendations … included in our initial audit report, Improper Medicaid Payments for Individuals Receiving Hospice Services … appliances and supplies; and drugs. When individuals are enrolled in both Medicaid and Medicare (referred to as …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-followMedicaid Program: Overpayments for Medicare Part C Claims (2023-S-13)
To determine whether Medicaid made improper payments on Medicare Part C claims for recipients covered by Medicare Advantage Plans.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2025-23s13.pdfLong Island Association for AIDS Care
… report 2012-0063 , entitled the Long Island Association for AIDS Care, Inc. (LIAAC). Based on information obtained … of the documents LIAAC submitted to support the reimbursement for employee health insurance (i.e., medical … our examination of medical and dental expenses claimed for reimbursement by LIAAC under their contracts with the …
https://www.osc.ny.gov/state-agencies/audits/2017/11/10/long-island-association-aids-care