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State Comptroller DiNapoli Releases Audits
… (ERUs) (Follow-Up) (2021-F-14) ERUs or “black boxes” are a valuable safety feature that allow for the monitoring of … functioning correctly, as required by work manuals. In a follow-up, auditors found that MTA officials have made … Tunnels: Efforts to Collect Tolls and Fees Using License Plate Images and Law Firms (Follow-Up) (2021-F-15) An audit …
https://www.osc.ny.gov/press/releases/2021/11/state-comptroller-dinapoli-releases-auditsMedicaid Program – Overpayments for Services Also Covered by Medicare Part B
… parts. Medicare Part B helps pay for medical care provided in outpatient settings. Medicaid is a joint state and federal … received Medicare Part B services totaling $740 million in 2009. These services were provided in outpatient settings such as doctors' offices, clinics, and …
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
… care providers’ Medicaid claims for therapy services and prescription drugs that are covered by Medicare. The audit … the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, 2012 to December 31, 2017 … occupational, and speech therapy services, as well as prescription drugs. When these services are rendered to …
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)
… of Health (Department) implemented the Medicare/Medicaid claim crossover system. Under this system, providers submit … claims. Auditors additionally identified $16.4 million in potential overpayments on similar claims because providers …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/overpayments-certain-medicare-crossover-claims-followOverpayments of Certain Medicare Crossover Claims
… Medicare is the primary claims payer - and Medicaid, as a secondary payer, pays the individual's Medicare deductibles …
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 …
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 … 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-followOverpayments for Medicare Part C Coinsurance Charges (Follow-Up)
… for cost-sharing liabilities such as deductibles and coinsurance. However, these liabilities may be paid by … Healthfirst took actions to prevent further errant claims and overpayments. Additionally, providers submitted claim … one recommendation for the Department of Health to review and recover the remaining Medicaid overpayments for excessive …
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)
… Background Our initial audit report, which was issued on April 18, 2012, examined whether the Department of Health … care payments (totaling about $111 million) that were made on behalf of 45,000 Medicare recipients who were ineligible …
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
… claims for services also covered by Medicare Advantage plans. The audit covered the period from January 1, 2013 to … Medicare benefits and offer different health care plans (referred to as Medicare Advantage plans) tailored to the specific needs of Medicare … claims for services also covered by Medicare Advantage plans …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesUnited HealthCare – Overpayments for Services Provided by Dr. John Gomes
… practice of Dr. John Gomes routinely waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the … pay medical claims for services provided to Empire Plan members. United contracts with certain providers who agree to … by United, to furnish medical services to Empire Plan members. United pays these “participating providers” directly …
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
… waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare … LLP waived Empire Plan members outofpocket costs and if so to quantify the overpayments made by …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… Medicaid and Medicare, Medicare is generally the primary payer while Medicaid is a secondary payer. As a secondary payer, Medicaid pays the balance not covered by Medicare …
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)
… Objective To determine the extent of implementation of the three recommendations made in our initial audit report, Medicaid Payments to Medicare Advantage Plan Providers (Report 2016-S-54 ). About … sufficient controls to detect and prevent such claims. Three providers in our review received significant …
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)
… Part A. Medicare Part A provides supplementary medical insurance for inpatient care in hospitals, post-hospital nursing home care, hospice, and home health services. If an individual is enrolled in both … payer and generally covers most of the eligible costs for health services. Medicaid, as a secondary payer, generally …
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
… Purpose To determine whether Medicaid made improper payments to providers who submitted Part B cost-sharing claims … To determine whether Medicaid made improper payments to providers who submitted Part B costsharing claims directly …
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)
… included in our initial audit report, Improper Payments of Medicare Buy-In Premiums for Ineligible … to determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Buy-in Program. The audit covered Medicaid payments for individuals enrolled in the Buy-in Program for …
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
… (DOH) for the Medicare buy-in program, maternity care, and drug and therapy claims. Nearly $400,000 in premiums may have … DOH for the Medicare buyin program maternity care and drug and therapy claims …
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)
… C, managed care companies administer Medicare benefits and offer different health care plans (referred to as … Plan, Medicaid is generally the secondary payer and reimburses providers for financial balances not covered by the Plan (typically deductibles and coinsurance). Our initial audit report, issued on …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followState Agencies Bulletin No. 468
… processing approved tax refund requests for current year Social Security (TF5) or current year Medicare (TF6) refunds. NOTE: … Affected Employees Employees who receive current year Social Security and Medicare tax refunds. Effective Date(s) …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/468-new-earnings-codes-current-year-social-security-and-medicare-adjustments