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Medicaid Program – Excessive Medicaid Payments to Federally Qualified Health Centers for Group Therapy Services
… To determine if Medicaid reimbursement rates for group therapy services provided by Federally Qualified Health … Qualified Health Centers (FQHCs) to provide group therapy services, including group therapy provided by clinical social workers, to Medicaid … To determine if Medicaid reimbursement rates for group therapy services provided by Federally Qualified Health …
https://www.osc.ny.gov/state-agencies/audits/2014/11/18/medicaid-program-excessive-medicaid-payments-federally-qualified-health-centers-groupImproper 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.pdfMadrid-Waddington Central School District - Claims Audit Process (2019M-1)
… Determine whether claims were adequately documented, were for appropriate purposes and were properly audited and … claims auditor did not audit two claims totaling $251,601 for health insurance and Medicare reimbursement. In addition, … $5,700. Key Recommendations Ensure that all claims for health insurance, Medicare reimbursements and scholarship …
https://www.osc.ny.gov/local-government/audits/school-district/2019/03/08/madrid-waddington-central-school-district-claims-audit-process-2019m-1Medicaid Program – Mainstream Managed Care Organizations: Administrative Costs Used in Premium Rate Setting
… Purpose To determine whether mainstream managed care organizations (MCOs) are submitting accurate … the administrative costs in determining mainstream managed care premium rates. Our audit covered the period January 1, … are economically disadvantaged and/or have special health care needs. For the State fiscal year ended March 31, 2015, …
https://www.osc.ny.gov/state-agencies/audits/2016/10/13/medicaid-program-mainstream-managed-care-organizations-administrative-costs-used-premiumMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… whether the Department of Health's eMedNY system processes Medicaid claims for ancillary services in accordance with Medicaid reimbursement policies. The audit covers the period … and home health care are typical ancillary services. Medicaid claims for ancillary services are processed by …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims
… be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with … Medicaid recipients are enrolled in both Medicaid and Medicare. Medicare is the primary payer for medical services provided … be achieved by modifying the reimbursement methodology for Medicare Part C costsharing claims in accordance with federal …
https://www.osc.ny.gov/state-agencies/audits/2021/09/21/medicaid-program-cost-saving-opportunities-payments-medicare-part-c-claimsNew 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 … Office estimates, the bill is also expected to result in higher health insurance premiums or loss of coverage for … the option for advance refunding of outstanding debt. In the past four years alone, this option has generated …
https://www.osc.ny.gov/press/releases/2017/12/new-york-state-comptroller-thomas-p-dinapoli-statement-federal-tax-reform-0DiNapoli: Medicaid Audits Find Nearly $800 Million in Savings and Revenue
… continue in earnest as the state Department of Health can do much more to save taxpayer dollars.” The New York State … MLTC plans. The plans provide long-term care services to people who are chronically ill or disabled. Medicaid pays … monthly managed care premiums and, in return, MLTC plans pay for all MLTC covered services. The Medicaid program is …
https://www.osc.ny.gov/press/releases/2020/01/dinapoli-medicaid-audits-find-nearly-800-million-savings-and-revenueMedicaid Program – Medicaid Payments Made Pursuant to Medicare Part C
… To determine if Medicaid made excessive payments for Medicare Part C cost-sharing liabilities. The audit covered … Background Many Medicaid recipients are also enrolled in Medicare. Such recipients are commonly referred to as "dual-eligibles." In 1997, Congress established Medicare Part C, also known as Medicare managed care or …
https://www.osc.ny.gov/state-agencies/audits/2014/05/09/medicaid-program-medicaid-payments-made-pursuant-medicare-part-cChildren's Development Group, PLLC – Compliance With the Reimbursable Cost Manual
… The audit covered costs reported on CDG’s CFR for the reporting year ended June 30, 2016. About the Program CDG is an SED-approved, for-profit provider of preschool special education services … are between three and five years of age. CDG is reimbursed for these services through rates set by SED, which are based …
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
… attention, as follows: $107.7 million in Medicaid managed care premiums were paid on behalf of recipients with … claims was paid for recipients enrolled in managed care; $1.6 million was paid for newborn birth claims; $1.4 … 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-31-2018Training Resources for State Agencies and Employees
View training materials and ondemand videos for classes presented by the Office of Operations
https://www.osc.ny.gov/state-agencies/trainingMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… for pharmacy services covered by recipients’ managed care plans. The audit covered the period October 1, 2011 … are economically disadvantaged and/or have special health care needs. In general, the Medicaid program pays medical … through either the fee-for-service method or the managed care plan method. Under the feefor- service method, Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careState Agencies Bulletin No. 1513
… agencies with the 2016 calendar year-end procedures for taxable travel reimbursement. Background Taxable travel … by receipts. The 2016 maximum rate allowed by IRS for PCM is 54 cents per mile effective from January 1, 2016 … December 31, 2016. Current maximum Federal per diems for the continental U.S. can be found in the Guide to …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1513-year-end-procedure-taxable-employee-expense-reimbursementsState Agencies Bulletin No. 1434
… agencies with the 2015 calendar year-end procedures for taxable travel reimbursement. Background Taxable travel … by receipts. The 2015 maximum rate allowed by IRS for PCM is 57.5 cents per mile effective from January 1, 2015 … December 31, 2015. Current maximum Federal per diems for the continental U.S. can be found in the Guide to …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1434-year-end-procedure-taxable-employee-expense-reimbursementsState Agencies Bulletin No. 1356
… agencies with the 2014 calendar year-end procedures for taxable travel reimbursement. Background Taxable travel … by receipts. The 2014 maximum rate allowed by IRS for PCM is 56 cents per mile effective from January 1, 2014 … December 31, 2014. Current maximum Federal per diems for the continental U.S. can be found in the Guide to …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1356-year-end-procedure-taxable-employee-expense-reimbursementsMedicaid Program – Improper Payments for Certain Third-Party Cost-Sharing Claims
… may have other sources of health care coverage, such as Medicare and group health plans (third-party insurers). … 45 are not. All claims submitted for Medicaid members with Medicare and/or other third-party insurance must accurately … $1,775,326 caused by an internal processing error at one Medicare Advantage plan 41 claims totaling overpayments of …
https://www.osc.ny.gov/state-agencies/audits/2025/11/05/medicaid-program-improper-payments-certain-third-party-cost-sharing-claimsDiNapoli: Audit Finds $6.8 Million in Medicaid Overpayments
… state’s Medicaid system made approximately $6.8 million in inappropriate payments, including $3.5 million for separately billed medical services that should have been covered by managed … abuse,” DiNapoli said. “My auditors found several cases in which the Department of Health’s eMedNY system failed to …
https://www.osc.ny.gov/press/releases/2016/11/dinapoli-audit-finds-68-million-medicaid-overpaymentsState Agencies Bulletin No. 1674
… Excess Personal Car Mileage (PCM) Reimbursements Excess Per Diem Payments Non-Overnight Meal Allowances Employee Payments … effective from January 1, 2018 through December 31, 2018. Current maximum Federal per diems for the continental U.S. …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1674-year-end-procedure-taxable-employee-expense-reimbursementsState Agencies Bulletin No. 1596
… Excess Personal Car Mileage (PCM) Reimbursements Excess Per Diem Payments Non-Overnight Meal Allowances Employee Payments … effective from January 1, 2017 through December 31, 2017. Current maximum Federal per diems for the continental U.S. …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1596-year-end-procedure-taxable-employee-expense-reimbursements