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Empire Plan Drug Rebate Revenue
… from six drug manufacturers. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, and school district … and pass 100 percent of the value of the agreements on to the prescription drug program. United subcontracted key …
https://www.osc.ny.gov/state-agencies/audits/2014/09/26/empire-plan-drug-rebate-revenueUnitedHealthcare – 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 2013-S-82 ). Background The New York State … with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to Empire …
https://www.osc.ny.gov/state-agencies/audits/2017/12/27/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59-followMedicaid Program – Overpayments for Medicare Part C Claims
… whether Medicaid made improper payments on Medicare Part C claims for recipients covered by Medicare Advantage … 2018 through April 2023. About the Program Under Medicare Part C, private insurance companies administer Medicare … as the correct payment amount. Key Findings We analyzed Part C claims for hospital-based inpatient and outpatient …
https://www.osc.ny.gov/state-agencies/audits/2024/12/04/medicaid-program-overpayments-medicare-part-c-claimsState Comptroller DiNapoli Releases Audits
… Division of Criminal Justice Services: Monitoring and Administration of Public Protection Grant Programs … Insurance Program (NYSHIP): CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil … collect and remit all rebate revenue that it invoiced to drug manufacturers for rebate-eligible prescription drug …
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
… active cases of Buy-in Program coverage for individuals without a benefit eligibility period in eMedNY and remove …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipientsState Agencies Bulletin No. 2204.1
… employee’s taxable gross, and reported on the employee’s Form W-2. Federal, State, and New York City income tax … payroll check, OSC will accept a photocopy of this form along with a new Report of Check Exchange. Questions: …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/22041-public-employees-federation-pef-2023-dental-stipendMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… renal disease who were eligible for, but not enrolled in, Medicare. The audit covered the period January 1, 2010 … Medicaid recipients with ESRD and helped guide them on how to apply for and enroll in Medicare. In response to our … age 65 who meet ESRD Medicare eligibility requirements who do not apply for Medicare. We requested that SSA issue a …
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
… the Medicaid costs of recipients who were eligible for Medicare based on age but were not enrolled in Medicare. The audit covered the period July 2016 through June … Individuals who are eligible or appear eligible for Medicare are required to apply for Medicare as a condition of …
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
… payments for Medicare Part C cost-sharing liabilities. The audit covered the period January 2008 through November 2012. Background … persons, plan providers bill Medicaid directly for the enrollee's Part C cost-sharing liabilities (deductibles, …
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)
… Plan, in which case the Medicaid Advantage Plan premium payment typically covers the recipient’s Medicare Part C … recover the improper payments; and correct the Medicaid payment system that allowed concurrent payments of 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
… 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
… cost-sharing amounts or indicated UnitedHealthcare did not cover the service. From a review of a sample of 125 claims totaling $151,069, we determined Medicaid overpaid 26 providers $61,711 (40.8 percent) for 54 claims. Most …
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
… Congress established Medicare Part C, the Medicare managed care program also known as Medicare Advantage. Under Medicare Part C, private managed care companies administer Medicare benefits through Medicare …
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
… December 31, 2020. About the Program The Department of Health administers the New York State Medicaid program. Many of the State’s Medicaid recipients are enrolled in both … Legislature approved a plan for Medicaid to pay 85 percent of dual-eligibles’ copayment or coinsurance on Medicare Part …
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)
… becomes the primary insurer (payer) and Medicaid the secondary. As a secondary payer, rather than pay for the … who do not apply for Medicare; and recover Medicaid claims paid for any retroactive Medicare enrollments of ESRD … 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/2018/09/05/reducing-medicaid-costs-recipients-end-stage-renal-disease-followCost Saving Opportunities on Payments of Medicare Part C Claims (Follow-Up)
… copayments. The Centers for Medicare & Medicaid Services (CMS) allows state Medicaid programs to determine the payment … fee, or a rate between those two amounts approved by CMS. In New York, Medicaid pays 85% of dual-eligibles’ …
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)
… Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for Medicare Part B, … eligible." Generally, Medicare is the primary payer of claims for services provided to dual-eligible recipients. … 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-followMedicaid Program – Improper Payments to a Physical Therapist
… whether Mark Amir, a physical therapist participating in New York’s Medicaid program, billed Medicaid in accordance with its policies and guidelines and whether … who owns and operates Madison Physical Therapy located in Brooklyn, New York. Mr. Amir’s patients are primarily …
https://www.osc.ny.gov/state-agencies/audits/2014/12/15/medicaid-program-improper-payments-physical-therapist