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Cost Saving Opportunities on Payments of Medicare Part C Claims (2020-S-65)
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.pdfOverpayments 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). … recipients. After Medicare adjudicates a claim, Medicaid pays the balance that is not covered by Medicare and would … of improper payments totaling $4.8 million from providers who inaccurately billed Medicare Part B claims. However, …
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
… through July 31, 2020. About the Program The Department of Health (Department) administers New York’s Medicaid program. Many of the State’s Medicaid recipients receive their services … center delivery costs associated with the maternity care of a recipient. However, MCOs are not eligible to receive …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-supplemental-maternity-capitation-payments-managed-careMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… Medicaid claims for services also covered by Medicare Advantage plans. The audit covered the period from January 1, … Plans deny a claim or pay a different amount than what a provider billed, Plans must communicate the reasons why to … submitting claims, providers are required to include the Plan-reported CARCs. The eMedNY system uses the CARCs to …
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 … certain individuals and families with low incomes. People who qualify for both Medicare and Medicaid are referred to as … while Medicaid is the secondary payer. Usually, Medicare pays 80 percent of the charges for approved Part B services, …
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)
… report, Overpayments for Services Also Covered by Medicare Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in Medicare Part B, which provides supplementary medical insurance for a …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followState Agencies Bulletin No. 1043
… Purpose To inform agencies of the content information for the 2010 Form W-2. Background … MD -- Maryland NJ -- New Jersey PA -- Pennsylvania SC -- South Carolina TX -- Texas PR – Puerto Rico Box 16 State Wages 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
… information which will appear on the Form W-2 Statement is described below: Box 1 Wage, Tips and Other Compensation The amount in this box is the Federal taxable gross wages Box 2 Federal Income Tax Withheld The amount in … agencies of the content information for the 2009 Form W2 …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/950-form-w-2-wage-and-tax-statement-calendar-year-2009Medicaid Program – Improper Premium Payments Made on Behalf of Managed Care Members Residing Outside the State
… Objective To determine if the Department of Health (DOH) improperly paid Medicaid managed care … October 2024. About the Program DOH administers New York State’s Medicaid program. Medicaid members must be residents …
https://www.osc.ny.gov/state-agencies/audits/2025/09/09/medicaid-program-improper-premium-payments-made-behalf-managed-care-members-residingMedicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… in our initial audit report, Medicaid Overpayments for Medicare Advantage Plan Services (Report 2017-S-46 ). About the … the Department overpaid health care providers’ Medicaid claims for services also covered by Plans. The audit covered …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followMedicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… that range from hospital care and physician services to dental and pharmacy benefits. In addition to Medicaid managed … services during the disenrollment period. (Note: A Plan is not at risk if it did not pay for medical services for a … formal clarification to HRA and other LDSS regarding what constitutes “at risk” to help ensure: ineligible …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamExamination of Outstanding Premiums
… Offset Program (SWOP), and (ii) the amount of outstanding premiums NYSIF may have been able to recover through SWOP … Background New York State businesses pay NYSIF premiums for workers compensation and disability insurance. If a … by the Department of Tax and Finance (DTF), is a way for State agencies to offset State payments to recover …
https://www.osc.ny.gov/state-agencies/audits/2016/08/19/examination-outstanding-premiumsCost 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.pdfOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… by Medicare (Report 2016-S-73 ). About the Program The New York State Medicaid program provides a wide range of medical … to as “dual-eligibles.” The Medicare program covers physical, occupational, and speech therapy services as well …
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
… Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by … to as “dual-eligibles.” The Medicare program covers physical, occupational, and speech therapy services, as well …
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)
To determine the extent of implementation of the six recommendations included in our initial audit report Improper Medicaid Payments Involving 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-clientState Comptroller DiNapoli Releases Audits
… usefulness in decision making. Auditors also found that many residents of long-term care facilities lack regular … for reimbursement. State Education Department (SED): Kids Unlimited, PT, OT & SLP, PLLC – Compliance With the … the same property where only one credit was due. Find out how your government money is spent at Open Book New York . …
https://www.osc.ny.gov/press/releases/2021/01/state-comptroller-dinapoli-releases-auditsAudit of the Tuition Reimbursement Account for the Five Fiscal Years Ended March 31, 2018
To express an opinion on the fair presentation of the Financial Statements of the Tuition Reimbursement Account for the five fiscal years ended March 31 2018
https://www.osc.ny.gov/state-agencies/audits/2019/09/06/audit-tuition-reimbursement-account-five-fiscal-years-ended-march-31-2018Comptroller DiNapoli Releases State Audits
… and one has not been implemented. State Department of Health: Medicaid Payments for Medicare Part A Beneficiaries … refer to health care services provided in the home, medical offices, clinics, and other freestanding sites. … recipients who were also covered by Medicare. Office of Mental Health, New York Psychiatric Center: Controls Over …
https://www.osc.ny.gov/press/releases/2014/04/comptroller-dinapoli-releases-state-auditsState Comptroller DiNapoli Releases Audits
… of Homeless Shelter Providers – Rescue Mission Alliance of Syracuse (Follow-Up) (2024-F-2) The Onondaga County … with the not-for-profit Rescue Mission Alliance of Syracuse (Rescue Mission) to provide homeless services. The … 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-audits