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Medicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… Purpose To determine whether the Department of Health (Department) made inappropriate premium payments to Medicaid mainstream managed care plans and Family Health Plus managed care plans (Plans) for recipients who … To determine whether the Department of Health made inappropriate premium payments to Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamOverpayments for Medicare Part C Coinsurance Charges (Follow-Up)
… our initial audit report, Overpayments for Medicare Part C Coinsurance Charges (2011-S-33). Background Our initial report, issued on September 26, … for services rendered to Medicaid recipients enrolled in a Healthfirst Medicare Advantage Plan. Many Medicaid … in our initial audit report Overpayments for Medicare Part C Coinsurance Charges …
https://www.osc.ny.gov/state-agencies/audits/2013/12/12/overpayments-medicare-part-c-coinsurance-charges-followExamination of Outstanding Premiums
… the New York State Insurance Fund (NYSIF) participates in the Statewide Offset Program (SWOP), and (ii) the amount … to offset State payments to recover outstanding debt. In May 2015, we recommended NYSIF participate in SWOP as a means to recover outstanding premium. Key …
https://www.osc.ny.gov/state-agencies/audits/2016/08/19/examination-outstanding-premiumsMedicaid Payments for Medicare Part A Beneficiaries (Follow-Up)
… made in our audit report, Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36). Background Our initial … for recipients who were also enrolled in Medicare Part A. Medicare Part A provides supplementary medical insurance for inpatient … made in our audit report Medicaid Payments for Medicare Part A Beneficiaries 2009S36 …
https://www.osc.ny.gov/state-agencies/audits/2014/04/04/medicaid-payments-medicare-part-beneficiaries-followAudit of the Tuition Reimbursement Account for the Five Fiscal Years Ended March 31, 2018
… the financial statements referred to above present fairly, in all material respects, the respective financial …
https://www.osc.ny.gov/state-agencies/audits/2019/09/06/audit-tuition-reimbursement-account-five-fiscal-years-ended-march-31-2018Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… Part C, private managed care companies administer Medicare benefits. These Medicare Advantage Plans typically have … 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-claimsImproper Supplemental Maternity Capitation Payments to Managed Care Organizations (Follow-Up)
… of implementation of the six recommendations included in our initial audit report, Improper Supplemental Maternity … (MCOs) a monthly premium for each enrolled recipient and, in turn, the MCOs pay for services their members require. In addition to the monthly premiums, MCOs can receive a …
https://www.osc.ny.gov/state-agencies/audits/2023/07/20/improper-supplemental-maternity-capitation-payments-managed-care-organizations-followOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… by Medicare Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for Medicare … by Medicare. Our initial audit report, which was issued on June 20, 2012, examined whether the Department of Health … providers did not properly report Medicare payment data on those claims. Key Findings Department officials made …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followState Comptroller DiNapoli Releases Audits
… and three were not implemented. New York State Health Insurance Program – Anthem Blue Cross – Coordination of Benefits With Medicare (2023-S-3) …
https://www.osc.ny.gov/press/releases/2024/08/state-comptroller-dinapoli-releases-auditsImproper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up)
… Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Report 2019-S-22 ). About the … individual who applies for Medicaid benefits is assigned a Client Identification Number (CIN), a unique identifier. … FeeforService Claims for Recipients With Multiple Client Identification Numbers Report 2019S22 …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/improper-medicaid-payments-involving-fee-service-claims-recipients-multiple-clientComptroller DiNapoli Releases State Audits
… audit report. This included the recovery of approximately $22.6 million in Medicaid overpayments. Of the initial … in July 2011, examined the Department of Transportation’s (DOT) oversight of grant activity. Auditors found that the … effective communication and information sharing within the DOT and with other state agencies that also provide grant …
https://www.osc.ny.gov/press/releases/2014/04/comptroller-dinapoli-releases-state-auditsMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… Purpose To determine if the Department of Health overpaid health care providers’ Medicaid claims for … Medicare Advantage plans) tailored to the specific needs of Medicare beneficiaries. Some Medicare Advantage plans … the reasons why to providers on the Explanation of Benefits (EOB) using Claim Adjustment Reason Codes …
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)
… Purpose To determine the extent of implementation of the two recommendations made in our audit report, … by Medicare Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in … To determine the extent of implementation of the two recommendations made in our …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followMedicaid Program – Overpayments for Services Also Covered by Medicare Part B
… while Medicaid is the secondary payer. Usually, Medicare pays 80 percent of the charges for approved Part B services, and Medicaid pays the remaining balances (typically for coinsurance) for …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bMedicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… of implementation of the five recommendations included in our initial audit report, Medicaid Overpayments for Medicare Advantage Plan Services (Report 2017-S-46 ). … program. Many Medicaid recipients are also enrolled in Medicare Part C, commonly referred to as Medicare Managed …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followComptroller DiNapoli Releases State Audits
… New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued: Research … $20.3 million overpayment from an incorrect reimbursement rate. Auditors found other overpayments of approximately $1.2 …
https://www.osc.ny.gov/press/releases/2014/01/comptroller-dinapoli-releases-state-auditsPlainview-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-insuranceState Comptroller DiNapoli Releases Audits
… (CUNY): Controls Over CUNY Fully Integrated Resources and Services Tool (Follow-Up) (2018-F-4) An initial audit … condition, exhibiting problems such as mold; water damage; structural damage; and fire safety issues, such as exposed wiring and missing smoke …
https://www.osc.ny.gov/press/releases/2018/09/state-comptroller-dinapoli-releases-audits-0Overpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by Medicare … Many of the State’s Medicaid recipients are also enrolled in Medicare. Such individuals are referred to as …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followCost-Saving Ideas: Overtime Planning and Management
… costs. Fair Labor Standards Act and the New York State Taylor Law In implementing actions relating to overtime, keep … well as collective bargaining principles under the State's Taylor Law (Civil Service Law article 14). Resources Local …
https://www.osc.ny.gov/local-government/publications/cost-saving-ideas-overtime-planning-and-management