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DiNapoli: Managed Care Companies Wasting Millions in State Medicaid Dollars

… the state’s Medicaid program, made at least $6.6 million in improper and questionable payments to ineligible providers … over a four-year period, including almost $60,000 in payments to pharmacies for medications that were … public health dollars and are costing taxpayers millions in questionable payments,” DiNapoli said. “My office will …

State Comptroller DiNapoli Releases State Audits

… point to weaknesses in the monitoring of bank accounts. Of 78 payments (totaling $3,136,579) paid from six selected bank …

Empire BlueCross BlueShield – Controls Over Payments for Special Items

… the identification and recovery of overpayments made to hospitals for special medical items; and took sufficient … of excessive payments which result from contracts with hospitals that do not include language that limits the … hospitalization program. Empire’s contracts with member hospitals include reimbursement rate schedules for the …

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

… Purpose To notify agencies that newly established FICA tax deficiency … CUNY (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 …

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

… Objective To determine whether participating organizations and members are paying excessively for dual Empire Plan Family coverage. The audit covered the … To determine whether participating organizations and members are paying excessively for dual Empire Plan Family coverage …

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

… payments for certain services covered by managed long-term care (MLTC) plans. The audit covered the period January 1, … are enrolled in MLTC plans. MLTC plans provide long-term care services, such as home health care, nursing home care, and durable medical equipment, to …

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)

… year are reasonable. Background The County of Rockland is authorized to issue debt totaling $96,000,000 to liquidate … for paying down the remaining $31.3 million deficit. The residential energy tax revenue estimate is overly optimistic … expenditures is imprudent. The County has not made an allowance for uncollectible taxes in the 2014 proposed …

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

… Bond Proceeds Proceeds from the issuance of voter-approved State debt. 36202 Rental Obligation / Lease Purchase Proceeds … Notes (TRAN) Proceeds from the sale of TRANs by New York State. 36205 Bond Anticipation Notes (BAN’s) Proceeds from … the maturity or interest rate of bonds. 36431 Premiums on Bonds Issued Premium (bond sale price is higher than par …

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

… on behalf of dual-eligible individuals receiving hospice care covered by Medicare. This audit covered the period … Hospice is a coordinated program of home and/or inpatient care that treats terminally ill individuals and their families. Hospice programs provide palliative care, including nursing, physician, and counseling services; …

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

… but also required states to maintain managed care coverage for enrolled recipients throughout the public health … motor vehicles driven in New York State possess adequate insurance coverage, or are financially secure, to compensate … the ongoing availability of TMH by approved providers as well as TMH providers’ compliance with TMH regulations. The …