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Cost Saving Opportunities on Payments of Medicare Part C Claims (2020-S-65)
To determine whether Medicaid cost savings can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with federal requirements.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2021-20s65.pdfOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… audit report, Overpayments for Services Also Covered by Medicare Part B (2010-S-50). Background Many of the State's Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followMedicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
… (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 … was paid when the SMCP date of service preceded the birth by 1 to 6 months. In many instances, MCOs agreed their SMCP …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-supplemental-maternity-capitation-payments-managed-careMedicaid 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-servicesMedicaid Program – Overpayments for Services Also Covered by Medicare Part B
… for dual eligible beneficiaries. About 570,000 of New York's Medicaid recipients received Medicare Part B services …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… enrolled in both Medicaid and Medicare, Medicare is generally the primary payer while Medicaid is a secondary payer. As a secondary payer, Medicaid pays the …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followState Agencies Bulletin No. 1043
… Purpose To inform agencies of the content information for the 2010 Form W-2. Background … information which will appear on the Form W-2 Statement is described below: Box 1 Wages, Tips and Other Compensation The amount in this box is the Federal taxable gross wages. Box 2 Federal Income Tax …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1043-form-w-2-wage-and-tax-statement-calendar-year-2010State Agencies Bulletin No. 950
… has worked for more than one (1) State agency during the year will receive only one (1) Form W-2. Employees who worked … SC -- South Carolina TX -- Texas PR -- Puerto RIco Box 16 State Wages The State wages reported are the same as the … Construction Fund 14-6019701 Industrial Exhibit Authority 16-1332929 Additional Employee Information Employees should …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/950-form-w-2-wage-and-tax-statement-calendar-year-2009Medicaid 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 … In return, managed care plans arrange for the provision of health care services their members require. The State’s Medicaid program offers different types of managed care. Most Medicaid recipients are enrolled in …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamMedicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… Objective To determine the extent of implementation of the five recommendations included in our initial audit … for Medicare Advantage Plan Services (Report 2017-S-46 ). About the Program The Department of Health (Department) …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followExamination of Outstanding Premiums
… Background New York State businesses pay NYSIF premiums for workers compensation and disability insurance. If a … by the Department of Tax and Finance (DTF), is a way for State agencies to offset State payments to recover … however, it has taken steps to participate in the program. For example, NYSIF received DOB approval to participate in …
https://www.osc.ny.gov/state-agencies/audits/2016/08/19/examination-outstanding-premiumsCost Saving Opportunities on Payments of Medicare Part C Claims (2020-S-65) 180-Day Response
To determine whether Medicaid cost savings can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with federal requirements.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2021-20s65-response.pdfOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by … 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, …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… care providers’ Medicaid claims for therapy services and prescription drugs that are covered by Medicare. The … 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, 2017 for therapy … The Medicare program covers physical, occupational, and speech therapy services, as well as prescription drugs. …
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
… identified in the initial report. Office of Children and Family Services (OCFS): Access Controls Over Selected … Of the two recommendations, OCFS officials implemented one and did not implement one. Department of Civil Service: New … same property where only one credit was due. Find out how your government money is spent at Open Book New York . Track …
https://www.osc.ny.gov/press/releases/2021/01/state-comptroller-dinapoli-releases-auditsImproper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up)
… of Social Services or the NY State of Health (the State’s online health insurance marketplace). Multiple eligibility …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/improper-medicaid-payments-involving-fee-service-claims-recipients-multiple-clientState Comptroller DiNapoli Releases Audits
… New York State Comptroller Thomas P. DiNapoli announced today the … implementing both recommendations. Office of Temporary and Disability Assistance – Reimbursement of Homeless Shelter … and three were not implemented. New York State Health Insurance Program – Anthem Blue Cross – Coordination of …
https://www.osc.ny.gov/press/releases/2024/08/state-comptroller-dinapoli-releases-auditsComptroller DiNapoli Releases State Audits
… York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued: New York City … issued in January 2012, found that the department did not place enough priority on ensuring that computer assets … in July 2011, examined the Department of Transportation’s (DOT) oversight of grant activity. Auditors found that the …
https://www.osc.ny.gov/press/releases/2014/04/comptroller-dinapoli-releases-state-auditsAudit of the Tuition Reimbursement Account for the Five Fiscal Years Ended March 31, 2018
… presentation of the Financial Statements of the Tuition Reimbursement Account for the five fiscal years ended March 31, 2018. About the …
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 Medicare Part B Services Billed Directly to eMedNY
… Medicare will pay 80 percent of its approved amount for a service and the enrollee is responsible for the remaining 20 …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emedny