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

… of Health: Overpayments for Services Also Covered by Medicare Part B (2010-S-50) Department of Health: Medicaid …

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

… therapy services and prescription drugs that are covered by Medicare. The audit covered the period January 1, 2012 to … to the automated claim information, should have been paid by Medicare, as follows: $18.6 million was paid for physical, … occupational, and speech therapy services provided by licensed therapists. Payments were made on behalf of 6,712 …

Overpayments of Certain Medicare Crossover Claims (Follow-Up)

… of the five recommendations made in our audit report, Overpayments of Certain Medicare Crossover Claims (2011-S-28). Background Many Medicaid recipients are also enrolled in Medicare, the … payer for medical services provided to dual-eligibles. Medicaid then typically pays for any remaining balance not …

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

… communicates with the Centers for Medicare & Medicaid Services (CMS) to ensure Medicare enrollment information is … from Civil Service’s health insurance enrollment system to determine which plan should pay member claims. Key …

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

… Medicaid made nearly 260,000 improper payments (totaling about $26.8 million) for people enrolled in the Medicare …

XIII. Employee Expense Reimbursement – XIII. Employee Expense Reimbursement

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

… audit concluded that the State’s Medicaid program paid $20.1 million for services that, according to the claims data, …

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

… Overpayments for Medicare Part C Coinsurance Charges (2011-S-33). Background Our initial report, issued on … of Health: Overpayments to Cabrini Medical Center (2011-S-8) … To determine the extent of implementation of the …

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

… and coinsurance for the recipients in question, the net savings to Medicaid would have been about $36 million. …

Medicaid 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 …

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

… Medicare Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in Medicare … or populations. Our initial audit report, which was issued on July 9, 2013, identified $7.3 million in Medicaid … potential recoveries were likely lost due to the inaction on overpayments for claims that are now more than six years …

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

… to Medicare Advantage Plan Providers (Report 2016-S-54 ). About the Program Many of the State’s Medicaid recipients are …

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

To determine the extent of implementation of the four recommendations made in our audit report Medicaid Payments for Medicare Part A Beneficiaries 2009S36

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

… Commercial Plan (Report 2022-S-24 ). About the Program The New York State Health Insurance Program (NYSHIP), administered by … the State. The objective of our initial audit, issued on September 13, 2023, was to determine whether CVS Caremark …

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

… the claims bypass the payment controls enforced by the crossover system. Key Findings Auditors identified up … limits. Key Recommendations Review the payments identified by the audit and recover overpayments, as appropriate. …

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

… program credits from January 1, 2015 to November 30, 2020. About the Program The Department of Health (Department) …

Medicaid Program – Overpayments for Medicare Part C Claims

… to enrollees. Many Medicaid recipients are enrolled in these Plans (referred to as “dual-eligibles”). Generally, … May 2018 through April 2023 and identified $121.4 million in claims that fell into at least one of the following three … incorrectly billed, but 17 incorrect claims did not result in overpayments [e.g., inpatient claims billed as a …

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

… individuals enrolled in the Buy-in Program for the period from January 1, 2015 through December 31, 2019 and associated Medicare Buy-in Program credits from January 1, 2015 to November 30, 2020. We determined the … the State may have been eligible for equitable relief from CMS for its share of $13 million in premiums paid beyond …

CVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service

… York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides … rebates. Key Findings We reviewed rebate revenue generated by Empire Plan Medicare Rx and found that CVS Health did not …

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

… Plains. This case has been assigned to U.S. District Court Judge Kenneth M. Karas. Berman also today announced the … date. The case is assigned to United States District Judge Nelson S. Román. JAMES SPINA, 59, of Middletown, New … any sentencing of the defendant would be determined by the judge. Manhattan U.S. Attorney Geoffrey S. Berman praised the …