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Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… 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 …
https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claimsMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… Medicaid inappropriately paid for recipients’ Medicare Part C cost-sharing liabilities. The audit covered the period … “dual-eligibles.” In 1997, Congress established Medicare Part C, the Medicare managed care program also known as …
https://www.osc.ny.gov/state-agencies/audits/2018/09/10/medicaid-program-medicaid-payments-medicare-advantage-plan-providersMedicaid Overpayments for Certain Medicare Part C Claims (Follow-Up)
… initial audit report, Medicaid Overpayments for Certain Medicare Part C Claims (Report 2013-S-35). Background Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2016/12/08/medicaid-overpayments-certain-medicare-part-c-claims-followReducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)
… them enroll, the Medicaid program could have saved as much as $146 million over the six-year audit period ended … recipients diagnosed with ESRD and instruct them on how and where to apply for Medicare; develop an outreach … for Medicare; follow up with Medicaid recipients who do not apply for Medicare; and recover Medicaid claims paid …
https://www.osc.ny.gov/state-agencies/audits/2018/09/05/reducing-medicaid-costs-recipients-end-stage-renal-disease-followOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… audit report, Overpayments for Services Also Covered by Medicare Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for Medicare Part B, which provides supplementary medical …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followMedicaid Program – Improper Payments to a Physical Therapist
… “crossover” claims. In December 2009, the Department of Health (Department) implemented an automated crossover … system. The crossover system improved the accuracy of Medicaid payments for dualeligible recipients. Prior to … Medicare payment information directly to Medicaid instead of using the crossover system. During our audit period, …
https://www.osc.ny.gov/state-agencies/audits/2014/12/15/medicaid-program-improper-payments-physical-therapistReimbursement of Social Services Costs (2013MS-3)
… 31, 2012. Background The Department of Social Services (DSS) incurs both direct and indirect program costs in the … by other county departments for the benefit of the DSS) that are directly billed to the DSS. In addition, counties are reimbursed for the indirect …
https://www.osc.ny.gov/local-government/audits/county/2013/12/13/reimbursement-social-services-costs-2013ms-3Medicaid 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 … 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, 2017 for therapy … The Medicare program covers physical, occupational, and speech therapy services, as well as prescription drugs. …
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)
… Purpose To determine the extent of implementation of the five recommendations made … to self-report accurate information to eMedNY regarding how much Medicare paid and how much Medicaid owed, which often …
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
… insurance programs. NYSHIP covers over 1.2 million active and retired State, participating local government, and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/new-york-state-health-insurance-program-incorrect-payments-cvs-caremark-medicare-rx-drugRetiree Annual Statement
… and taxes. It also gives you an explanation of the pension payment option you chose at retirement. Mailed Delivery: We … . Do not use your Statement for tax purposes . Net Benefit Payment The total amount you received after credits, deductions and taxes. Pension Payment Option An explanation of the pension payment option …
https://www.osc.ny.gov/retirement/retirees/retiree-annual-statementImproper Payments Related to the Medicare Buy-In Program (Follow-Up)
… extent of implementation of the five recommendations made in our audit report, Improper Payments Related to the Medicare Buy-In Program ( 2010-S-76 ). Background The federal government established the Medicare buy-in program to assist certain low-income people pay …
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)
… services to those who are economically disadvantaged and/or have special health care needs. Many of the State’s … the providers often did not bill Medicare for the services or incorrectly reported a modifier code, which caused …
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)
… included in our initial audit report, Overpayments for Medicare Part C Coinsurance Charges (2011-S-33). … Medicaid made inappropriate payments to medical providers for services rendered to Medicaid recipients enrolled in a … participating providers that the plans reimburse directly for services provided to enrollees. Medicare Advantage Plan …
https://www.osc.ny.gov/state-agencies/audits/2013/12/12/overpayments-medicare-part-c-coinsurance-charges-followUnnecessary 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 …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… Purpose To determine if the Department of Health overpaid health care … plans. The audit covered the period from January 1, 2013 to July 31, 2017. Background Many Medicaid recipients are … using Claim Adjustment Reason Codes (CARCs). Providers submit claims for unpaid amounts to Medicaid through eMedNY, …
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)
… for a broad range of outpatient medical services, physicians’ fees, and medical supplies. For individuals …
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)
… made in our initial audit report, Medicaid Payments to Medicare Advantage Plan Providers (Report 2016-S-54 ). About … of the State’s Medicaid recipients are also enrolled in Medicare, the federal health insurance program for people age …
https://www.osc.ny.gov/state-agencies/audits/2019/10/15/medicaid-payments-medicare-advantage-plan-providers-followMedicaid Payments for Medicare Part A Beneficiaries (Follow-Up)
… in our audit report, Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36). Background Our initial audit … of Health: Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36) … To determine the extent of …
https://www.osc.ny.gov/state-agencies/audits/2014/04/04/medicaid-payments-medicare-part-beneficiaries-follow