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Medicaid Program – Improper Payments to a Physical Therapist

… Medicare deductibles and coinsurance. Medicaid claims for Medicare deductibles or coinsurance are called … system improved the accuracy of Medicaid payments for dualeligible recipients. Prior to the implementation, … claims using the National Provider Identifier (NPI) for his group practice and the related Medicaid claims using …

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

… if the Department of Health overpaid health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period … 31, 2009. Background Medicare is a federal health program for the elderly and disabled. It consists of several parts. …

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 … 31, 2017 for therapy services. About the Program Many of the State’s Medicaid recipients are also enrolled in … by licensed therapists. Payments were made on behalf of 6,712 dual-eligible recipients, and 20 providers accounted …

Overpayments of Certain Medicare Crossover Claims (Follow-Up)

… medical claims for dual-eligible individuals to Medicare. After Medicare processes the claims, they are electronically … Key Recommendation Officials are given 30 days after the issuance of the follow-up report to provide …

XIII. Employee Expense Reimbursement – XIII. Employee Expense Reimbursement

New York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan

… the issue and develop a process to reconcile the data in their respective systems to reduce the risk of processing … To Civil Service and CVS Caremark: Review the $12,358,531 in claims identified in this report as incorrectly paid under the Commercial Plan …

Improper Payments Related to the Medicare Buy-In Program (Follow-Up)

… Purpose To determine the extent of implementation of the five recommendations made in our audit report, … buy-in program to assist certain low-income people pay out-of-pocket Medicare expenses. Under the buy-in program, …

Overpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)

… Key Recommendation Officials are given 30 days after the issuance of this follow-up to provide information …

Overpayments for Medicare Part C Coinsurance Charges (Follow-Up)

… Purpose To determine the extent of implementation of the one recommendation included in our initial audit … providers. As a result, 14 providers billed Medicaid for excessive amounts of coinsurance on 497 claims for clinic …

Unnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)

… initial audit report, Unnecessary Managed Care Payments for Medicaid Recipients With Medicare (Report 2010-S-75). … made premium payments to Medicaid managed care plans for Medicaid recipients who also had Medicare health insurance coverage, known as "dual eligibles." For the three-year audit period ended May 31, 2010, we …

Medicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services

… Background Many Medicaid recipients are also enrolled in Medicare Part C, also known as Medicare Managed Care or … Plan. We sampled 266 such claims (totaling $220,661 in Medicaid payments) to determine the appropriateness of the …

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

… in Medicare Part B, which provides supplementary medical insurance for a broad range of outpatient medical services, … (such as deductibles and coinsurance). Federally qualified health centers (FQHCs) receive enhanced reimbursements from … FQHCs are “safety net” providers, such as community health centers and public housing centers, that provide …

Medicaid Payments to Medicare Advantage Plan Providers (Follow-Up)

… made in our initial audit report, Medicaid Payments to Medicare Advantage Plan Providers (Report 2016-S-54 ). About … enrolled in Medicare, the federal health insurance program for people age 65 and older and people under 65 who have certain disabilities. Under Medicare Part C, private managed care companies administer Medicare …

Medicaid Payments for Medicare Part A Beneficiaries (Follow-Up)

… of the costs, such as coinsurance or deductibles. For the two years ended December 31, 2007, our audit identified $14 …

Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan (Follow-up)

… Objective To assess the extent of implementation of the three recommendations included in … about 1.2 million active and retired State, participating local government, and school district employees, and their …

Medicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY

… Medicaid made improper payments to providers who submitted Part B cost-sharing claims directly to eMedNY. The audit covered … of the State’s Medicaid recipients are also eligible for Medicare, the federal health insurance program for people age …

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

… Objective To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program. The audit covered Medicaid payments …

Medicaid Program – Overpayments for Medicare Part C Claims

… by Medicare Advantage Plans. The audit covered the period from May 2018 through April 2023. About the Program Under … health care providers for services rendered to enrollees. Many Medicaid recipients are enrolled in these Plans (referred to as “dual-eligibles”). Generally, …

Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)

… Program The Department of Health (Department) administers New York’s Medicaid program. Many Medicaid recipients are …

Reimbursement of Social Services Costs (2013MS-3)

… (DSS) incurs both direct and indirect program costs in the administration of social services programs and a … benefit of the DSS) that are directly billed to the DSS. In addition, counties are reimbursed for the indirect costs … failed to seek reimbursement for more than $1.4 million in eligible costs, potentially losing almost $1 million in …