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Opinion 97-2
… that bear on the issues discussed in the opinion. INSURANCE -- Health Insurance (authority to cover former school board members); … (municipal cooperative health benefit plans) -- Self-Insurance (municipal cooperative health benefit plans) … reimburse a former school board member for Part B Medicare insurance premiums paid by the former school board member …
https://www.osc.ny.gov/legal-opinions/opinion-97-2Cost-Saving Ideas: Monitoring Health Insurance Premiums for Retirees
… and school districts, employees have the option to receive health insurance coverage after retirement. Among other … the eligible retiree dies. required to contribute to the health insurance coverage costs. offered subsidized health insurance costs by allowing the retiree to buy …
https://www.osc.ny.gov/local-government/publications/cost-saving-ideas-monitoring-health-insurance-premiums-retireesMedicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients
… Program by CMS with coverage beginning more than two years retroactively, despite limitations on premium liability beyond two years. The State may be eligible for equitable relief from … its share of $13 million in premiums paid beyond the two years. Key Recommendations Increase oversight of Local …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipientsImproper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
… included in our initial audit report, Improper Payments of Medicare Buy-In Premiums for Ineligible Recipients (Report … program. Many Medicaid recipients are also enrolled in Medicare. Under the Medicare buy-in program (Buy-in Program), administered by the … included in our initial audit report Improper Payments of Medicare BuyIn Premiums for Ineligible Recipients Report …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/improper-payments-medicare-buy-premiums-ineligible-recipients-followMedicaid Payments Made Pursuant to Medicare Part C (Follow-Up)
… in our audit report, Medicaid Payments Made Pursuant to Medicare Part C (Report 2012-S-133). Background Medicaid … Medicaid recipients are also enrolled in Medicare. Under Medicare Part C, also known as Medicare managed care or … Medicare benefits. Medicare pays a fixed amount for each Medicare Part C beneficiary every month to companies offering …
https://www.osc.ny.gov/state-agencies/audits/2016/12/15/medicaid-payments-made-pursuant-medicare-part-c-followUnnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… and utility of the Medicare eligibility data it uses and take action to improve data quality or develop alternate … standards to the broker agreement regarding timely removal of dual eligibles from Medicaid managed care … and to implement procedures to help ensure that Medicaid does not pay managed care premiums for enrollees of the …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followDiNapoli Finds Over $100 Million in Inappropriate Medicaid Payments
… the Medicare buy-in program, maternity care, and drug and therapy claims. Nearly $400,000 in premiums may have been … 2019 examined payments made for prescription drugs and therapy services. It found Medicaid paid $20.1 million for … $18.6 million for physical, occupational, and speech therapy services, and $1.5 million for prescription drugs. A …
https://www.osc.ny.gov/press/releases/2021/11/dinapoli-finds-over-100-million-inappropriate-medicaid-paymentsExcessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans (Follow-Up)
… Medicaid program. Many Medicaid recipients are enrolled in Medicare and are referred to as “dual-eligibles.” … Managed Care (MMC), which provides comprehensive coverage, and Health and Recovery Plans (HARP), which provide … disenrolling dual-eligible recipients from MMC and HARP as part of the COVID-19 public health emergency unwind process. …
https://www.osc.ny.gov/state-agencies/audits/2024/05/08/excessive-premium-payments-dual-eligible-recipients-enrolled-mainstream-managed-care-andMedicaid Program – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare
… Objective To determine whether the Department of Health (Department) took sufficient steps to control the Medicaid costs of recipients who were eligible for Medicare based on age but were not … To determine whether the Department of Health Department took sufficient steps to …
https://www.osc.ny.gov/state-agencies/audits/2023/09/14/medicaid-program-reducing-medicaid-costs-recipients-who-are-eligible-medicareReducing Medicaid Costs for Recipients Who Are Eligible for Medicare (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Medicaid Program – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare (Report 2021-S-16 ). About the … Medicaid. When Medicaid recipients are also enrolled in Medicare, Medicare becomes the primary payer and Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2025/08/13/reducing-medicaid-costs-recipients-who-are-eligible-medicare-followImproper Payments Related to the Medicare Buy-In Program (Follow-Up)
… Improper Payments Related to the Medicare Buy-In Program ( 2010-S-76 ). Background The federal government established … Improper Payments Related to the Medicare Buy-In Program (2010-S-76) …
https://www.osc.ny.gov/state-agencies/audits/2014/11/18/improper-payments-related-medicare-buy-program-followUnified Court System Bulletin No. UCS-132
… health care expenses With the exception of State health insurance premiums, these expenses require a receipt. The first two … for health care expenses, including State health insurance premiums, will be processed through the payroll system. …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/unified-court-system/ucs-132-judicial-supplemental-support-allowanceMedicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance
… of individuals who had comprehensive third-party health insurance coverage. The audit covered the period January 1, … the recipients from managed care retroactively and recover premiums paid to the MCO for those recipients during the … concurrent comprehensive TPHI: $26.9 million (about 73,000 premiums) can be recovered because the recipients’ MCO is the …
https://www.osc.ny.gov/state-agencies/audits/2018/06/13/medicaid-program-managed-care-premium-payments-recipients-comprehensive-third-partyReducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)
… Purpose To determine the implementation status of the five recommendations made in our initial audit … To determine the implementation status of the five recommendations made in our initial audit …
https://www.osc.ny.gov/state-agencies/audits/2018/09/05/reducing-medicaid-costs-recipients-end-stage-renal-disease-followMedicaid Program – Excessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans
… Medicaid program. Many Medicaid recipients are enrolled in Medicare and are referred to as “dual-eligibles.” … Managed Care (MMC), which provides comprehensive coverage, and Health and Recovery Plans (HARP), which provide … the Families First Coronavirus Response Act, which, in part, increased the federal medical assistance percentage to …
https://www.osc.ny.gov/state-agencies/audits/2022/10/31/medicaid-program-excessive-premium-payments-dual-eligible-recipients-enrolled-mainstreamState Comptroller DiNapoli Releases State Audits
… of Health (DOH) Medicaid Payments Made Pursuant to Medicare Part C (Follow-Up) (2016-F-16) An audit released in … have saved up to $69 million if it limited payments of Medicare Part C cost-sharing liabilities. The audit also identified several scenarios under which Medicare Part C cost-sharing liabilities were improperly …
https://www.osc.ny.gov/press/releases/2016/12/state-comptroller-dinapoli-releases-state-audits-1Improper Payments of Medicare Buy-In Premiums for Ineligible Recipients (2020-S-35)
To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2022-20s35.pdfDiNapoli: State Missing Out on Millions in Medicare Payments for Kidney Patients
… of Health (DOH) could have saved the Medicaid program as much as $146 million over a six-year period if it had helped … them enrolled, the Medicaid program could have saved as much as $146 million. Based on an analysis of potential … auditors estimate the Medicaid program could save as much as $69 million more from 2016 through 2018 if DOH takes …
https://www.osc.ny.gov/press/releases/2017/03/dinapoli-state-missing-out-millions-medicare-payments-kidney-patientsMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… Purpose To determine whether the Department of Health took sufficient steps to control the Medicaid costs of recipients diagnosed with … To determine whether the Department of Health took sufficient …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseIV.4.C General State Charges – IV. Accounting Codes - Uses and Descriptions
… pursuant to collective bargaining agreements. 60004 Dental Insurance State’s contribution to the Dental Insurance plan. 60007 Dependent Care Advantage Employer … levied by OSC as required by §8-a of the State Finance Law. 60025 Health Insurance –MedicalActive Employee State's …
https://www.osc.ny.gov/state-agencies/gfo/chapter-iv/iv4c-general-state-charges