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Medicaid Program – Improper Payments to a Physical Therapist

… Medicare deductibles and coinsurance. Medicaid claims for Medicare deductibles or coinsurance are called … system improved the accuracy of Medicaid payments for dualeligible recipients. Prior to the implementation, … claims using the National Provider Identifier (NPI) for his group practice and the related Medicaid claims using …

Medicaid Program – Overpayments for Services Also Covered by Medicare Part B

… overpaid health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period … January 1, 2009 through December 31, 2009. Background Medicare is a federal health program for the elderly and …

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 …

Overpayments of Certain Medicare Crossover Claims (Follow-Up)

… also enrolled in Medicare, the federal health care program for people 65 years of age and older and people under 65 … “dual-eligibles.” Generally, Medicare is the primary payer for medical services provided to dual-eligibles. Medicaid then typically pays for any remaining balance not covered by Medicare, including …

XIII. Employee Expense Reimbursement – XIII. Employee Expense Reimbursement

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

… Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), is one of the nation’s largest public sector health insurance … were incorrectly paid under the Commercial Plan instead of the Medicare Rx Plan. We found the misprocessing of claims …

Improper Payments Related to the Medicare Buy-In Program (Follow-Up)

… New York City (local districts). Annual Medicaid payments for the Medicare buy-in program total approximately $1.3 … 260,000 improper payments (totaling about $26.8 million) for people enrolled in the Medicare buy-in program. We … controls to ensure accurate payment of Medicare expenses for individuals enrolled in the buy-in program. Key Finding …

Overpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)

… by Medicare  (Report 2016-S-73 ). About the Program The New York State Medicaid program provides a wide range of … the initial audit, we identified over $17.7 million in new improper payments and further actions are still needed to …

Overpayments 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 …

Unnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)

… take action to improve data quality or develop alternate means to compensate for data deficiencies. We also …

State Agencies Bulletin No. 611

… and Medicare Tax Refund Certification, has been developed for this purpose. Affected Employees Employees who are … wages previously reported. OSC will also create the check for the refund. Agency Actions Agencies are required to have …

Medicaid 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 … automated claims processing and payment system. When submitting claims, providers are required to include the …

Overpayments for Services Also Covered by Medicare Part B (Follow-Up)

… audit report, Overpayments for Services Also Covered by Medicare Part B (Report 2012-S-27). Background Many of the State’s Medicaid recipients are also enrolled in Medicare Part B, which provides supplementary medical …

Medicaid Payments to Medicare Advantage Plan Providers (Follow-Up)

… recipients are also enrolled in Medicare, the federal health insurance program for people age 65 and older and people … companies administer Medicare benefits and offer different health care plans (Medicare Advantage plans) tailored to the …

Medicaid Payments for Medicare Part A Beneficiaries (Follow-Up)

… in hospitals, post-hospital nursing home care, hospice, and home health services. If an individual is enrolled in both Medicaid and Medicare (commonly referred to as "dual-eligible"), Medicare is the primary payer and generally covers most of the eligible costs for health …

Medicaid 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 … Part B provides supplementary medical insurance coverage for a range of outpatient medical services, physician …

Medicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients

… Objective To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program. The audit covered Medicaid payments …

Medicaid Program – Overpayments for Medicare Part C Claims

… for which Medicaid pays 100%. When Plans deny a claim or pay a different amount than what a provider billed (e.g., … risk-based approach, to identify and review hospitals that bill questionable Part C claims, including the hospitals …

Improper 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 Recipients (Report … program. Many Medicaid recipients are also enrolled in Medicare. Under the Medicare buy-in program (Buy-in Program), …

CVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service

… rebate revenue to the Department of Civil Service for prescription drugs provided under the Empire Plan … The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Individuals … Drug Plan with expanded coverage designed especially for NYSHIP. Since 2014, Civil Service has contracted with CVS …