Search
Medicaid Program – Excessive Medicaid Payments to Federally Qualified Health Centers for Group Therapy Services
… Purpose To determine if Medicaid reimbursement rates for group … for a group therapy session for eight recipients. The provider did not bill the appropriate FQHC payment rate of … $7.7 million. Clarify to the FQHCs that were overpaid how to properly bill Medicaid for group therapy services. …
https://www.osc.ny.gov/state-agencies/audits/2014/11/18/medicaid-program-excessive-medicaid-payments-federally-qualified-health-centers-groupMadrid-Waddington Central School District - Claims Audit Process (2019M-1)
… to audit. The claims auditor did not audit and approve any of the District’s health insurance claims and Medicare …
https://www.osc.ny.gov/local-government/audits/school-district/2019/03/08/madrid-waddington-central-school-district-claims-audit-process-2019m-1Medicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims
… can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with … Part C outpatient claims, except for ambulance and psychology services, for which Medicaid pays 100 percent of … Social Services Law § 367-a, effective July 1, 2016. The number of Medicaid recipients joining Medicare Advantage …
https://www.osc.ny.gov/state-agencies/audits/2021/09/21/medicaid-program-cost-saving-opportunities-payments-medicare-part-c-claimsMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… Department's Medicaid reimbursement policies. Some edits check various Department files to verify recipient eligibility, provider credentials, and medical necessity. Other edits … Interest Department of Health: Overpayments of Ambulatory Patient Group Claims (2011-S-43) Department of Health: …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientImproper Payments of Medicare Buy-In Premiums for Ineligible Recipients (2020-S-35) 180-Day Response
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-response.pdfMedicaid Program – Mainstream Managed Care Organizations: Administrative Costs Used in Premium Rate Setting
… is appropriately applying the administrative costs in determining mainstream managed care premium rates. Our … the State fiscal year 2014-15, approximately $1.2 billion was for MCOs’ administrative costs. The Department is … As of early 2015, the total value of the contract was $38.6 million. Under the New York State Social Services …
https://www.osc.ny.gov/state-agencies/audits/2016/10/13/medicaid-program-mainstream-managed-care-organizations-administrative-costs-used-premiumNew York State Comptroller Thomas P. DiNapoli Statement on Federal Tax Reform
… "The Republican tax bill moving forward in Congress remains a bad deal for New York. "The cap on state and local tax deductions would nullify billions of … and the Consumer Financial Protection Bureau. Based on Congressional Budget Office estimates, the bill is also …
https://www.osc.ny.gov/press/releases/2017/12/new-york-state-comptroller-thomas-p-dinapoli-statement-federal-tax-reform-0Medicaid Program – Medicaid Payments Made Pursuant to Medicare Part C
… Part C, also known as Medicare managed care or Medicare Advantage. Under Medicare Part C, private managed care … services provided to enrollees. For dual-eligible persons, plan providers bill Medicaid directly for the enrollee's Part … a pacemaker, for which a Medicare Advantage Plan paid the provider $25,322. In comparison, Medicaid's fee for the …
https://www.osc.ny.gov/state-agencies/audits/2014/05/09/medicaid-program-medicaid-payments-made-pursuant-medicare-part-cDiNapoli: Medicaid Audits Find Nearly $800 Million in Savings and Revenue
… billions of dollars in waste, fraud and abuse. Our role is to help lower Medicaid program costs by identifying … care premiums for recipients who had comprehensive TPHI. Find out how your government money is spent at Open Book New York . …
https://www.osc.ny.gov/press/releases/2020/01/dinapoli-medicaid-audits-find-nearly-800-million-savings-and-revenueState Agencies Bulletin No. 1513
… with the 2016 calendar year-end procedures for taxable travel reimbursement. Background Taxable travel … Employee Payments Taxable Under the IRS One-Year Rule Excess PCM and Per Diem Amounts: IRS rules relating to …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1513-year-end-procedure-taxable-employee-expense-reimbursementsState Agencies Bulletin No. 1434
… W-2 reporting on any excess amounts paid. “Excess amount” is the portion that is greater than the applicable Federal … and employment taxes if employment away from home at a single location is realistically expected to last for more … include all reimbursements paid by the SFS from November 20, 2015 through December 4, 2015. The reimbursements will be …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1434-year-end-procedure-taxable-employee-expense-reimbursementsState Agencies Bulletin No. 1356
… with the 2014 calendar year-end procedures for taxable travel reimbursement. Background Taxable travel … Employee Payments Taxable Under the IRS One-Year Rule Excess PCM and Per Diem Amounts: IRS rules relating to …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1356-year-end-procedure-taxable-employee-expense-reimbursementsOverpayments of Certain Medicare Crossover Claims
… the federal health insurance program available to people 65 or more years-old, as well as people under 65 with certain disabilities. Individuals …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/overpayments-certain-medicare-crossover-claimsState Agencies Bulletin No. 1596
… Purpose To provide agencies with the 2017 calendar year-end procedures for taxable travel … taxes from meal allowances for non-overnight travel (day trips). One-Year Rule The IRS requires employers to … final transfer of taxable travel reimbursements for 2017 will occur on November 30, 2017, and will include all …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1596-year-end-procedure-taxable-employee-expense-reimbursementsState Agencies Bulletin No. 1674
… agencies with the 2018 calendar year-end procedures for taxable travel reimbursement Background Taxable travel … Federal per diems for the continental U.S. can be found in the Guide to Financial Operations Chapter XIII, Section … The IRS requires employers to report and withhold income and employment taxes from meal allowances for …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1674-year-end-procedure-taxable-employee-expense-reimbursementsChildren's Development Group, PLLC – Compliance With the Reimbursable Cost Manual
… Objective To determine whether the costs submitted by Children’s Development Group, PLLC … the Program CDG is an SED-approved, for-profit provider of preschool special education services to children with … reported costs must comply with SED’s Reimbursable Cost Manual (RCM) requirements. For the reporting year ended …
https://www.osc.ny.gov/state-agencies/audits/2019/12/11/childrens-development-group-pllc-compliance-reimbursable-cost-manualMedicaid Program – Medicaid Claims Processing Activity October 1, 2017 Through March 31, 2018
… Purpose To determine whether the Department of Health’s eMedNY system reasonably ensured that Medicaid … with concurrent comprehensive third-party health insurance (TPHI); $3.2 million was paid for claims that were … federal 340B program; and $290,676 was paid for episodic home health care claims that did not comply with Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2019/02/05/medicaid-program-medicaid-claims-processing-activity-october-1-2017-through-march-31-2018Medicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… Purpose To determine whether Medicaid made improper fee-for-service claim payments for pharmacy services covered by … provides a wide range of medical services to those who are economically disadvantaged and/or have special health care needs. In general, the Medicaid program pays medical providers through either the fee-for-service …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careState Health Department Unnecessarily Paid over $1 Billion for Patients Covered by Private Insurance
… paid $1.28 billion in unnecessary Medicaid managed care premiums over a nearly six-year period for enrollees who … provide medical services. As of August 2017, 4.4 million people were enrolled in mainstream managed care plans – about … and the third-party provider are the same, the state can remove the recipients from managed care retroactively and …
https://www.osc.ny.gov/press/releases/2018/06/state-health-department-unnecessarily-paid-over-1-billion-patients-covered-private-insuranceState Agencies Bulletin No. 1031
… To update calendar year-end procedures relating to taxable travel reimbursements in order for the State to comply with IRS reporting requirements. This … Personal Car Mileage (PCM) Reimbursements; Excess Per Diem Payments; Non-Overnight Meal Allowances; and Employee …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1031-year-end-procedure-taxable-travel-reimbursement