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Comptroller DiNapoli Releases State Audits

… New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued: Research … $20.3 million overpayment from an incorrect reimbursement rate. Auditors found other overpayments of approximately $1.2 …

Medicaid – Federal Funding and New York

…     Medicaid (Assistance Listing Number 93.778) is a health insurance entitlement program for low-income adults … (DOE) and Early Intervention services in the Department of Health and Mental Hygiene (DOHMH). FIGURE 1 – NYC Medicaid Enrollment   Sources: NYS Department of Health; OSC analysis FIGURE 2 – Medicaid Revenue by …

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

… the financial statements referred to above present fairly, in all material respects, the respective financial …

State Comptroller DiNapoli Releases Audits

… an estimated value of $150 million and a replacement cost of $216.7 million, the audit determined the fleet and … Center for Learning – Compliance With the Reimbursable Cost Manual (2022-S-7) Cantalician, a not-for-profit special … actions were needed. Namely, the Office of the Medicaid Inspector General had yet to materially recover the …

Medicaid Program – Overpayments for Medicare Part C Claims

… copayments, 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 …

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

To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buyin program

Medicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease

… entitlement to Medicare and taken proactive steps to help get them enrolled, the Medicaid program could have saved as … age 65 who meet ESRD Medicare eligibility requirements who do not apply for Medicare. We requested that SSA issue a … apply for Medicare. Follow up with recipients who do not apply for Medicare by implementing a process that: …

Medicaid Program – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare

… When SSA receives an SSI application for someone who is 65 years of age, it also checks the individual’s Medicare …

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

… for Recipients Who Are Eligible for Medicare (Report 2021-S-16 ). About the Program DOH administers the State’s … for Medicare are required to apply for Medicare as a condition of receiving Medicaid. When Medicaid recipients … saved $294.4 million on behalf of these recipients for clinic, inpatient, and practitioner claims that could have …

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

… The state Department of Health (DOH) could have saved the Medicaid program as much … and struggling with day-to-day life should be informed of their Medicare eligibility, which could reduce their out-of-pocket expenses and may provide them with more options for …

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

… State Comptroller Thomas P. DiNapoli, Geoffrey S. Berman, the United States Attorney … has been assigned to U.S. District Court Judge Kenneth M. Karas. Berman also today announced the guilty plea of … State Comptroller Thomas P DiNapoli announced the unsealing today of an indictment …

Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims

… Part C, private managed care companies administer Medicare benefits. These Medicare Advantage Plans typically have … Part C cost-sharing liabilities (deductibles, coinsurance, and copayments). Key Finding From a review of Medicare Part C … copayments, or deductibles. Ten providers adjusted and re-submitted their claims to eMedNY resulting in Medicaid …

Medicaid Program – Medicaid Payments to Medicare Advantage Plan Providers

… Purpose To determine whether Medicaid inappropriately paid for recipients’ Medicare Part C cost-sharing … To determine whether Medicaid inappropriately paid for recipients Medicare Part C costsharing liabilities …

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

… Purpose To determine the extent of implementation of the three recommendations included in our initial audit … disadvantaged and/or have special health care needs. Many of the State’s Medicaid recipients are also enrolled in … To determine the extent of implementation of the three recommendations included in …

Reducing 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 …

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

… by Medicare Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for Medicare … by Medicare. Our initial audit report, which was issued on June 20, 2012, examined whether the Department of Health … providers did not properly report Medicare payment data on those claims. Key Findings Department officials made …

Medicaid Program – Improper Payments to a Physical Therapist

… whether Mark Amir, a physical therapist participating in New York’s Medicaid program, billed Medicaid in accordance with its policies and guidelines and whether … who owns and operates Madison Physical Therapy located in Brooklyn, New York. Mr. Amir’s patients are primarily …

XIII. Employee Expense Reimbursement – XIII. Employee Expense Reimbursement

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

… while Medicaid is the secondary payer. Usually, Medicare pays 80 percent of the charges for approved Part B services, and Medicaid pays the remaining balances (typically for coinsurance) for …

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

… Objective To determine if the Department of Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by … To determine if the Department of Health overpaid health care providers Medicaid claims for …