State Audits by Agency or Authority

Medicaid Payments for Pharmacy Claims – Joia Pharmacy and a Related Prescriber (Follow-Up)
Issued: 12/27/18

Medicaid Program – Improper Medicaid Payments for Recipients in Hospice Care
Issued: 12/11/18

Medicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
Issued: 12/11/18

Medicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
Issued: 12/11/18

Medicaid Program – Improper Medicaid Payments for Childhood Vaccines
Issued: 12/06/18

Medicaid Program – Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program
Issued: 11/20/18

Errors in Identification of 340B Providers in the Medicaid Drug Rebate Program (Follow-Up)
Issued: 10/23/18

Medicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
Issued: 09/10/18

Medicaid Program – Improper Medicaid Payments to a Transportation Provider
Issued: 09/05/18

Reducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)
Issued: 09/05/18

Medicaid Managed Care Organization Fraud and Abuse Detection (Follow-Up)
Issued: 08/22/18

Medicaid Program – Medicaid Claims Processing Activity April 1, 2017 Through September 30, 2017
Issued: 08/03/18

Medicaid Program – Maximizing Drug Rebates for Health and Recovery Plans
Issued: 06/22/18

Medicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance
Issued: 06/13/18

Improper Episodic Payments to Home Health Providers (Follow-Up)
Issued: 05/04/18

Medicaid Program – Inappropriate Payments Related to Procedure Modifiers
Issued: 04/17/18

Medicaid Program – Managed Care Organizations: Payments to Ineligible Providers
Issued: 02/26/18

Optimizing Medicaid Drug Rebates (Follow-Up)
Issued: 12/20/17

Medicaid Program – Appropriateness of Payments to Transportation Management Contractors and Providers
Issued: 12/15/17

Medicaid Program – Medicaid Claims Processing Activity October 1, 2016 Through March 31, 2017
Issued: 12/08/17

Appropriateness of Medicaid Eligibility Determined by the New York State of Health System (Follow-Up)
Issued: 12/07/17

Eye Care Provider and Family Inappropriately Enroll as Recipients and Overcharge for Vision Services (Follow-Up)
Issued: 10/12/17

Improper Medicaid Payments to Eye Care Providers
Issued: 10/06/17

Improper Payments for Recipients No Longer Enrolled in Managed Long Term Care Partial Capitation Plans (Follow-Up)
Issued: 10/06/17

Medicaid Program – Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (Follow-Up)
Issued: 10/06/17

Medicaid Program – Managed Long Term Care Premium Rate Setting
Issued: 09/27/17

Questionable Payments for Practitioner Services and Pharmacy Claims Pertaining to a Selected Physician (Follow-Up)
Issued: 09/19/17

Medicaid Program – Administrative Costs Used in Premium Rate Setting of Mainstream Managed Care Organizations
Issued: 09/13/17

Medicaid Program – Medicaid Claims Processing Activity April 1, 2016 Through September 30, 2016
Issued: 07/25/17

Medicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
Issued: 07/11/17

Medicaid Drug Rebate Program Under Managed Care (Follow-Up)
Issued: 06/30/17

Medicaid Program – Errors in Identification of 340B Providers in the Medicaid Drug Rebate Program
Issued: 06/30/17

Medicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
Issued: 06/27/17

Medicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
Issued: 03/01/17

Multiple Same-Day Procedures on Ambulatory Patient Groups Claims (Follow-Up)
Issued: 01/12/17

Medicaid Payments Made Pursuant to Medicare Part C (Follow-Up)
Issued: 12/15/16

Improper Payments to a Physical Therapist (Follow-Up)
Issued: 12/08/16

Medicaid Overpayments for Certain Medicare Part C Claims (Follow-Up)
Issued: 12/08/16

Medicaid Program – Improper Episodic Payments to Home Health Providers
Issued: 12/08/16

Overpayments to Managed Care Organizations and Hospitals for Low Birth Weight Newborns (Follow-Up)
Issued: 12/07/16

Medicaid Program – Medicaid Claims Processing Activity October 1, 2015 Through March 31, 2016
Issued: 11/30/16

Medicaid Program – Mainstream Managed Care Organizations: Administrative Costs Used in Premium Rate Setting
Issued: 10/13/16

Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Follow-Up)
Issued: 09/23/16

Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits (Follow-Up)
Issued: 09/23/16

Medicaid Program – Medicaid Claims Processing Activity April 1, 2015 Through September 30, 2015
Issued: 08/09/16

Medicaid Program - Medicaid Managed Care Organization Fraud and Abuse Detection
Issued: 07/15/16

Medicaid Program – Improper Payments for Recipients No Longer Enrolled in Managed Long Term Care Partial Capitation Plans
Issued: 03/30/16

Medicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
Issued: 03/29/16

Medicaid Program – Eye Care Provider and Family Inappropriately Enroll as Recipients and Overcharge for Vision Services
Issued: 03/21/16

Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
Issued: 02/18/16