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Medicaid 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 … covered the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, 2017 for therapy services. About the Program Many of the State’s …
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)
… 65 years of age and older and people under 65 years old with certain disabilities. Individuals enrolled in both …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/overpayments-certain-medicare-crossover-claims-followUnited HealthCare – Overpayments for Services Provided by Dr. John Gomes
… 2011 through September 30, 2014. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government and school district … the primary health benefits plan for NYSHIP. The New York State Department of Civil Service (Department) contracts with …
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
… contracts with United HealthCare (United) to process and pay medical claims from health care providers for services … participating providers who agree to accept payments, at rates established by United, to furnish medical services to Empire Plan members. Members pay a nominal co-payment to the participating provider for …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandOverpayments 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 …
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)
… Purpose To determine the extent of implementation of the five … made in our audit report, Improper Payments Related to the Medicare Buy-In Program ( 2010-S-76 ). Background The …
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)
… (Report 2016-S-73 ). About the Program The New York State Medicaid program provides a wide range of medical … and/or have special health care needs. Many of the State’s Medicaid recipients are also enrolled in Medicare. … 2017 for therapy services. The audit concluded that the State’s Medicaid program paid $20.1 million for services …
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)
… included in our initial audit report, Overpayments for Medicare Part C Coinsurance Charges (2011-S-33). Background … rendered to Medicaid recipients enrolled in a Healthfirst Medicare Advantage Plan. Many Medicaid recipients are also …
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)
… six prior audit recommendations, three were implemented, two were not implemented, and one was no longer applicable. Key Recommendations None Other …
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
… 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)
… for a broad range of outpatient medical services, physicians’ fees, and medical supplies. For individuals …
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)
… made in our initial audit report, Medicaid Payments to Medicare Advantage Plan Providers (Report 2016-S-54 ). About … of the State’s Medicaid recipients are also enrolled in Medicare, the federal health insurance program for people age …
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)
… Purpose To determine the extent of implementation of the four recommendations made in our audit report, … Background Our initial audit report, which was issued on September 20, 2010, examined whether Medicaid made …
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
… from June 1, 2012 through May 31, 2017. Background Many of the State’s Medicaid recipients are also eligible for … supplementary medical insurance coverage for a range of outpatient medical services, physician services, and … B cost-sharing amounts (e.g., deductibles and coinsurance) on behalf of dual-eligibles. In December 2009, the Department …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyImproper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
… by the Centers for Medicare & Medicaid Services (CMS), Medicaid pays Medicare premiums for individuals who … and process enrollment in the Buy-in Program. In addition, CMS automatically enrolls certain individuals. Medicaid … who were automatically added to the Buy-in Program by CMS with coverage beginning more than 2 years retroactively, …
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 Laparoscopic Surgery
… obligations. However, if a non-participating provider does not collect (i.e., waives) the member’s out-of-pocket …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgeryUnited HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… 1, 2011 through March 31, 2015. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, and school district … procedures and physician office visits. The New York State Department of Civil Service contracts with United …
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 Hudson Valley Bone and Joint Surgeons, LLP
… 1, 2011 through October 31, 2015. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, and school district … procedures and physician office visits. The New York State Department of Civil Service contracts with United …
https://www.osc.ny.gov/state-agencies/audits/2016/09/08/united-healthcare-overpayments-services-provided-hudson-valley-bone-and-joint-surgeons-llpUnited HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
… 1, 2011 through December 31, 2014. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, and school district … procedures and physician office visits. The New York State Department of Civil Service contracts with United …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialistsState Comptroller DiNapoli Releases Audits
… Accuracy of Empire Plan Commercial Rebate Revenue Remitted to the Department of Civil Service (2023-S-42) The New York … (Civil Service), provides health insurance coverage to about 1.2 million active and retired State, participating … of Civil Service has contracted with CVS Caremark to administer the prescription drug program. In accordance …
https://www.osc.ny.gov/press/releases/2025/04/state-comptroller-dinapoli-releases-audits