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New York’s Economy and Finances in the COVID-19 Era (June 24, 2021)

… June 24, 2021 Edition Growth in Use of Telehealth Services Among Medicaid and Child Health Plus … medical practitioners in person, increasing numbers of people used telehealth services. While telehealth usage in … above pre-pandemic levels, though still only a small share of overall utilization. The U.S. Centers for Medicare & …

Medicaid – Federal Funding and New York

…     Medicaid (Assistance Listing Number 93.778) is a health insurance entitlement … Medicaid Assistance Listing Number 93778 is a health insurance entitlement …

Audit of the Tuition Reimbursement Account for the Five Fiscal Years Ended March 31, 2018

… Financial Statements of the Tuition Reimbursement Account for the five fiscal years ended March 31, 2018. About the Program Students are eligible for a tuition refund when they are enrolled in a … in operation – students who drop out are also eligible for a tuition refund. Students in such schools are also …

State Comptroller DiNapoli Releases Audits

… programs. The audit identified $358,254 in costs that did not comply with SED’s requirements for reimbursement. … programs. The audit identified $236,209 in costs that did not comply with SED’s requirements for reimbursement. …

Medicaid Program – Overpayments for Medicare Part C Claims

… and coinsurance, as follows. Medicaid pays 100% of the deductibles. Medicaid pays 100% of the copayments and coinsurance on inpatient claims, and Medicaid pays 85% of the copayments and coinsurance on outpatient claims except …

Medicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients

… Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program. The … to November 30, 2020. About the Program The Department of Health (Department) administers New York’s Medicaid … eligibility requirements. The State’s Local Departments of Social Services (Local Districts) determine eligibility …

Medicaid 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 end stage renal disease who were … medical equipment, and laboratory services) on behalf of 10,906 Medicaid recipients who were diagnosed with ESRD. …

Medicaid 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 … Medicare are required to apply for Medicare as a condition of receiving Medicaid. When Medicaid recipients are also …

Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare (Follow-Up)

… reaching age 65 to apply for Medicare, we found DOH did not ensure Local Districts complied. Also, DOH did not require Local Districts to have Medicaid recipients …

DiNapoli: State Missing Out on Millions in Medicare Payments for Kidney Patients

… of their Medicare eligibility, which could reduce their out-of-pocket expenses and may provide them with more options … This could allow Medicaid to pay ESRD recipients' Medicare out-of-pocket costs, such as premiums and coinsurance. … about Medicare benefits and Medicaid's payment of Medicare out-of-pocket costs, and to actively assist recipients in …

Four Individuals Charged in Widespread Scheme to Defraud Medicare and Other Health Insurance Providers Through Fraudulent Medical Corporations and False Billing Resulting in Tens of Millions of Dollars in Losses

… announced the unsealing today of an indictment charging JAMES SPINA, JEFFREY SPINA, ANDREA GROSSMAN, and KIMBERLY … multiple different qualified individuals. But in reality, JAMES SPINA and JEFFREY SPINA, who are doctors of … medical service corporations. According to the indictment, JAMES SPINA and JEFFREY SPINA, together with GROSSMAN, made …

Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims

… rendered to recipients enrolled in UnitedHealthcare’s Medicare Advantage plan: UnitedHealthcare Dual Complete. The … 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, the Medicare managed care program also known …

Medicaid Program – Medicaid Payments to Medicare Advantage Plan Providers

… selected Medicare Advantage plan contracts offered by Fidelis and WellCare and, based on judgmental sampling, …

Medicaid Overpayments for Certain Medicare Part C Claims (Follow-Up)

… patient cost-sharing amounts or indicated UnitedHealthcare did not cover the service. We reviewed 125 Medicaid claims … high risk claims (5,571 - 125) totaling $506,239 that we did not examine in detail, and make recoveries where …

Reducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)

… in Medicare, Medicare becomes the primary insurer (payer) and Medicaid the secondary. As a secondary payer, rather than pay for the medical service itself, …

Overpayments for Services Also Covered by Medicare Part B (Follow-Up)

… were overpaid by almost $8.5 million because providers did not properly report Medicare payment data on those …

Medicaid Program – Improper Payments to a Physical Therapist

… claims using his NPI as an individual provider. Mark Amir did not comply with certain Department regulations and …

XIII. Employee Expense Reimbursement – XIII. Employee Expense Reimbursement

Medicaid Program – Overpayments for Services Also Covered by Medicare Part B

… Purpose To determine if the Department of Health overpaid health care providers for Medicaid claims … health program for the elderly and disabled. It consists of several parts. Medicare Part B helps pay for medical care … is the secondary payer. Usually, Medicare pays 80 percent of the charges for approved Part B services, and Medicaid …

Medicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare

… the services were covered by Medicare and, therefore, did not bill Medicare. $1.5 million was paid for prescription …