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UnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
… Payments for Medical Services Designated By Modifier Code 59 (Report 2013-S-82 ). Background The New York State … that indicate the medical services performed. Modifier code 59 is used to indicate that a provider performed a … paid for medical services designated with modifier code 59 that were not distinct and independent from other …
https://www.osc.ny.gov/state-agencies/audits/2017/12/27/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59-followEmpire Plan Drug Rebate Revenue
… for rebates, discounts, and other considerations and pass 100 percent of the value of the agreements on to the … and $18,686 in discounts that Express Scripts did not pass on to the Department. United agreed to credit $670,470 …
https://www.osc.ny.gov/state-agencies/audits/2014/09/26/empire-plan-drug-rebate-revenueMedicaid Program – Overpayments for Medicare Part C Claims
… 2023. About the Program Under Medicare Part C, private insurance companies administer Medicare benefits through … Plans deny a claim or pay a different amount than what a provider billed (e.g., after netting out cost-sharing …
https://www.osc.ny.gov/state-agencies/audits/2024/12/04/medicaid-program-overpayments-medicare-part-c-claimsState Agencies Bulletin No. 2204.1
… agencies of OSC’s automatic processing of the PEF 2023 Dental Stipend and to provide agency instructions for … a $400 lump sum payment to offset out-of-pocket dental expenses for eligible employees. The payment is … payable each fiscal year until the State enters into a new dental services contract for eligible NYSHIP enrollees. These …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/22041-public-employees-federation-pef-2023-dental-stipendState Comptroller DiNapoli Releases Audits
… generic TLD (gTLD) and to operate, manage, maintain, and market the .nyc gTLD program. Auditors found DoITT collected …
https://www.osc.ny.gov/press/releases/2021/11/state-comptroller-dinapoli-releases-audits-0Medicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients
… Objective To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the … Program eligibility determinations and to prevent improper premium payments. During our audit scope: Medicaid made $31.7 million in improper Medicare premium payments on behalf of 42,586 individuals who did not …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipientsMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… to control the Medicaid costs of recipients diagnosed with end stage renal disease who were eligible for, but not … on behalf of 10,906 Medicaid recipients who were diagnosed with ESRD. Medicaid recipients with ESRD are eligible for Medicare coverage if they receive …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseMedicaid Program – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare
… enrolled in Medicare, Medicare becomes the primary payer and Medicaid the secondary. As a secondary payer, rather than … can pay a recipient’s Medicare premiums, deductibles, and coinsurance amounts, which allows for a significant cost … or will be turning age 65 within a 3-month time frame, and have them apply for Medicare. The Social Security …
https://www.osc.ny.gov/state-agencies/audits/2023/09/14/medicaid-program-reducing-medicaid-costs-recipients-who-are-eligible-medicareMedicaid Program – Medicaid Payments Made Pursuant to Medicare Part C
… To determine if Medicaid made excessive payments for Medicare Part C cost-sharing liabilities. The audit covered … Background Many Medicaid recipients are also enrolled in Medicare. Such recipients are commonly referred to as "dual-eligibles." In 1997, Congress established Medicare Part C, also known as Medicare managed care or …
https://www.osc.ny.gov/state-agencies/audits/2014/05/09/medicaid-program-medicaid-payments-made-pursuant-medicare-part-cMedicaid Payments Made Pursuant to Medicare Part C (Follow-Up)
… C (Report 2012-S-133). Background Medicaid provides health care services to those who are economically disadvantaged and/or have special health care needs. Many of the State’s Medicaid recipients are also … Part C, also known as Medicare managed care or Medicare Advantage, private managed care companies administer Medicare …
https://www.osc.ny.gov/state-agencies/audits/2016/12/15/medicaid-payments-made-pursuant-medicare-part-c-followReducing Medicaid Costs for Recipients Who Are Eligible for Medicare (Follow-Up)
… apply for Medicare. The Social Security Administration (SSA) determines Medicare eligibility and enrolls individuals. … are eligible to receive Medicaid. When SSA receives an SSI application for someone who is 65 years of age, it also checks the individual’s Medicare …
https://www.osc.ny.gov/state-agencies/audits/2025/08/13/reducing-medicaid-costs-recipients-who-are-eligible-medicare-followDiNapoli: State Missing Out on Millions in Medicare Payments for Kidney Patients
… disease (ESRD) who meet certain eligibility requirements get the Medicare benefits to which they are entitled, … their entitlement to Medicare and taken steps to help get them enrolled, the Medicaid program could have saved as … renal disease who meet certain eligibility requirements get the Medicare benefits to which they are entitled …
https://www.osc.ny.gov/press/releases/2017/03/dinapoli-state-missing-out-millions-medicare-payments-kidney-patientsMedicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… are commonly referred to as “dual-eligibles.” In 1997, Congress established Medicare Part C, the Medicare managed …
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
… Purpose To determine whether Medicaid inappropriately paid for … in Medicare. Such recipients are commonly referred to as “dual-eligibles.” In 1997, Congress established … providers that they reimburse for services provided to enrollees. For dual-eligibles, Medicaid reimburses the …
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)
… recommendations included in our initial audit report, Medicaid Overpayments for Certain Medicare Part C Claims (Report 2013-S-35). Background Medicaid provides health care services to those who are … three recommendations included in our initial audit report Medicaid Overpayments for Certain Medicare Part C Claims …
https://www.osc.ny.gov/state-agencies/audits/2016/12/08/medicaid-overpayments-certain-medicare-part-c-claims-followMedicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims
… by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with federal … deductibles, coinsurance, and copayments. Under Medicare Part C, private companies administer Medicare benefits by … Medicaid programs several options for paying the Medicare Part C cost-sharing. States can pay: the full Medicare …
https://www.osc.ny.gov/state-agencies/audits/2021/09/21/medicaid-program-cost-saving-opportunities-payments-medicare-part-c-claimsState Comptroller DiNapoli Releases Audits
… million. Multi-Agency: Compliance With Executive Order 95 - Achieving Transparency and Citizen Engagement Through … of reports to examine state agencies’ compliance with EO 95 to improve accountability and support continuous … Recreation and Historic Preservation. Compliance with EO 95 requirements varied across the five agencies audited. OSC …
https://www.osc.ny.gov/press/releases/2021/11/state-comptroller-dinapoli-releases-auditsReducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)
… Purpose To determine the implementation status of the five … recommendations made in our initial audit report, Reducing Medicaid Costs for Recipients With End Stage Renal Disease (Report 2015-S-14 ). … To determine the implementation status of the five … recommendations made in our initial audit report Reducing Medicaid Costs for Recipients With End Stage Renal Disease …
https://www.osc.ny.gov/state-agencies/audits/2018/09/05/reducing-medicaid-costs-recipients-end-stage-renal-disease-followCost Saving Opportunities on Payments of Medicare Part C Claims (Follow-Up)
… audit report, Cost Saving Opportunities on Payments of Medicare Part C Claims (Report 2020-S-65 ). About the Program … in Medicare and are referred to as “dual-eligibles.” Medicare Part A provides hospital insurance and Part B … insurance for doctors’ services and outpatient care. Under Medicare Part C, companies administer Medicare benefits …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/cost-saving-opportunities-payments-medicare-part-c-claims-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 … supplies. Individuals enrolled in both Medicaid and Medicare are commonly referred to as "dual eligible." …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-follow