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Medicaid Program – Improper Payments to a Physical Therapist
… physical therapist who owns and operates Madison Physical Therapy located in Brooklyn, New York. Mr. Amir’s patients … “crossover” claims. In December 2009, the Department of Health (Department) implemented an automated crossover … system. The crossover system improved the accuracy of Medicaid payments for dualeligible recipients. Prior to …
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
… overpaid health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period … the elderly and disabled. It consists of several parts. Medicare Part B helps pay for medical care provided in … About 570,000 of New York's Medicaid recipients received Medicare Part B services totaling $740 million in 2009. These …
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
… Many of the State’s Medicaid recipients are also enrolled in Medicare. Such individuals are referred to as … Medicaid. Key Findings The audit identified $20.1 million in Medicaid payments for services provided to dual-eligible … by Medicaid. Key Recommendations Review the $20.1 million in Medicaid payments for therapy services and prescription …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicareOverpayments of Certain Medicare Crossover Claims (Follow-Up)
… to self-report accurate information to eMedNY regarding how much Medicare paid and how much Medicaid owed, which often … the crossover system and the controls that it affords. We made five recommendations to the Department to review and …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/overpayments-certain-medicare-crossover-claims-followUnited HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… Purpose To determine whether Orthopedic Associates of Long Island, LLP waived Empire Plan members’ out-of-pocket … on claims submitted to United by Orthopedic Associates of Long Island, LLP (Orthopedic Associates), a non-participating provider located in Long Island, New York. During the period January 1, 2011 …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandUnited HealthCare – Overpayments for Services Provided by Dr. John Gomes
… Purpose To determine whether the practice of Dr. John Gomes routinely waived Empire Plan members’ … City, an obstetrics and gynecology practice operated by Dr. John Gomes, located on Franklin Avenue in Garden City, New York. With respect to the Empire Plan, Dr. Gomes’ practice is a non-participating provider. During …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-dr-john-gomesOverpayments of Certain Medicare Crossover Claims
… Purpose To determine if Medicaid overpaid Medicare crossover claims for physician and other outpatient … Background Many Medicaid recipients are also eligible for Medicare, the federal health insurance program available to … eligible." In general, for dual eligible individuals, Medicare is the primary claims payer - and Medicaid, as a …
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)
… Medicaid claim processing controls to ensure accurate payment of Medicare expenses for individuals enrolled in the … initial audit, we identified $9.6 million in additional premium payments for individuals in the buy-in program whose …
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)
… included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by Medicare … Medicare program covers physical, occupational, and speech therapy services as well as prescription drugs. When these … overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followOverpayments for Medicare Part C Coinsurance Charges (Follow-Up)
… Background Our initial report, issued on September 26, 2012, examined whether Medicaid made inappropriate …
https://www.osc.ny.gov/state-agencies/audits/2013/12/12/overpayments-medicare-part-c-coinsurance-charges-followUnnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… Purpose To determine the extent of implementation of the six recommendations included in our initial audit report, Unnecessary Managed Care Payments for Medicaid Recipients With Medicare (Report … To determine the extent of implementation of the six recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… To determine if the Department of Health overpaid health care providers’ Medicaid claims for services also covered by Medicare Advantage plans. The audit covered the period from January 1, … in Medicare Part C, also known as Medicare Managed Care or Medicare Advantage. Under Medicare Part C, private …
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)
… Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in Medicare Part B, … and medical supplies. For individuals enrolled in both Medicaid and Medicare, Medicare is generally the primary payer while Medicaid is a secondary payer. As a secondary payer, Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followMedicaid Payments to Medicare Advantage Plan Providers (Follow-Up)
… enrolled in Medicare, the federal health insurance program for people age 65 and older and people under 65 who have certain … We issued our initial audit report on September 10, 2018. The audit objective was to determine whether …
https://www.osc.ny.gov/state-agencies/audits/2019/10/15/medicaid-payments-medicare-advantage-plan-providers-followMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… are also eligible for Medicare, the federal health insurance program for people age 65 or older and people under … parts. Medicare Part B provides supplementary medical insurance coverage for a range of outpatient medical … transferred to the Department’s eMedNY system for payment of deductibles and coinsurance. The intent of the …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyMedicaid 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 … 20, 2010, examined whether Medicaid made overpayments for recipients who were also enrolled in Medicare Part A. … Medicare Part A provides supplementary medical insurance for inpatient care in hospitals, post-hospital nursing home …
https://www.osc.ny.gov/state-agencies/audits/2014/04/04/medicaid-payments-medicare-part-beneficiaries-followImproper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
… Program coverage on behalf of individuals who do not have a benefit eligibility period – a date range for which the individual has Medicaid … 2021, was to determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/improper-payments-medicare-buy-premiums-ineligible-recipients-followUnited HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
… Purpose To determine whether Long Island Spine Specialists, P.C. waived Empire Plan … claim. Our audit focused on claims submitted to United by Long Island Spine Specialists, P.C. (Long Island Spine), a non-participating provider located in … To determine whether Long Island Spine Specialists PC waived Empire Plan members …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialistsUnited HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… Purpose To determine whether Eastern Orange Ambulatory Surgery Center, LLC waived Empire … claim. Our audit focused on claims submitted to United by Eastern Orange Ambulatory Surgery Center, LLC (Eastern Orange), a non-participating provider located in … To determine whether Eastern Orange Ambulatory Surgery Center LLC waived Empire …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-eastern-orange-ambulatory-surgery-centerUnited HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… Purpose To determine whether Long Island Laparoscopic Surgery, PLLC waived Empire Plan … claim. Our audit focused on claims submitted to United by Long Island Laparoscopic Surgery, PLLC (Long Island Laparoscopic), a non-participating provider … To determine whether Long Island Laparoscopic Surgery PLLC waived Empire Plan …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgery