Search

DiNapoli: Managed Care Companies Wasting Millions in State Medicaid Dollars

… United HealthCare and Amerigroup, managed care organizations (MCOs) that contract with the … Health (DOH) to provide health services under the state’s Medicaid program, made at least $6.6 million in improper and … claim costs totaled more than $51 billion, of which managed care premiums comprised nearly $27 billion. At the …

State Comptroller DiNapoli Releases State Audits

… execution of the state’s technology transformation, with little or no evidence that many basic planning steps were performed. As a result, OITS had little data to quantify or measure what benefits, if any, the …

Empire BlueCross BlueShield – Controls Over Payments for Special Items

… Purpose To determine if Empire BlueCross BlueShield: implemented sufficient controls … and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The Empire Plan covers a comprehensive range of services …

Medicaid Program: Overpayments for Medicare Part C Claims (2023-S-13)

To determine whether Medicaid made improper payments on Medicare Part C claims for recipients covered by Medicare Advantage Plans.

XII.6.I Paying a Non-State Employee – XII. Expenditures

… Statement: State agencies must appropriately classify workers as either employees or independent contractors so the workers are properly taxed. The Internal Revenue Service’s … circumstances that apply to a group of similarly situated workers, then Business Units may make and document one worker …

Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan (Follow-up)

… of implementation of the three recommendations included in our initial audit report, Incorrect Payments by CVS … Findings Civil Service and CVS Caremark made some progress in addressing the issues identified in the initial audit, including reprocessing over $5 million …

State Agencies Bulletin No. 1493

… Purpose To notify agencies that newly established FICA tax deficiency … NYS (SS/Medicare Deficiency) with an effective date prior to 9/1/16 and will remain at their current rate. Affected … as FICA Exempt earnings which have since been determined to be FICA taxable. Rarely, an employee may have simultaneous …

CUNY Bulletin No. CU-547

… 582 CUNY (SS/Medicare Deficiency), will have a deduction rate of ten percent of gross pay applied. Existing FICA tax … an effective date prior to 9/1/16 and will remain at their current rate. Affected Employees Employees who originally had … (corrections) can be made, without interest, pursuant to Treasury Regulations. Treasury Regulation §31.6205-1 (b) …

XIII.8 - Procedures for Employee Non-Travel Expense Reimbursement – XIII. Employee Expense Reimbursement

Medicaid Program – Payments for Death-Related One-Day Inpatient Admissions

… effectively implemented and applied the new APR DRG-based hospital inpatient payment system for Medicaid services when … implemented to provide a more equitable payment method for hospital inpatient services and to better reflect the … For instance, Medicaid paid $153,329 on a claim with hospital charges totaling $9,685 for a patient who died …

New York State Health Insurance Program - Empire Plan Members With Dual Family Coverage

… and members are paying excessively for dual Empire Plan Family coverage. The audit covered the period January 1, 2014 … policies and procedures. The annual cost for Empire Plan Family coverage ranged from $20,570 to $28,953 during the … to the full cost of coverage. The State does not allow two Family coverages for its employees; if a member and their …

Medicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans

… Objective The objective of this audit was to determine whether the Department of Health (Department) made improper fee-for-service (FFS) … Department administers New York’s Medicaid program. Many of the State’s Medicaid recipients are enrolled in MLTC … The objective of this audit was to determine whether the Department of …

New York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan

… CVS Caremark paid claims under the correct prescription drug plan. The audit covered the period from January 2015 … L.L.C. (CVS Caremark) to administer the prescription drug program for the Empire Plan. This program includes the Empire Plan Medicare Rx drug plan (Medicare Rx Plan) for retired members and their …

Rockland County – Budget Review (B6-13-22)

… Rockland County Budget Review B61322 …

IV.5.B Bond and Debt Proceeds – IV. Accounting Codes - Uses and Descriptions

… Bond proceeds includes the proceeds of general obligation bonds and short-term notes issued in the form of commercial … from a lease purchase or rental obligation. 36203 Sale Bonds / Notes Proceeds from the sale of Bonds or Notes other than General Obligation. 36204 Tax & …

Medicaid Program – Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare

… services; home health aides; physical and occupational therapy; medical appliances and supplies; and drugs. When …

League for the Handicapped – Compliance With the Reimbursable Cost Manual

… LFH offers a range of services and programs to children with disabilities from birth through eight years of age. In 2014, … were not directly related to the programs, unallowable working capital interest, and credit card late fees. Key …

Empire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011

… from July through December 2011. Background The New York State Health Insurance Program (NYSHIP) provides health coverage to active and retired State, participating local government and school district … Payments for hospital services are generally based on standard fee schedules. However, hospitals may be entitled …

Medicaid Program – Medicaid Payments to Medicare Advantage Plan Providers

… Purpose To determine whether Medicaid inappropriately paid for recipients’ Medicare Part C … January 1, 2012 through December 31, 2016. Background Many Medicaid recipients are also enrolled in Medicare. Such … for services provided to enrollees. For dual-eligibles, Medicaid reimburses the plan providers for the enrollee’s …

State Comptroller DiNapoli Releases Audits

… Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans (2021-S-37) For individuals enrolled in Medicaid managed care, the department pays for services through monthly … (2022-S-10) Arc Erie, a not-for-profit special education provider located in Williamsville, is authorized by the State …