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Medicaid Program – Overpayments for Medicare Part C Claims
… Medicaid made improper payments on Medicare Part C claims for recipients covered by Medicare Advantage Plans. The audit … Plans (Plans). Plans reimburse health care providers for services rendered to enrollees. Many Medicaid recipients … Part C claims, including the hospitals identified in this report, and ensure corrective steps are taken. Enhance …
https://www.osc.ny.gov/state-agencies/audits/2024/12/04/medicaid-program-overpayments-medicare-part-c-claimsOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… included in our initial audit report, Overpayments for Services Also Covered by Medicare Part B (2010-S-50). … Many of the State's Medicaid recipients are also eligible for Medicare Part B, which provides supplementary medical … Generally, Medicare is the primary payer of claims for services provided to dual-eligible recipients. After …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followMedicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
… the Department pays managed care organizations (MCOs) a monthly premium for each enrolled recipient and, in turn, … in termination or miscarriage; and $2.4 million was paid when the SMCP date of service preceded the birth by 1 to 6 … payments. The Department’s eMedNY claims processing system does not have access to maternity encounter data to verify …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-supplemental-maternity-capitation-payments-managed-careCost Saving Opportunities on Payments of Medicare Part C Claims (2020-S-65) 180-Day Response
To determine whether Medicaid cost savings can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with federal requirements.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2021-20s65-response.pdfMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… of Health overpaid health care providers’ Medicaid claims for services also covered by Medicare Advantage plans. The … plans (Plans) also offer supplemental insurance benefits for services that are not covered by original Medicare (e.g., … dental services). Plans reimburse health care providers for services provided to enrollees. Generally, Medicaid is …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesMedicaid 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 …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bOverpayments 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-followState Agencies Bulletin No. 1043
… who has worked for one (1) company, State of New York (NYS) or City University of New York (CUNY) during the year … in more than one (1) company (for example, both CUNY and NYS) will receive a Form W-2 for each company. The … excluded amount. This is the amount awarded by the NYS Workers’ Compensation Board which is excluded from the …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1043-form-w-2-wage-and-tax-statement-calendar-year-2010State Agencies Bulletin No. 950
… Form W-2 Content 2009 Form W-2s will include earnings paid in paychecks dated: Administration: 1/7/09 through 12/23/09 … will receive only one (1) Form W-2. Employees who worked in more than one (1) company (for example, both CUNY and NYS) … CA -- California FL -- Florida GA -- Georgia MA -- Massachusetts MD -- Maryland NJ -- New Jersey PA -- …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/950-form-w-2-wage-and-tax-statement-calendar-year-2009Medicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… Medicaid mainstream managed care plans and Family Health Plus managed care plans (Plans) for recipients who were no … managed care, during the audit period, Family Health Plus (FHP) was a publicly funded managed care program for …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamExamination of Outstanding Premiums
… Consider system enhancements to identify policyholders and account balances for each category of receivables. Assess the …
https://www.osc.ny.gov/state-agencies/audits/2016/08/19/examination-outstanding-premiumsMedicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… in our initial audit report, Medicaid Overpayments for Medicare Advantage Plan Services (Report 2017-S-46 ). … is generally the secondary payer and reimburses providers for financial balances not covered by the Plan (typically … Department overpaid health care providers’ Medicaid claims for services also covered by Plans. The audit covered the …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… who are economically disadvantaged and/or have special health care needs. Many of the State’s Medicaid recipients … these services are rendered to dual-eligible recipients, health care providers are required to bill Medicare, which is … The audit objective was to determine if the Department of Health (Department) overpaid health care providers’ Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… of Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered … covered the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, 2017 for therapy services. About the Program Many of the State’s …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareImproper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up)
… of Social Services or the NY State of Health (the State’s online health insurance marketplace). Multiple eligibility …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/improper-medicaid-payments-involving-fee-service-claims-recipients-multiple-clientState Comptroller DiNapoli Releases Audits
… residents of long-term care facilities lack regular access to ombudsman services, due in part to a decline in the number of volunteers combined with a lack … containing confidential information were insufficient to prevent unnecessary or inappropriate access to those …
https://www.osc.ny.gov/press/releases/2021/01/state-comptroller-dinapoli-releases-auditsState Comptroller DiNapoli Releases Audits
… of social services (Local Districts) to ensure that all required documents have been included, and assessing … of social services (Local Districts) to ensure that all required documents have been included, and assessing …
https://www.osc.ny.gov/press/releases/2024/08/state-comptroller-dinapoli-releases-auditsComptroller DiNapoli Releases State Audits
… New York State Comptroller Thomas P. DiNapoli announced today the following … partially implemented, and one has not been implemented. State Department of Health: Medicaid Payments for Medicare … three were implemented and one was not implemented. State Department of Health, Medicaid Program: Improper …
https://www.osc.ny.gov/press/releases/2014/04/comptroller-dinapoli-releases-state-auditsMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… from June 1, 2012 through May 31, 2017. Background Many of the State’s Medicaid recipients are also eligible for … supplementary medical insurance coverage for a range of outpatient medical services, physician services, and … the claims bypass the payment controls enforced by the crossover system. Key Findings Auditors identified up …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyPlainview-Old Bethpage Central School District - Retiree Health Insurance (2018M-148)
… Establish a process to periodically monitor the status of all retirees and their spouses and dependents receiving …
https://www.osc.ny.gov/local-government/audits/school-district/2018/09/21/plainview-old-bethpage-central-school-district-retiree-health-insurance