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Improper 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 – 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 Centers were correctly applied. The audit covered the … Qualified Health Centers (FQHCs) to provide group therapy services, including group therapy provided by …
https://www.osc.ny.gov/state-agencies/audits/2014/11/18/medicaid-program-excessive-medicaid-payments-federally-qualified-health-centers-groupMedicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims
… to these dual-eligible recipients. Medicaid typically pays for cost-sharing liabilities, which include Medicare … for ambulance and psychology services, for which Medicaid pays 100 percent of the cost-sharing liability (inpatient … and it is similar to how New York Medicaid currently pays Medicare Part B cost-sharing. We project that, using …
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
… Medicaid claims for ancillary services in accordance with Medicaid reimbursement policies. The audit covers the … eMedNY designed to pay Medicaid claims in accordance with the Department's Medicaid reimbursement policies. Some … Medicaid claims for ancillary services in accordance with Medicaid reimbursement policie …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Mainstream Managed Care Organizations: Administrative Costs Used in Premium Rate Setting
… The Department issues MMCOR instructions to guide MCOs on how to report administrative expenses. Of the $17.8 billion …
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
… tax bill moving forward in Congress remains a bad deal for New York. "The cap on state and local tax deductions … the Social Services Block Grant, federal highway aid for emergencies and the Consumer Financial Protection Bureau. … in higher health insurance premiums or loss of coverage for many New Yorkers. "The legislation will drive up the cost …
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
… collecting rebates from drug makers. “New York state faces a projected budget gap of $6 billion for the coming fiscal … Covered by Managed Long-Term Care (MLTC) Plans (2018-S-65) Many of the state’s Medicaid recipients are enrolled in MLTC … 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-revenueMedicaid Program – Medicaid Payments Made Pursuant to Medicare Part C
… During the audit period, Medicaid could have saved up to $69 million if it limited payments of Medicare Part C …
https://www.osc.ny.gov/state-agencies/audits/2014/05/09/medicaid-program-medicaid-payments-made-pursuant-medicare-part-cState 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. 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. 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-reimbursementsState Agencies Bulletin No. 1674
… to last for more than one year. Further explanations of rules for excess PCM, Per Diem Amounts, Non-Overnight Meal … a “Taxable Expense” (Earnings code TXE).The final transfer of taxable travel reimbursements for 2018 will occur on … reflected as “Taxable Expense” on the advices or pay stubs of the Administration and Institution paychecks dated …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1674-year-end-procedure-taxable-employee-expense-reimbursementsState Agencies Bulletin No. 1596
… Employee Payments Taxable Under the IRS One-Year Rule Excess PCM and Per Diem Amounts: IRS rules relating to … allowances for non-overnight travel (day trips). One-Year Rule The IRS requires employers to report travel … Administration and Institution paychecks dated December 13, 2017 and December 21, 2017, respectively. OSC …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1596-year-end-procedure-taxable-employee-expense-reimbursementsChildren's Development Group, PLLC – Compliance With the Reimbursable Cost Manual
… reporting year ended June 30, 2016. About the Program CDG is an SED-approved, for-profit provider of preschool special … who are between three and five years of age. CDG is reimbursed for these services through rates set by SED, …
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 … 1, 2017 through March 31, 2018. Background The Department of Health (Department) administers the State’s Medicaid … 184 million claims, resulting in payments to providers of more than $31 billion. The claims are processed and paid …
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 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 Medicare and/or other third-party insurance must accurately reflect payments, adjustments …
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
… New York state’s Medicaid system made approximately $6.8 million in … to an audit released today by State Comptroller Thomas P. DiNapoli. By the end of audit fieldwork, about $2.4 … administered by the state Department of Health (DOH), is a federal, state, and locally funded program that provides a …
https://www.osc.ny.gov/press/releases/2016/11/dinapoli-audit-finds-68-million-medicaid-overpaymentsOverpayments of Certain Medicare Crossover Claims
… Purpose To determine if Medicaid overpaid Medicare crossover claims for physician and other outpatient services and to identify the claims processing control weaknesses that … To determine if Medicaid overpaid Medicare crossover claims …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/overpayments-certain-medicare-crossover-claimsMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… health care needs. In general, the Medicaid program pays medical providers through either the fee-for-service … plan method. Under the feefor- service method, Medicaid pays providers directly for Medicaid-eligible services … recipients. Under the managed care plan method, Medicaid pays managed care organizations (MCOs) a monthly premium for …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-care