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Medicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… Purpose To determine whether the Department of Health (Department) made inappropriate premium payments to Medicaid mainstream managed care plans and Family Health Plus managed care plans (Plans) for recipients who … To determine whether the Department of Health made inappropriate premium payments to Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamOverpayments for Medicare Part C Coinsurance Charges (Follow-Up)
… our initial audit report, Overpayments for Medicare Part C Coinsurance Charges (2011-S-33). Background Our initial report, issued on September 26, … for services rendered to Medicaid recipients enrolled in a Healthfirst Medicare Advantage Plan. Many Medicaid … in our initial audit report Overpayments for Medicare Part C Coinsurance Charges …
https://www.osc.ny.gov/state-agencies/audits/2013/12/12/overpayments-medicare-part-c-coinsurance-charges-followExamination of Outstanding Premiums
… the New York State Insurance Fund (NYSIF) participates in the Statewide Offset Program (SWOP), and (ii) the amount … to offset State payments to recover outstanding debt. In May 2015, we recommended NYSIF participate in SWOP as a means to recover outstanding premium. Key …
https://www.osc.ny.gov/state-agencies/audits/2016/08/19/examination-outstanding-premiumsMedicaid Payments for Medicare Part A Beneficiaries (Follow-Up)
… made in our audit report, Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36). Background Our initial … for recipients who were also enrolled in Medicare Part A. Medicare Part A provides supplementary medical insurance for inpatient … made in our audit report Medicaid Payments for Medicare Part A Beneficiaries 2009S36 …
https://www.osc.ny.gov/state-agencies/audits/2014/04/04/medicaid-payments-medicare-part-beneficiaries-followAudit of the Tuition Reimbursement Account for the Five Fiscal Years Ended March 31, 2018
… the financial statements referred to above present fairly, in all material respects, the respective financial …
https://www.osc.ny.gov/state-agencies/audits/2019/09/06/audit-tuition-reimbursement-account-five-fiscal-years-ended-march-31-2018Medicaid 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-claimsImproper Supplemental Maternity Capitation Payments to Managed Care Organizations (Follow-Up)
… of implementation of the six recommendations included in our initial audit report, Improper Supplemental Maternity … (MCOs) a monthly premium for each enrolled recipient and, in turn, the MCOs pay for services their members require. In addition to the monthly premiums, MCOs can receive a …
https://www.osc.ny.gov/state-agencies/audits/2023/07/20/improper-supplemental-maternity-capitation-payments-managed-care-organizations-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-followState Comptroller DiNapoli Releases Audits
… and three were not implemented. New York State Health Insurance Program – Anthem Blue Cross – Coordination of Benefits With Medicare (2023-S-3) …
https://www.osc.ny.gov/press/releases/2024/08/state-comptroller-dinapoli-releases-auditsImproper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up)
… Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Report 2019-S-22 ). About the … individual who applies for Medicaid benefits is assigned a Client Identification Number (CIN), a unique identifier. … FeeforService Claims for Recipients With Multiple Client Identification Numbers Report 2019S22 …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/improper-medicaid-payments-involving-fee-service-claims-recipients-multiple-clientComptroller DiNapoli Releases State Audits
… audit report. This included the recovery of approximately $22.6 million in Medicaid overpayments. Of the initial … in July 2011, examined the Department of Transportation’s (DOT) oversight of grant activity. Auditors found that the … effective communication and information sharing within the DOT and with other state agencies that also provide grant …
https://www.osc.ny.gov/press/releases/2014/04/comptroller-dinapoli-releases-state-auditsMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… Purpose To determine if the Department of Health overpaid health care providers’ Medicaid claims for … Medicare Advantage plans) tailored to the specific needs of Medicare beneficiaries. Some Medicare Advantage plans … the reasons why to providers on the Explanation of Benefits (EOB) using Claim Adjustment Reason Codes …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… Medicare Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in Medicare … or populations. Our initial audit report, which was issued on July 9, 2013, identified $7.3 million in Medicaid … potential recoveries were likely lost due to the inaction on overpayments for claims that are now more than six years …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followMedicaid Program – Overpayments for Services Also Covered by Medicare Part B
… while Medicaid is the secondary payer. Usually, Medicare pays 80 percent of the charges for approved Part B services, and Medicaid pays the remaining balances (typically for coinsurance) for …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bMedicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… of implementation of the five recommendations included in our initial audit report, Medicaid Overpayments for Medicare Advantage Plan Services (Report 2017-S-46 ). … program. Many Medicaid recipients are also enrolled in Medicare Part C, commonly referred to as Medicare Managed …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followComptroller DiNapoli Releases State Audits
… New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued: Research … $20.3 million overpayment from an incorrect reimbursement rate. Auditors found other overpayments of approximately $1.2 …
https://www.osc.ny.gov/press/releases/2014/01/comptroller-dinapoli-releases-state-auditsPlainview-Old Bethpage Central School District - Retiree Health Insurance (2018M-148)
… Determine whether the District is paying health insurance premiums for deceased retirees or their dependents. Key Findings The District did not pay health insurance premiums for deceased retirees or their dependents. District officials …
https://www.osc.ny.gov/local-government/audits/school-district/2018/09/21/plainview-old-bethpage-central-school-district-retiree-health-insuranceState Comptroller DiNapoli Releases Audits
… to approval by the Comptroller’s Office. IPRO entered into subcontractor agreements with five firms to help perform the … services. Auditors found DOH approved payments to IPRO for subcontractor expenses that were not allowable under the …
https://www.osc.ny.gov/press/releases/2018/09/state-comptroller-dinapoli-releases-audits-0Overpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by Medicare … Many of the State’s Medicaid recipients are also enrolled in Medicare. Such individuals are referred to as …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followCost-Saving Ideas: Overtime Planning and Management
… costs. Fair Labor Standards Act and the New York State Taylor Law In implementing actions relating to overtime, keep … well as collective bargaining principles under the State's Taylor Law (Civil Service Law article 14). Resources Local …
https://www.osc.ny.gov/local-government/publications/cost-saving-ideas-overtime-planning-and-management