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Medicaid Program – Improper Payments to a Physical Therapist
… whether Mark Amir, a physical therapist participating in New York’s Medicaid program, billed Medicaid in accordance with its policies and guidelines and whether … who owns and operates Madison Physical Therapy located in Brooklyn, New York. Mr. Amir’s patients are primarily …
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
… 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 Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… Objective To determine if the Department of Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by … To determine if the Department of Health overpaid health care providers Medicaid claims for …
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)
… are referred to as “dual-eligibles.” Generally, Medicare is the primary payer for medical services provided to …
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 … To determine if Medicaid overpaid Medicare crossover claims …
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)
… 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 out-of-pocket Medicare expenses. Under the buy-in program, Medicaid pays …
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)
… 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-followOverpayments 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-followUnnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… Purpose To determine the extent of implementation of the six … Department of Health (Department) made premium payments to Medicaid managed care plans for Medicaid recipients who … for the recipients in question, the net savings to Medicaid would have been about $36 million. The …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followState Comptroller DiNapoli Releases Audits
… of Civil Service, provides health insurance coverage to over 1.2 million active and retired state, participating … collection because license plate images could not always be processed, resulting in potential lost revenue of $2.4 … however, nearly all counties submitted RETT information in hard copy form at the time of the audit, of which only a …
https://www.osc.ny.gov/press/releases/2021/11/state-comptroller-dinapoli-releases-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)
… Purpose To determine the extent of implementation of the two recommendations made in our audit report, … by Medicare Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in … To determine the extent of implementation of the two recommendations made in our …
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)
… (Report 2016-S-54 ). About the Program Many of the State’s Medicaid recipients are also enrolled in Medicare, … and copayments). We issued our initial audit report on September 10, 2018. The audit objective was to determine … providers reported inflated Part C cost-sharing amounts on claims and the Department of Health (Department) lacked …
https://www.osc.ny.gov/state-agencies/audits/2019/10/15/medicaid-payments-medicare-advantage-plan-providers-followMedicaid 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-followMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… June 1, 2012 through May 31, 2017. Background Many of the State’s Medicaid recipients are also eligible for Medicare, … B cost-sharing amounts (e.g., deductibles and coinsurance) on behalf of dual-eligibles. In December 2009, the Department … $2.3 million to providers for the Part B coinsurance on services Medicaid did not cover. Overpayments totaling …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyUnited HealthCare – Overpayments for Services Provided by Dr. John Gomes
… September 30, 2014. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage … Members pay a nominal co-payment to the participating provider for the services rendered. Members may also choose … Other Related Audits/Reports of Interest United Health Care: New York State Health Insurance Program - Overpayments …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-dr-john-gomesUnited HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… December 31, 2014. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage … covering a range of services from inpatient hospital care to outpatient surgical procedures and physician office … Members pay a nominal co-payment to the participating provider for the services rendered. Members may also choose …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandImproper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
… of implementation of the five recommendations included in our initial audit report, Improper Payments of Medicare Buy-In Premiums for Ineligible Recipients (Report 2020-S-35 ). … program. Many Medicaid recipients are also enrolled in Medicare. Under the Medicare buy-in program (Buy-in …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/improper-payments-medicare-buy-premiums-ineligible-recipients-followDiNapoli Finds Over $100 Million in Inappropriate Medicaid Payments
… released three reports that found more than $100 million in improper payments made by the Department of Health (DOH) for the Medicare buy-in program, maternity care, and drug and therapy claims. Nearly $400,000 in premiums may have been … released three reports that found more than $100 million in improper payments made by the Department of Health DOH for …
https://www.osc.ny.gov/press/releases/2021/11/dinapoli-finds-over-100-million-inappropriate-medicaid-paymentsMedicaid 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-follow