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Medicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… Purpose To determine whether the Department of Health took sufficient steps to control the Medicaid costs of … Medicaid recipients with ESRD are eligible for Medicare coverage if they receive regular dialysis treatments or a … amount of time under Social Security, the Railroad Retirement Board, or as a government employee; (2) are …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseMedicaid Program – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare
… the Medicaid costs of recipients who were eligible for Medicare based on age but were not enrolled in Medicare. The audit covered the period July 2016 through June …
https://www.osc.ny.gov/state-agencies/audits/2023/09/14/medicaid-program-reducing-medicaid-costs-recipients-who-are-eligible-medicareMedicaid Program – Medicaid Payments Made Pursuant to Medicare Part C
… Purpose To determine if Medicaid made excessive payments for Medicare Part C cost-sharing liabilities. The audit covered … enrolled in Part C. Key Recommendations Re-evaluate the reimbursement methodology for Medicare Part C cost-sharing, …
https://www.osc.ny.gov/state-agencies/audits/2014/05/09/medicaid-program-medicaid-payments-made-pursuant-medicare-part-cMedicaid Payments Made Pursuant to Medicare Part C (Follow-Up)
… in our audit report, Medicaid Payments Made Pursuant to Medicare Part C (Report 2012-S-133). Background Medicaid … We recommended that the Department: re-evaluate the reimbursement methodology for Medicare Part C cost-sharing; …
https://www.osc.ny.gov/state-agencies/audits/2016/12/15/medicaid-payments-made-pursuant-medicare-part-c-followDiNapoli: State Missing Out on Millions in Medicare Payments for Kidney Patients
… The state Department of Health (DOH) could have saved the Medicaid program as much … over a six-year period if it had helped Medicaid patients with end stage renal disease (ESRD) who meet certain … initiative to defray Medicaid program costs." Medicaid is a federal, state, and locally funded medical program that …
https://www.osc.ny.gov/press/releases/2017/03/dinapoli-state-missing-out-millions-medicare-payments-kidney-patientsState Comptroller DiNapoli Releases Audits
… Units (ERUs) (Follow-Up) (2021-F-14) ERUs or “black boxes” are a valuable safety feature that allow for the monitoring of the train equipment and … that persons who are required to register as sales tax vendors, including those with no physical presence in the …
https://www.osc.ny.gov/press/releases/2021/11/state-comptroller-dinapoli-releases-auditsMedicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… These Medicare Advantage Plans typically have networks of participating providers they reimburse directly for … coinsurance, and copayments). Key Finding From a review of Medicare Part C claims for services rendered to Medicaid … UnitedHealthcare did not cover the service. From a review of a sample of 125 claims totaling $151,069, we determined …
https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claimsMedicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… Purpose To determine whether Medicaid inappropriately paid for recipients’ Medicare Part C cost-sharing liabilities. The audit covered …
https://www.osc.ny.gov/state-agencies/audits/2018/09/10/medicaid-program-medicaid-payments-medicare-advantage-plan-providersMedicaid Overpayments for Certain Medicare Part C Claims (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations included in our initial audit … disadvantaged and/or have special health care needs. Many of the State’s Medicaid recipients are also enrolled in …
https://www.osc.ny.gov/state-agencies/audits/2016/12/08/medicaid-overpayments-certain-medicare-part-c-claims-followMedicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims
… Medicaid cost savings can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with …
https://www.osc.ny.gov/state-agencies/audits/2021/09/21/medicaid-program-cost-saving-opportunities-payments-medicare-part-c-claimsReducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)
… Purpose To determine the implementation status of the five recommendations made in our initial audit report, … audit objective was to determine whether the Department of Health (Department) took sufficient steps to control the Medicaid costs of recipients diagnosed with end stage renal disease (ESRD) …
https://www.osc.ny.gov/state-agencies/audits/2018/09/05/reducing-medicaid-costs-recipients-end-stage-renal-disease-followCost Saving Opportunities on Payments of Medicare Part C Claims (Follow-Up)
… audit report, Cost Saving Opportunities on Payments of Medicare Part C Claims (Report 2020-S-65 ). About the Program … of the State’s Medicaid recipients are also enrolled in Medicare and are referred to as “dual-eligibles.” Medicare …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/cost-saving-opportunities-payments-medicare-part-c-claims-followOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations included in … Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for Medicare Part B, … referred to as "dual eligible." Generally, Medicare is the primary payer of claims for services provided to …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followUnited HealthCare – Overpayments for Services Provided by Dr. John Gomes
… Purpose To determine whether the practice of Dr. John Gomes routinely waived Empire Plan members’ … City, an obstetrics and gynecology practice operated by Dr. John Gomes, located on Franklin Avenue in Garden City, … billing fraud, as the Empire Plan typically reimbursed 80 percent of what it understood to be Dr. Gomes’ actual …
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
… Purpose To determine whether Orthopedic Associates of Long Island, LLP waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made … primary health benefits plan for NYSHIP, covering a range of services from inpatient hospital care to outpatient …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandMedicaid Program – Improper Payments to a Physical Therapist
… “crossover” claims. In December 2009, the Department of Health (Department) implemented an automated crossover … system. The crossover system improved the accuracy of Medicaid payments for dualeligible recipients. Prior to … Medicare payment information directly to Medicaid instead of using the crossover system. During our audit period, …
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
… if the Department of Health overpaid health care providers for Medicaid claims for Medicare Part B coinsurance. The audit covers the period …
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
… of Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by Medicare. The audit covered the period January 1, 2012 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)
… Purpose To determine the extent of implementation of the five recommendations made in our audit report, Overpayments of Certain Medicare Crossover Claims (2011-S-28). Background …
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 other outpatient services and to identify … adjustment codes; and did not properly apply Medicaid reimbursement limits. The potential overpayments totaled …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/overpayments-certain-medicare-crossover-claims