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Anthem Blue Cross – Coordination of Benefits With Medicare
… whether Anthem Blue Cross coordinated benefits to properly pay claims for NYSHIP Empire Plan members with Medicare … whether Anthem Blue Cross coordinated benefits to properly pay claims for NYSHIP Empire Plan members with Medicare …
https://www.osc.ny.gov/state-agencies/audits/2024/08/19/anthem-blue-cross-coordination-benefits-medicareCVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service
… Objective To determine if CVS Health appropriately invoiced drug manufacturers and remitted corresponding rebate revenue … drugs provided under the Empire Plan Medicare Rx drug benefit. Our audit covered the period January 1, 2014 … in the Empire Plan and Medicare have their prescription drug coverage under Empire Plan Medicare Rx, a Medicare Part …
https://www.osc.ny.gov/state-agencies/audits/2023/06/21/cvs-health-accuracy-empire-plan-medicare-rx-drug-rebate-revenue-remitted-department-civilCVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
… Objective To assess the extent of implementation of the two recommendations included in our initial audit … Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service (Report 2022-S-1 ). About the … To assess the extent of implementation of the two recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2025/08/27/cvs-health-accuracy-empire-plan-medicare-rx-drug-rebate-revenue-remitted-department-civilIncorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan (Follow-up)
… initial audit report, Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under … The Empire Plan is the primary health benefits plan for NYSHIP, covering over 1 million members. Civil Service … CVS Caremark to administer the prescription drug program for the Empire Plan. This program includes a Commercial Plan …
https://www.osc.ny.gov/state-agencies/audits/2025/06/18/incorrect-payments-cvs-caremark-medicare-rx-drug-claims-were-improperly-paid-underNew York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan
… prescription drug plan. The audit covered the period from January 2015 through March 2022. About the Program The … Rx or Commercial). CVS Caremark also relies on information from Civil Service’s health insurance enrollment system to … the issue and develop a process to reconcile the data in their respective systems to reduce the risk of processing …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/new-york-state-health-insurance-program-incorrect-payments-cvs-caremark-medicare-rx-drugCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… Objective To determine if CVS Health remitted commercial drug rebate revenue related to Empire Plan drug … period, Civil Service received more than $1 billion in commercial drug rebates (rebates exclusive of Medicare Part D … To determine if CVS Health remitted commercial drug rebate revenue related to Empire Plan drug …
https://www.osc.ny.gov/state-agencies/audits/2020/08/21/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… manufacturers and found that CVS Health did not always invoice drug manufacturers for rebates, collect rebates from …
https://www.osc.ny.gov/state-agencies/audits/2019/06/06/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCVS Caremark – Accuracy of Empire Plan Commercial Rebate Revenue Remitted to the Department of Civil Service
… and remit all rebate revenue to Civil Service. Based on judgmental samples of 10 manufacturers and 25 drugs, we …
https://www.osc.ny.gov/state-agencies/audits/2025/03/18/cvs-caremark-accuracy-empire-plan-commercial-rebate-revenue-remitted-department-civilCVS Health – Temporary Holding Account Rebate Revenue
… drug claims maintained in CVS Health’s temporary holding account. Our audit covered the period January 1, 2014 through … CVS Health improperly designated a temporary holding account, used to process certain prescription drug claims, as … is due to Civil Service for rebate-eligible claims in the account for the period January 1, 2014 through December 31, …
https://www.osc.ny.gov/state-agencies/audits/2019/10/17/cvs-health-temporary-holding-account-rebate-revenueCVS Caremark – Effectiveness of CVS Caremark Audits of the Empire Plan Prescription Drug Program
… of its responsibilities regarding the identification and referral of fraud and abuse than what is outlined in the …
https://www.osc.ny.gov/state-agencies/audits/2025/10/02/cvs-caremark-effectiveness-cvs-caremark-audits-empire-plan-prescription-drug-programState Comptroller DiNapoli Releases Audits
… Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance (Follow-Up) (2024-F-25) When Medicaid recipients have other third-party health insurance (TPHI) in …
https://www.osc.ny.gov/press/releases/2025/06/state-comptroller-dinapoli-releases-auditsAnthem Blue Cross – Coordination of Benefits with Medicare (2023-S-30)
To determine whether Anthem Blue Cross coordinated benefits to properly pay claims for NYSHIP Empire Plan members with Medicare coverage.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2024-23s30.pdfDiNapoli: Former Medical Office Manager Arrested for Scheme to Defraud the New York State Health Insurance Plan
… Clegg, and the FBI Hudson Valley White Collar Crime Task Force. “Gina Bradshaw allegedly took advantage of her …
https://www.osc.ny.gov/press/releases/2023/09/dinapoli-former-medical-office-manager-arrested-scheme-defraud-new-york-state-health-insurance-planNew York State Health Insurance Program - Empire Plan Members With Dual Family Coverage
… and members are paying excessively for dual Empire Plan Family coverage. The audit covered the period January 1, 2014 … policies and procedures. The annual cost for Empire Plan Family coverage ranged from $20,570 to $28,953 during the … to the full cost of coverage. The State does not allow two Family coverages for its employees; if a member and their …
https://www.osc.ny.gov/state-agencies/audits/2021/01/07/new-york-state-health-insurance-program-empire-plan-members-dual-family-coverageNew York State Health Insurance Program – Empire Plan Members With Dual Family Coverage (Follow-Up)
… Objective To assess the extent of implementation of the two … health benefits plan for NYSHIP, providing coverage to about 1.1 million members. NYSHIP offers several … member and their spouse/domestic partner are both eligible to enroll in NYSHIP, only one may elect Family coverage (the …
https://www.osc.ny.gov/state-agencies/audits/2022/09/26/new-york-state-health-insurance-program-empire-plan-members-dual-family-coverage-followUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy
… December 13, 2011, the Department paid United more than $6.2 million for 52,485 claims submitted by Davis Ethical. … by this audit. Formally assess the payments we did not test and determine the extent to which Davis Ethical …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyDiNapoli: Former Medical Office Manager Pleads Guilty to Defrauding New York State Health Insurance Plan
… County District Attorney ’s office, the Federal Bureau of Investigations (FBI) – Hudson Valley White Collar Crime Task … began with a complaint from United Healthcare Special Investigations Unit, who assisted with the investigation. … Hotline at 1-888-672-4555, by filing a complaint online at investigations@osc.ny.gov , or by mailing a complaint to: …
https://www.osc.ny.gov/press/releases/2024/05/dinapoli-former-medical-office-manager-pleads-guilty-defrauding-new-york-state-health-insurance-planUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Report 2012-S-10). Background Our initial audit … made improper payments totaling $137,459 to Davis Ethical Pharmacy. Based on information obtained from the prescribers … 10, 2015, William Davis, former owner Davis Ethical Pharmacy, pleaded guilty to Grand Larceny in the Second …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyState Agencies Bulletin No. 1140
… Pay Period 25L, paychecks dated 3/28/2012 (Administration) and Pay Period 25L, paychecks dated 4/5/2012 (Institution) … receive equal bi-weekly payments totaling $3,000 annually for opting out of Family coverage or $1,000 annually for opting out of Single coverage. Civil Service will …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1140-new-york-state-health-insurance-plan-nyship-opt-out-paymentsAnnual Statement
… Statement: Sign in to Retirement Online . Look under My Account Summary . Click View My Retiree Annual Statement … Retirement Online Tools and Tips If you don’t have an account or for help signing in to an existing account, check … Information . Click update next to address, email or phone number. Enter your updated information (overwrite any …
https://www.osc.ny.gov/retirement/retirees/annual-statement