Office of the New York State Comptroller, Division of State Government Accountability
8 indexed reports
Medicaid Program: Oversight of Managed Care Provider Networks
DOH did not maintain sufficient oversight of Medicaid managed care provider networks during 2023, with data reliability and process control issues affecting the accuracy of deficiency reporting and SO...
Medicaid Program: Improper Premium Payments Made on Behalf of Managed Care Members Residing Outside the State
None
Medicaid Program: Claims Processing Activity April 1, 2024 Through September 30, 2024
The audit concluded that eMedNY reasonably ensured Medicaid claims were submitted by approved providers, processed in accordance with Medicaid requirements, and paid correctly overall. However, improv...
Medicaid Program: Overpayments for Medicare Part C Claims
DOH oversight identified improper Medicaid payments related to Medicare Part C cost-sharing, primarily driven by provider misinterpretation of rules, incomplete CARC reporting, and system limitations....
Medicaid Program: Provider Compliance With the Electronic Visit Verification Program
DOH’s EVV program showed significant control weaknesses and data quality issues, with large volumes of Medicaid payments made without matching EVV records and with low EVV-claim match rates (56% for P...
Medicaid Program: Claims Processing Activity October 1, 2023 Through March 31, 2024
The audit concluded that eMedNY reasonably ensured that Medicaid claims were submitted by approved providers, processed in accordance with Medicaid requirements, and resulted in correct payments. Howe...
Medicaid Program: Maximizing Drug Rebates Under the Federal Medicaid Drug Rebate Program
While the Department has made significant process improvements and system enhancements in the rebate collection process, certain weaknesses remain, resulting in $183.7 million in Medicaid drug rebates...
Medicaid Program: Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare
The Office of the Inspector General notes that it is not expressing an opinion on the State Comptroller’s report or its results; however, the OSC encourages CMS to consider the report and its results ...