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Anthem Blue Cross – Coordination of Benefits With Medicare
… 2020 through June 2023. About the Program The New York State Health Insurance Program (NYSHIP), administered by the … NYSHIP covers about 1.2 million active and retired State, participating local government, and school district …
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
… for prescription drugs provided under the Empire Plan Medicare Rx drug benefit. Our audit covered the period … the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service …
https://www.osc.ny.gov/state-agencies/audits/2023/06/21/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)
… Medicare-eligible members since the initial audit (from April 2022 through December 2024). All three of the initial …
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
… and retired State, participating local government, and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. Civil Service …
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
… in accordance with its contract with the Department of Civil Service. Our audit covered the period January 1, … Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance … $850 million in commercial drug rebates (rebates exclusive of Medicare Part D rebates). Key Findings We reviewed the …
https://www.osc.ny.gov/state-agencies/audits/2019/06/06/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCVS 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 utilization in accordance with its …
https://www.osc.ny.gov/state-agencies/audits/2020/08/21/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
… 2019 through December 2022. About the Program The New York State Health Insurance Program (NYSHIP), administered by the … insurance coverage to about 1.2 million active and retired State, participating local government, and school district …
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
… if CVS Health remitted to the State Department of Civil Service all commercial drug rebate revenue attributable … Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance …
https://www.osc.ny.gov/state-agencies/audits/2019/10/17/cvs-health-temporary-holding-account-rebate-revenueState Comptroller DiNapoli Releases Audits
… New York State Comptroller Thomas P. DiNapoli announced today the … Drugs (Follow-Up) (2024-F-34) The New York State Health Insurance Program (NYSHIP) is administered by … and reassessments must be performed, as well as wait list prioritization. A prior audit, issued in July 2023, …
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
… the arrest yesterday of Gina Bradshaw, an officer manager for numerous doctors’ offices in Manhattan, for her alleged role in a long-term scheme to defraud the New … out of over $12,000 by submitting fraudulent claims for reimbursement. The arrest was the result of a joint …
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
… organizations and members are paying excessively for dual Empire Plan Family coverage. The audit covered the … Article XI of the New York State Civil Service Law (Law) for the purpose of providing health insurance benefits to … retirees, and their dependents. The Law also allows for the inclusion of other public employees in New York, …
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 recommendations included in our initial audit report, New … Individual and Family coverage. The State does not permit two Family coverages for its employees; if a member and their … partner are both eligible to enroll in NYSHIP, only one may elect Family coverage (the other may either elect …
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
… Ethical Pharmacy inappropriately billed United HealthCare for prescription medications under the State's employee … The Empire Plan (Plan) is the primary health benefits plan for NYSHIP and includes prescription drug coverage. The … on the primary contract, the Department reimburses United for all properly adjudicated claims. Davis Ethical Pharmacy …
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
… New York State Comptroller Thomas P. DiNapoli and Ulster County … Manhattan, has pleaded guilty to defrauding the New York State Insurance Plan (NYSHIP) out of more than $12,000 by …
https://www.osc.ny.gov/press/releases/2024/05/dinapoli-former-medical-office-manager-pleads-guilty-defrauding-new-york-state-health-insurance-planState Agencies Bulletin No. 1140
… proof of other health insurance who elect to opt-out of State health insurance. Affected Employees Employees … the Laws of 2011 which implemented agreements between the State of New York and CSEA, PEF, and MC and a subsequent plan … proof of other health insurance may elect to opt-out of State health insurance and receive equal bi-weekly payments …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1140-new-york-state-health-insurance-plan-nyship-opt-out-paymentsUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… January 1, 2008 through December 13, 2011, the New York State Health Insurance Plan (NYSHIP) made improper payments … with the Nassau County District Attorney and the New York State Department of Financial Services. On December 10, 2015, … February 9, 2016 and made restitution of $231,919 to the State, of which $137,459 was paid to NYSHIP for the improper …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyAn Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… The New York State Health Insurance Program (NYSHIP), administered by the State Department of Civil Service (Civil Service), is one of …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesPreventing Inappropriate and Excessive Costs in the New York State Health Insurance Program
… Program (NYSHIP), administered by the State Department of Civil Service (Civil Service), is one of the nation’s largest public sector …
https://www.osc.ny.gov/state-agencies/audits/2018/05/09/preventing-inappropriate-and-excessive-costs-new-york-state-health-insurance-programUnited HealthCare – Compensation and Benefit Costs for the Empire Plan for the Period January 1, 2008 through December 31, 2010
… Department of Civil Service (Civil Service) is responsible for administering the New York State Health Insurance Program … (United) to process and pay medical and surgical claims for services provided to Empire Plan members. During the … 31, 2010, the State paid United more than $50 million for direct costs related to employee compensation and …
https://www.osc.ny.gov/state-agencies/audits/2013/04/10/united-healthcare-compensation-and-benefit-costs-empire-plan-period-january-1-2008-through