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Medicaid Program – Overpayments for Medicare Part C Claims
… Medicaid made improper payments on Medicare Part C claims for recipients covered by Medicare Advantage Plans. The audit … Plans (Plans). Plans reimburse health care providers for services rendered to enrollees. Many Medicaid recipients … the copayments and coinsurance on outpatient claims except for ambulance and psychology services, for which Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2024/12/04/medicaid-program-overpayments-medicare-part-c-claimsOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Overpayments for Services Also … fees, and medical supplies. Individuals enrolled in both Medicaid and Medicare are commonly referred to as … to dual-eligible recipients. After Medicare adjudicates a claim, Medicaid pays the balance that is not covered by …
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 (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.pdfMedicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
… Program The Department of Health (Department) administers New York’s Medicaid program. Many of the State’s Medicaid …
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 … submitting claims, providers are required to include the Plan-reported CARCs. The eMedNY system uses the CARCs to …
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
… if the Department of Health overpaid health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period …
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)
… two recommendations made in our audit report, Overpayments for Services Also Covered by Medicare Part B (Report 2012-S-27). Background Many of the …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followState Agencies Bulletin No. 1043
… amount in the box is the Federal income tax withheld. Box 3 Social Security Wages The amount in this box is the wages … moving expense reimbursements (not included in Bo x es 3 and 5) Box 13 Checkboxes A check mark is placed in the … as the return address for all 2010 Form W-2 Statements. OSC will mail Form W-2s to the employees’ mailing address …
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
… amount in this box is the Federal income tax withheld. Box 3 Social Security Wages The amount in this box is the wages … moving expense reimbursements (not included in Boxes 3 and 5) Box 13 Checkboxes A check mark is placed in the … as the return address for all 2009 Form W-2 Statements. OSC will mail Form W-2s to employees’ addresses currently in …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/950-form-w-2-wage-and-tax-statement-calendar-year-2009Medicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
… in our initial audit report, Medicaid Overpayments for Medicare Advantage Plan Services (Report 2017-S-46 ). …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followMedicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… plans and Family Health Plus managed care plans (Plans) for recipients who were no longer enrolled. Our audit covered … managed care plans receive monthly premium payments for individuals enrolled in their plans. In return, managed … Plans can either void their claims for the improperly paid premiums or refund the inappropriate premiums by check. Key …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamExamination of Outstanding Premiums
… of submitting receivables which meet SWOP criteria to DTF on an individual basis prior to implementation of proposed …
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)
… Objective To assess the extent of implementation of the three recommendations included in our initial audit … and speech therapy services as well as prescription drugs. When these services are rendered to dual-eligible recipients, …
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
… of Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by Medicare. The audit covered the period January 1, 2012 to …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareImproper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up)
… may enroll in Medicaid through Local Departments of Social Services or the NY State of Health (the State’s online health … identified were voided. However, we determined OMIG does not have a process to recover improper payments for …
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
… 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-auditsState Comptroller DiNapoli Releases Audits
… State developed the New York State Pollinator Protection Plan in 2016 to address the high loss of pollinators in the … ensure honey bees entering the State are healthy and free from disease. Additionally, Ag&Mkts did not have support or … of social services (Local Districts) to ensure that all required documents have been included, and assessing budgeted …
https://www.osc.ny.gov/press/releases/2024/08/state-comptroller-dinapoli-releases-auditsComptroller DiNapoli Releases State Audits
… the risk that equipment may be misappropriated, or used for personal use. In a follow-up, auditors found the … State Department of Health: Medicaid Payments for Medicare Part A Beneficiaries (Follow-Up) (2013-F-16) An … to pay Medicaid claims in accordance with Medicaid reimbursement policies. During the audit period, eMedNY …
https://www.osc.ny.gov/press/releases/2014/04/comptroller-dinapoli-releases-state-auditsMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… period from June 1, 2012 through May 31, 2017. Background Many of the State’s Medicaid recipients are also eligible for … to minimize the need for providers to self-report Medicare claim data to eMedNY and thereby improve the accuracy of … still submit these claims directly to eMedNY for payment (i.e., self-report Medicare data). In these situations, the …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emedny