State Audits by Agency or Authority

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

Medicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
Issued: 11/29/21

Overpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
Issued: 11/29/21

Medicaid Program – Claims Processing Activity April 1, 2020 Through September 30, 2020
Issued: 09/21/21

Medicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims
Issued: 09/21/21

Improper Fee-for-Service Payments for Services Covered by Managed Long-Term Care Plans (Follow-Up)
Issued: 08/31/21

Improper Managed Care Premium Payments for Recipients With Duplicate Client Identification Numbers (Follow-Up)
Issued: 08/17/21

Medicaid Program – Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements
Issued: 08/17/21

Medicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
Issued: 08/17/21

Improper Fee-for-Service Payments for Services Covered by Managed Care (Follow-Up)
Issued: 02/11/21

Improper Payments for Sexual and Erectile Dysfunction Drugs, Procedures, and Supplies Provided to Medicaid Recipients, Including Sex Offenders (Follow-Up)
Issued: 02/08/21

Medicaid Program – Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare
Issued: 12/28/20

Improper Medicaid Payments for Childhood Vaccines (Follow-Up)
Issued: 12/23/20

Medicaid Program – Claims Processing Activity October 1, 2019 Through March 31, 2020
Issued: 10/20/20

Improper Medicaid Payments for Recipients in Hospice Care (Follow-Up)
Issued: 10/15/20

Medicaid Program – Accuracy of Medicaid Eligibility Determined by NY State of Health
Issued: 09/17/20

Medicaid Program – Cost of Pharmacy Services Under Managed Care
Issued: 09/17/20

Medicaid Program – Improper Medicaid Payments for Terminated Drugs
Issued: 09/17/20

Medicaid Program – Improper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers
Issued: 09/17/20

Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services (Follow-Up)
Issued: 09/15/20

Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition (Follow-Up)
Issued: 09/02/20

Medicaid Program – Claims Processing Activity April 1, 2019 Through September 30, 2019
Issued: 09/02/20

Medicaid Overpayments for Medicare Advantage Plan Services (Follow-Up)
Issued: 07/01/20

Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY (Follow-Up)
Issued: 07/01/20

Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Follow-Up)
Issued: 05/07/20

Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Follow-Up)
Issued: 02/25/20

Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance (Follow-Up)
Issued: 01/17/20

Maximizing Drug Rebates for Health and Recovery Plans (Follow-Up)
Issued: 01/17/20

Medicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans
Issued: 01/17/20

Medicaid Program – Medicare Part D Clawback Payments
Issued: 01/17/20

Medicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
Issued: 10/30/19

Improper Medicaid Payments to a Transportation Provider (Follow-Up)
Issued: 10/15/19

Medicaid Payments to Medicare Advantage Plan Providers (Follow-Up)
Issued: 10/15/19

Medicaid Program – Claims Processing Activity October 1, 2018 Through March 31, 2019
Issued: 09/27/19

Managed Care Organizations – Payments to Ineligible Providers (Follow-Up)
Issued: 09/06/19

Inappropriate Payments Related to Procedure Modifiers (Follow-Up)
Issued: 07/31/19

Medicaid Program – Improper Managed Care Payments for Recipients With Duplicate Client Identification Numbers
Issued: 07/29/19

Medicaid Program – Medicaid Claims Processing Activity April 1, 2018 Through September 30, 2018
Issued: 07/10/19

Medicaid Program – Improper Payments for Sexual and Erectile Dysfunction Drugs, Procedures, and Supplies Provided to Medicaid Recipients, Including Sex Offenders
Issued: 06/03/19

Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
Issued: 05/16/19

Medicaid Program – Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition
Issued: 04/08/19

Medicaid Program – Medicaid Claims Processing Activity October 1, 2017 Through March 31, 2018
Issued: 02/05/19

Medicaid Program – Improper Fee-for-Service Payments for Services Covered by Managed Care
Issued: 01/10/19

Improper Medicaid Payments to Eye Care Providers (Follow-Up)
Issued: 12/27/18

Mainstream Managed Care Organizations – Administrative Costs Used in Premium Rate Setting (Follow-Up)
Issued: 12/27/18