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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. …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… care providers’ Medicaid claims for therapy services and prescription drugs that are covered by Medicare. The audit … the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, 2017 … occupational, and speech therapy services, as well as prescription drugs. When these services are rendered to …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareOverpayments of Certain Medicare Crossover Claims (Follow-Up)
… also enrolled in Medicare, the federal health care program for people 65 years of age and older and people under 65 … “dual-eligibles.” Generally, Medicare is the primary payer for medical services provided to dual-eligibles. Medicaid then typically pays for any remaining balance not covered by Medicare, including …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/overpayments-certain-medicare-crossover-claims-followNew York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan
… CVS Caremark paid claims under the correct prescription drug plan. The audit covered the period from January 2015 … L.L.C. (CVS Caremark) to administer the prescription drug program for the Empire Plan. This program includes the Empire Plan Medicare Rx drug plan (Medicare Rx Plan) for retired members and their …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/new-york-state-health-insurance-program-incorrect-payments-cvs-caremark-medicare-rx-drugImproper Payments Related to the Medicare Buy-In Program (Follow-Up)
… for the Medicare buy-in program total approximately $1.3 billion. Our initial audit report, which was issued on …
https://www.osc.ny.gov/state-agencies/audits/2014/11/18/improper-payments-related-medicare-buy-program-followOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… recipients, health care providers are required to bill Medicare, which is generally the primary payer, before … audit concluded that the State’s Medicaid program paid $20.1 million for services that, according to the claims data, … therapists. As a result, the providers often did not bill Medicare for the services or incorrectly reported a …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followOverpayments for Medicare Part C Coinsurance Charges (Follow-Up)
… for Medicare Part C Coinsurance Charges (2011-S-33). Background Our initial report, issued on September 26, …
https://www.osc.ny.gov/state-agencies/audits/2013/12/12/overpayments-medicare-part-c-coinsurance-charges-followReimbursement 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 …
https://www.osc.ny.gov/local-government/audits/county/2013/12/13/reimbursement-social-services-costs-2013ms-3Unnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… Background Our initial audit report, which was issued on April 18, 2012, examined whether the Department of Health … care payments (totaling about $111 million) that were made on behalf of 45,000 Medicare recipients who were ineligible …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followRetiree Annual Statement
… Your Retiree Annual Statement provides a year-end summary of your … Online . Look under My Account Summary . Click View My Retiree Annual Statement button. If Retirement System is … Look under My Profile Information . Click update next to ‘Retiree Annual Statement by.’ Choose Email from dropdown. Be …
https://www.osc.ny.gov/retirement/retirees/retiree-annual-statementMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… Purpose To determine if the Department of Health overpaid health care providers’ Medicaid claims for services also covered by Medicare Advantage plans. The audit covered the period from January 1, 2013 to July 31, … To determine if the Department of Health overpaid health care providers …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… two recommendations made in our audit report, Overpayments for Services Also Covered by Medicare Part B (Report … Part B, which provides supplementary medical insurance for a broad range of outpatient medical services, physicians’ fees, and medical supplies. For individuals enrolled in both Medicaid and Medicare, …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followMedicaid Payments to Medicare Advantage Plan Providers (Follow-Up)
… and copayments). We issued our initial audit report on September 10, 2018. The audit objective was to determine … implemented. Key Recommendation Officials are given 30 days after the issuance of the follow-up report to provide …
https://www.osc.ny.gov/state-agencies/audits/2019/10/15/medicaid-payments-medicare-advantage-plan-providers-followIncorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan (Follow-up)
… of implementation of the three recommendations included in our initial audit report, Incorrect Payments by CVS … Findings Civil Service and CVS Caremark made some progress in addressing the issues identified in the initial audit, including reprocessing over $5 million …
https://www.osc.ny.gov/state-agencies/audits/2025/06/18/incorrect-payments-cvs-caremark-medicare-rx-drug-claims-were-improperly-paid-underMedicaid Payments for Medicare Part A Beneficiaries (Follow-Up)
… Part A. Medicare Part A provides supplementary medical insurance for inpatient care in hospitals, post-hospital nursing home care, hospice, and home health services. If an individual is enrolled in both … payer and generally covers most of the eligible costs for health services. Medicaid, as a secondary payer, generally …
https://www.osc.ny.gov/state-agencies/audits/2014/04/04/medicaid-payments-medicare-part-beneficiaries-followMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… under 65 with certain disabilities. Individuals enrolled in both programs are commonly referred to as “dual-eligible.” … deductibles and coinsurance) on behalf of dual-eligibles. In December 2009, the Department of Health (Department) … the accuracy of Medicaid payments for dual-eligibles. In certain instances, providers may still submit these claims …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyImproper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
… Buy-In Premiums for Ineligible Recipients (Report 2020-S-35 ). About the Program The Department of Health (Department) …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/improper-payments-medicare-buy-premiums-ineligible-recipients-followCVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service
… invoiced drug manufacturers and remitted corresponding rebate revenue to the Department of Civil Service for prescription drugs provided under the Empire Plan … invoiced drug manufacturers and remitted corresponding rebate revenue to the Department of Civil Service for …
https://www.osc.ny.gov/state-agencies/audits/2023/06/21/cvs-health-accuracy-empire-plan-medicare-rx-drug-rebate-revenue-remitted-department-civilDiNapoli Finds Over $100 Million in Inappropriate Medicaid Payments
… (DOH) for the Medicare buy-in program, maternity care, and drug and therapy claims. Nearly $400,000 in premiums may have … DOH for the Medicare buyin program maternity care and drug and therapy claims …
https://www.osc.ny.gov/press/releases/2021/11/dinapoli-finds-over-100-million-inappropriate-medicaid-paymentsMedicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… C, managed care companies administer Medicare benefits and offer different health care plans (referred to as … Plan, Medicaid is generally the secondary payer and reimburses providers for financial balances not covered by the Plan (typically deductibles and coinsurance). Our initial audit report, issued on …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-follow