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Empire BlueCross BlueShield – Controls Over Payments for Special Items
… range of services including, but not limited to, hospital services, office visits, home care, medical equipment, mental health services, and prescription drugs. The State … rate schedules for the payment of inpatient and outpatient hospital services. Empire’s hospital contracts also allow …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
… and retired State, participating local government, and school district employees, and their dependents. The Empire …
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
… 31, 2013. In accordance with the contract, United is required to negotiate agreements with drug manufacturers for … we requested, and refused to provide certain amendments to manufacturer agreements. This limited our ability to ensure … Improper Claims Submitted by Davis Ethical Pharmacy (2012-S-10) United HealthCare: New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2014/09/26/empire-plan-drug-rebate-revenueMedicaid Program – Overpayments for Medicare Part C Claims
… copayments, and coinsurance, as follows. Medicaid pays 100% of the deductibles. Medicaid pays 100% of the copayments and coinsurance on inpatient claims, and Medicaid pays 85% of the copayments and coinsurance on outpatient …
https://www.osc.ny.gov/state-agencies/audits/2024/12/04/medicaid-program-overpayments-medicare-part-c-claimsState Agencies Bulletin No. 2204.1
… position Goal Balance: Leave blank Please Note: Agencies do not need to make any changes to a previously entered Time Entry record and do not need to enter an Additional Pay record if the employee …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/22041-public-employees-federation-pef-2023-dental-stipendState Comptroller DiNapoli Releases Audits
… of Public Protection Grant Programs (Follow-Up) (2021-F-21) An audit released in April 2020 found that the Division … (TLD) is the last part of an Internet address, such as .com, .net, or .org. In March 2012, DoITT entered into a …
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 determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buyin program
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
… entitlement to Medicare and taken proactive steps to help get them enrolled, the Medicaid program could have saved as … age 65 who meet ESRD Medicare eligibility requirements who do not apply for Medicare. We requested that SSA issue a … apply for Medicare. Follow up with recipients who do not apply for Medicare by implementing a process that: …
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
… 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/2023/09/14/medicaid-program-reducing-medicaid-costs-recipients-who-are-eligible-medicareMedicaid Program – Medicaid Payments Made Pursuant to Medicare Part C
… Purpose To determine if Medicaid made excessive payments for Medicare Part C cost-sharing liabilities. The audit covered … in Medicare. Such recipients are commonly referred to as "dual-eligibles." In 1997, Congress established … To determine if Medicaid made excessive payments for Medicare …
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)
… Purpose To determine the extent of implementation of the six recommendations made in our audit report, Medicaid … disadvantaged and/or have special health care needs. Many of the State’s Medicaid recipients are also enrolled in … To determine the extent of implementation of the six recommendations made in our …
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)
… for Recipients Who Are Eligible for Medicare (Report 2021-S-16 ). About the Program DOH administers the State’s … for Medicare are required to apply for Medicare as a condition of receiving Medicaid. When Medicaid recipients … saved $294.4 million on behalf of these recipients for clinic, inpatient, and practitioner claims that could have …
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
… The state Department of Health (DOH) could have saved the Medicaid program as much … and struggling with day-to-day life should be informed of their Medicare eligibility, which could reduce their out-of-pocket expenses and may provide them with more options for …
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
… 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-claimsMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… Purpose To determine whether Medicaid inappropriately paid for recipients’ Medicare Part C cost-sharing liabilities. The audit covered … in Medicare. Such recipients are commonly referred to as “dual-eligibles.” In 1997, Congress established … To determine whether Medicaid inappropriately paid for …
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)
… Purpose To determine the extent of implementation of the three recommendations included in our initial audit … disadvantaged and/or have special health care needs. Many of the State’s Medicaid recipients are also enrolled in … To determine the extent of implementation of the three recommendations included in …
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 these dual-eligible recipients. Medicaid typically pays for cost-sharing liabilities, which include Medicare … for ambulance and psychology services, for which Medicaid pays 100 percent of the cost-sharing liability (inpatient … and it is similar to how New York Medicaid currently pays Medicare Part B cost-sharing. We project that, using …
https://www.osc.ny.gov/state-agencies/audits/2021/09/21/medicaid-program-cost-saving-opportunities-payments-medicare-part-c-claimsReducing 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 … To determine the implementation status of the five recommendations made in our initial audit …
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 Many of the … in Medicare and are referred to as “dual-eligibles.” Medicare Part A provides hospital insurance and Part B … audit report Cost Saving Opportunities on Payments of Medicare Part C Claims Report 2020S65 …
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)
… 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-follow