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Medicaid Payments Made Pursuant to Medicare Part C (Follow-Up)
… Purpose To determine the extent of implementation of the six … to those who are economically disadvantaged and/or have special health care needs. Many of the State’s Medicaid … initial audit found the State’s Medicaid program did not have limitations on the amounts it paid for Part C …
https://www.osc.ny.gov/state-agencies/audits/2016/12/15/medicaid-payments-made-pursuant-medicare-part-c-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, … $69 million from 2016 to 2018, which includes $17 million in savings for counties and New York City. "New Yorkers … their entitlement to Medicare and taken steps to help get them enrolled, the Medicaid program could have saved as …
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
… identify Medicaid overpayments made to medical providers for services rendered to recipients enrolled in … of participating providers they reimburse directly for services provided to enrollees. For dual-eligibles, plan providers bill Medicaid directly for …
https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claimsUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
… ). Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and … The Empire Plan is the primary health benefits plan for NYSHIP. The New York State Department of Civil Service …
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
… Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and … The Department contracted with United to administer the NYSHIP prescription drug program between January 1, 2008 and …
https://www.osc.ny.gov/state-agencies/audits/2014/09/26/empire-plan-drug-rebate-revenueMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… 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, the Medicare … liabilities on 7,072 Medicaid claims resulting in overpayments of $770,935. We determined three 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)
… and/or have special health care needs. Many of the State’s Medicaid recipients are also enrolled in Medicare, … and found Medicaid overpaid 54 claims (43.2 percent) by $61,711. Most overpayments occurred because the providers …
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
… can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with … both Medicaid and Medicare. Medicare is the primary payer for medical services provided to these dual-eligible recipients. Medicaid typically pays for cost-sharing liabilities, which include Medicare …
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)
… 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-followOverpayments 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). … Many of the State's Medicaid recipients are also eligible for Medicare Part B, which provides supplementary medical … Generally, Medicare is the primary payer of claims for services provided to dual-eligible recipients. After …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followCost Saving Opportunities on Payments of Medicare Part C Claims (Follow-Up)
… extent of implementation of the recommendation included in our initial audit report, Cost Saving Opportunities on … Many of the State’s Medicaid recipients are also enrolled in Medicare and are referred to as “dual-eligibles.” Medicare … fee, or a rate between those two amounts approved by CMS. In New York, Medicaid pays 85% of dual-eligibles’ copayment …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/cost-saving-opportunities-payments-medicare-part-c-claims-followState Agencies Bulletin No. 2232
… enters into a new dental services contract for eligible NYSHIP enrollees. These monies will not be added to base … 433 Total Unemployment Ins Owed 442 Pre-Tax Adoption 500 Medicare Deficiency 501 Social Security Deficiency 502 NYS SS/Medicare Deficiency GARNSH Garnishments HIBTRG Regular Before …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/2232-public-employees-federation-pef-2024-dental-stipendMedicaid Program – Improper Payments to a Physical Therapist
… Medicare deductibles and coinsurance. Medicaid claims for Medicare deductibles or coinsurance are called … system improved the accuracy of Medicaid payments for dualeligible recipients. Prior to the implementation, … claim payment data. Nevertheless, providers can still report Medicare payment information directly to Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2014/12/15/medicaid-program-improper-payments-physical-therapistMedicaid 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 audit covers the period … 31, 2009. Background Medicare is a federal health program for the elderly and disabled. It consists of several parts. …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… of Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered … covered the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, 2017 for therapy services. About the Program Many of the State’s …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareState Comptroller DiNapoli Releases Audits
… entered into a franchise agreement with a vendor to apply for the “.nyc” generic TLD (gTLD) and to operate, manage, … all rebate revenue that it invoiced to drug manufacturers for rebate-eligible prescription drug claims paid on behalf … of the Empire Plan, the primary health benefits plan for NYSHIP; therefore, Civil Service did not receive $453,029 …
https://www.osc.ny.gov/press/releases/2021/11/state-comptroller-dinapoli-releases-audits-0Overpayments of Certain Medicare Crossover Claims (Follow-Up)
… recipients are also enrolled in Medicare, the federal health care program for people 65 years of age and older and … and coinsurance. On December 3, 2009, the Department of Health (Department) implemented the Medicare/Medicaid claim … Other Related Audits/Reports of Interest Department of Health: Overpayments of Certain Medicare Crossover Claims …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/overpayments-certain-medicare-crossover-claims-followOverpayments of Certain Medicare Crossover Claims
… Purpose To determine if Medicaid overpaid Medicare crossover claims for physician and other outpatient services and to identify the claims processing control weaknesses that …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/overpayments-certain-medicare-crossover-claimsImproper Payments Related to the Medicare Buy-In Program (Follow-Up)
… extent of implementation of the five recommendations made in our audit report, Improper Payments Related to the Medicare Buy-In Program ( 2010-S-76 ). Background The federal government established the Medicare buy-in program to assist certain low-income people pay …
https://www.osc.ny.gov/state-agencies/audits/2014/11/18/improper-payments-related-medicare-buy-program-followOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… for Therapy Services and Prescription Drugs Covered by Medicare (Report 2016-S-73 ). About the Program The New … therapy services and prescription drugs that are covered by Medicare. The audit covered the period January 1, 2012 to … on the service dates. Key Finding Department officials made some progress in addressing the problems identified in …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-follow