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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 …
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
… health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period January 1, … and disabled. It consists of several parts. Medicare Part B helps pay for medical care provided in outpatient … Medicare pays 80 percent of the charges for approved Part B services, and Medicaid pays the remaining balances …
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
… services and prescription drugs that are covered by Medicare. The audit covered the period January 1, 2012 to … of the State’s Medicaid recipients are also enrolled in Medicare. Such individuals are referred to as “dual-eligibles.” The Medicare program covers physical, occupational, and speech …
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)
… made in our audit report, Overpayments of Certain Medicare Crossover Claims (2011-S-28). Background Many Medicaid recipients are also enrolled in Medicare, the federal health care program for people 65 years … programs are referred to as “dual-eligibles.” Generally, Medicare is the primary payer for medical services provided …
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 … December 3, 2009 through March 31, 2012. Background Many Medicaid recipients are also eligible for Medicare, the … individuals, Medicare is the primary claims payer - and Medicaid, as a secondary payer, pays the individual's …
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)
… Our initial audit report, which was issued on October 26, 2012, determined that, from March 2006 through February … made nearly 260,000 improper payments (totaling about $26.8 million) for people enrolled in the Medicare buy-in …
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 services to … Medicare, which is generally the primary payer, before billing Medicaid. We issued our initial report on October 30, … to provide information on any actions that are planned to address the unresolved issues discussed in the report. …
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)
… liabilities of Medicaid recipients to some of its healthcare providers. As a result, 14 providers billed …
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)
… Our initial audit report, which was issued on April 18, 2012, examined whether the Department of Health (Department) … standards to the broker agreement regarding timely removal of dual eligibles from Medicaid managed care …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followUnited HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… - Overpayments for Services at the Capital Region Ambulatory Surgery Center (2007-S-72) New York State Health Insurance …
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
… Program - Overpayments for Services at the Capital Region Ambulatory Surgery Center (2007-S-72) United Health Care: New York State Health …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-dr-john-gomesMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… (typically deductibles and coinsurance). If Plans deny a claim or pay a different amount than what a provider billed, … to providers on the Explanation of Benefits (EOB) using Claim Adjustment Reason Codes (CARCs). Providers submit … indicated a Plan payment of zero on its Medicaid claim, or did not follow the Plan’s billing guidelines. …
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 … the Part B services they provide. FQHCs are “safety net” providers, such as community health centers and public …
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)
… individuals enrolled in Medicaid and Medicare, providers bill Medicaid for the enrollee’s Part C cost-sharing … payments, advise the three providers how to properly bill Medicaid for Medicare Part C cost sharing, and prevent …
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
… Many of the State’s Medicaid recipients are also eligible for Medicare, the federal health insurance program for people age 65 or older and people under 65 with certain … system was to minimize the need for providers to self-report Medicare claim data to eMedNY and thereby improve 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)
… Part A. Medicare Part A provides supplementary medical insurance for inpatient care in hospitals, post-hospital … to provide information on any actions that are planned to address the unresolved issues discussed in this report. Other …
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)
… Objective To assess the extent of implementation of the five recommendations included in our initial audit report, … eligibility period in eMedNY. Of the initial report’s five audit recommendations, two had been implemented, two had … To assess the extent of implementation of the five recommendations included in our initial audit report …
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
State Comptroller Thomas P DiNapoli today released three reports that found more than $100 million in improper payments made by the Department of Health 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)
… in our initial audit report, Medicaid Overpayments for Medicare Advantage Plan Services (Report 2017-S-46 ). About the Program The … program. Many Medicaid recipients are also enrolled in Medicare Part C, commonly referred to as Medicare Managed … in our initial audit report Medicaid Overpayments for Medicare Advantage Plan Services Report 2017S46 …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-advantage-plan-services-followState Agencies Bulletin No. 468
… To notify Agencies of two new Earnings Codes, TF8 - SS Refund Wage Adjustment and TF9 - Med Refund Wage Adjustment, used by OSC in Time Entry for processing approved tax refund requests for current year Social Security (TF5) or … To notify Agencies of two new Earnings Codes TF8 SS Refund Wage Adjustment and TF9 Med Refund Wage Adjustment …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/468-new-earnings-codes-current-year-social-security-and-medicare-adjustments