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UnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
… our audit report, UnitedHealthcare: Improper Payments for Medical Services Designated By Modifier Code 59 (Report … with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to Empire Plan members. United’s payments to medical providers are based, in part, on procedure codes …
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
… Purpose To determine if United HealthCare Insurance Company of New York (United) credited the … drug manufacturers. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating … To determine if United HealthCare Insurance Company of New York United credited the Department …
https://www.osc.ny.gov/state-agencies/audits/2014/09/26/empire-plan-drug-rebate-revenueMedicaid Program – Overpayments for Medicare Part C Claims
… Objective To determine whether Medicaid made improper payments on Medicare Part C claims for … care providers for services rendered to enrollees. Many Medicaid recipients are enrolled in these Plans (referred to as “dual-eligibles”). Generally, Medicaid is the secondary payer and covers 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
… is to inform agencies of OSC’s automatic processing of the PEF 2023 Dental Stipend and to provide agency instructions … the 2023-2026 Agreement between the State of New York and PEF which includes a side letter authorizing a $400 lump sum … increases, and are not pensionable. Effective Dates: The PEF 2023 Dental Stipend will be processed in Administration …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/22041-public-employees-federation-pef-2023-dental-stipendState Comptroller DiNapoli Releases Audits
… not receive $453,029 in rebate revenue for the period of Jan. 1, 2014 through Dec. 31, 2018. In a follow-up, auditors … government financial records, track state contracts, and find commonly requested data. …
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
… to ensure accurate eligibility determinations and timely closure of Buy-in Program cases for ineligible individuals. …
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
… (1) have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a … benefits to be enrolled in Medicare without a recipient’s consent. However, this policy does not address Medicaid … ESRD could be similarly enrolled, without a recipient’s consent, as long as they met ESRD Medicare requirements. Key …
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
… control the Medicaid costs of recipients who were eligible for Medicare based on age but were not enrolled in Medicare. … program. Individuals who are eligible or appear eligible for Medicare are required to apply for Medicare as a condition of receiving Medicaid. When …
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
… total Medicare and Medicaid payment for a service did not exceed Medicaid's normal service fee. Other states already … use this approach, and New York uses this approach to limit payments for certain other Medicare cost-sharing … so that the Medicare and Medicaid payment in total did not exceed Medicaid's fee, Medicaid would not have paid the …
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)
… audit report, Medicaid Payments Made Pursuant to Medicare Part C (Report 2012-S-133). Background Medicaid provides … recipients are also enrolled in Medicare. Under Medicare Part C, also known as Medicare managed care or Medicare … benefits. Medicare pays a fixed amount for each Medicare Part C beneficiary every month to companies offering 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)
… audit report, Medicaid Program – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare (Report 2021-S-16 ). About the Program DOH … program. Individuals who are eligible or appear eligible for Medicare are required to apply for Medicare as a … audit report Medicaid Program Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare Report 2021S16 …
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
… had approximately 7.4 million enrollees and Medicaid claim costs totaled about $56 billion. The federal government … Medicaid recipients with ESRD and helps guide them on how to apply for and enroll in Medicare. In response to the … in applying for Medicare; Follow up with recipients who do not apply for Medicare by implementing a process that …
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
… provided to enrollees. For dual-eligibles, plan providers bill Medicaid directly for the enrollee’s Part C cost-sharing … providers, including those identified in this report, to bill Medicare Part C claims in accordance with existing …
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
… through Medicare Advantage plans, which have networks of participating providers that they reimburse for services … on 7,072 Medicaid claims resulting in overpayments of $770,935. We determined three of the providers were overpaid 58, 74, and 79 percent of 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)
… in Medicare, the federal health insurance program for the elderly and disabled. Under Medicare Part C, also known as …
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
To determine whether Medicaid cost savings can be achieved by modifying the reimbursement methodology for Medicare Part C costsharing claims in accordance with federal requirements
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
… 1, 2015 through Dec. 31, 2019. Metropolitan Transportation Authority (MTA) - New York City Transit: Maintenance and … Department of State, Office of General Services, Olympic Regional Development Authority, Department of Environmental … complying with contract terms, despite central office and regional office managers’ concerns. The department could also …
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)
… made in our initial audit report, Reducing Medicaid Costs for Recipients With End Stage Renal Disease (Report 2015-S-14 … with end stage renal disease (ESRD) who were eligible for, but not enrolled in Medicare. Medicaid recipients with ESRD may be eligible for Medicare coverage if they meet certain conditions. When …
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)
… on Payments of Medicare Part C Claims (Report 2020-S-65 ). About the Program Many of the State’s Medicaid …
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)
… for Medicare Part B, which provides supplementary medical insurance covering a broad range of outpatient medical … to provide information on any actions that are planned to address the unresolved issues discussed in this report. Other …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-follow