State Audits by Agency or Authority

Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims (Follow-Up)
Issued: 03/12/25

Medicaid Program – Claims Processing Activity October 1, 2023 Through March 31, 2024
Issued: 02/06/25

Medicaid Program – Impact of Rejected Encounters on the Collection of Drug Rebates
Issued: 12/23/24

Maximizing Drug Rebates Under the Federal Medicaid Drug Rebate Program (Follow-Up)
Issued: 12/20/24

Excessive Payments for Durable Medical Equipment Rentals (Follow-Up)
Issued: 12/04/24

Medicaid Program – Overpayments for Medicare Part C Claims
Issued: 12/04/24

Medicaid Program – Managed Care Payments for Services Not Coordinated Through Recipient Restriction Program Providers
Issued: 11/26/24

Medicaid Program – Provider Compliance With the Electronic Visit Verification Program
Issued: 11/13/24

Improper Medicaid Payments to Hospitals for Outpatient Services Billed as Inpatient Services for Recipients Enrolled in Managed Care
Issued: 08/28/24

Improper Payments for Brand Name Drugs (Follow-Up)
Issued: 07/03/24

Medicaid Program – Managed Care Payments to Unenrolled Providers
Issued: 06/04/24

Excessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans (Follow-Up)
Issued: 05/08/24

Medicaid Program – Claims Processing Activity April 1, 2023 Through September 30, 2023
Issued: 04/24/24

Improper Overlapping Medicaid and Essential Plan Enrollments (Follow-Up)
Issued: 04/10/24

Oversight of Managed Long-Term Care Member Eligibility (Follow-Up)
Issued: 03/13/24

Medicaid Program – Improper Payments for Drugs Without a Federal Drug Rebate Agreement
Issued: 02/23/24

Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance (Follow-Up)
Issued: 01/31/24

Improper Payments for Services Related to Ordering, Prescribing, Referring, or Attending Providers No Longer Participating in the Medicaid Program (Follow-Up)
Issued: 01/03/24

Improper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)
Issued: 12/06/23

Medicaid Program – Claims Processing Activity October 1, 2022 Through March 31, 2023
Issued: 10/25/23

Medicaid Program – Recovering Managed Care Payments for Inpatient Services on Behalf of Recipients With Third-Party Health Insurance
Issued: 09/27/23

Medicaid Program – Improper Medicaid Payments During Permissible Overlapping Medicaid and Essential Plan Coverage
Issued: 09/14/23

Medicaid Program – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare
Issued: 09/14/23

Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements (Follow-Up)
Issued: 09/13/23

Medicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
Issued: 08/30/23

Improper Supplemental Maternity Capitation Payments to Managed Care Organizations (Follow-Up)
Issued: 07/20/23

Improper Medicaid Managed Care Payments for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies on Behalf of Recipients in Nursing Homes (Follow-Up)
Issued: 06/21/23

Medicaid Program – Claims Processing Activity April 1, 2022 Through September 30, 2022
Issued: 05/11/23

Medicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance
Issued: 05/11/23

Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
Issued: 04/12/23

Medicaid Program – Excessive Payments for Durable Medical Equipment Rentals
Issued: 04/12/23

Medicaid Program – Maximizing Drug Rebates Under the Federal Medicaid Drug Rebate Program
Issued: 04/05/23

Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
Issued: 02/13/23

Improper Medicaid Payments for Misclassified Patient Discharges (Follow-Up)
Issued: 01/18/23

Medicaid Program – Claims Processing Activity October 1, 2021 Through March 31, 2022
Issued: 12/13/22

Medicaid Program – Improper Payments for Brand Name Drugs
Issued: 12/13/22

Medicaid Program – Excessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans
Issued: 10/31/22

Medicaid Program – Improper Overlapping Medicaid and Essential Plan Enrollments
Issued: 10/11/22

Accuracy of Medicaid Eligibility Determined by NY State of Health (Follow-Up)
Issued: 09/30/22

Cost Saving Opportunities on Payments of Medicare Part C Claims (Follow-Up)
Issued: 09/08/22

Improper Medicaid Payments for Terminated Drugs (Follow-Up)
Issued: 09/08/22

Improper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up)
Issued: 09/08/22

Medicaid Program – Claims Processing Activity April 1, 2021 Through September 30, 2021
Issued: 08/19/22

Medicaid Program – Improper Managed Care Payments for Misclassified Patient Discharges
Issued: 08/19/22

Medicaid Program – Oversight of Managed Long-Term Care Member Eligibility
Issued: 08/05/22

Medicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance
Issued: 07/13/22

Medicaid Program – Claims Processing Activity October 1, 2020 Through March 31, 2021
Issued: 04/19/22

Medicaid Program – Improper Medicaid Managed Care Payments for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies on Behalf of Recipients in Nursing Homes
Issued: 04/19/22

Medicaid Program – Improper Payments for Services Related to Ordering, Prescribing, Referring, or Attending Providers No Longer Participating in the Medicaid Program
Issued: 04/19/22

Medicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients
Issued: 11/29/21