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Anthem Blue Cross – Coordination of Benefits With Medicare
… Blue Cross coordinated benefits to properly pay claims for NYSHIP Empire Plan members with Medicare coverage. The audit covered the period from January …
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
… remitted corresponding rebate revenue to the Department of Civil Service for prescription drugs provided under the … Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance … the prescription drug program. Since then, the cost of the prescription drug program averaged $2.5 billion per …
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)
… audit report, Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the … 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/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
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … for the Empire Plan. This program includes the Empire Plan Medicare Rx drug plan (Medicare Rx Plan) for retired members and their dependents …
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
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Civil Service … million in commercial drug rebates (rebates exclusive of Medicare Part D rebates). Key Findings We reviewed the rebate …
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
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … billion in commercial drug rebates (rebates exclusive of Medicare Part D rebates). Key Findings We reviewed …
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
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … The Empire Plan is the primary health benefits plan for NYSHIP, covering over 1 million members. Since 2014, Civil … Empire Plan commercial drug rebates (rebates exclusive of Medicare Part D rebates). Key Findings We reviewed rebate …
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
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Civil Service … billion in commercial drug rebates (rebates exclusive of Medicare Part D rebates). Key Findings CVS Health improperly …
https://www.osc.ny.gov/state-agencies/audits/2019/10/17/cvs-health-temporary-holding-account-rebate-revenueState Comptroller DiNapoli Releases Audits
… improve the extent and clarity of its guidance to include strategies to manage and mitigate prolonged service …
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
… Thomas P. DiNapoli, announced the arrest yesterday of Gina Bradshaw, an officer manager for numerous doctors’ … will be held accountable.” Gina Bradshaw, 50, of Maybrook, NY, worked as an office manager for multiple doctors in … assisted with the investigation. Bradshaw was arraigned in Town of Ulster Court before Judge S. Kesick and charged with …
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
… the Program The New York State Health Insurance Program (NYSHIP) was established under Article XI of the New York … collectively referred to as participating organizations). NYSHIP covers over 1.2 million active and retired State and … The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. The Department …
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)
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … The Empire Plan is the primary health benefits plan for NYSHIP, providing coverage to about 1.1 million members. NYSHIP offers several coverage options, including Individual …
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
… Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and … Empire Plan (Plan) is the primary health benefits plan for NYSHIP and includes prescription drug coverage. The … Findings From January 1, 2008 through December 13, 2011, NYSHIP overpaid $137,459 for 147 (26 percent) of the 572 …
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
… the New York State Police. “Ms. Bradshaw thought she could game New York State’s employee benefit system by submitting …
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)
… 13, 2011, the New York State Health Insurance Plan (NYSHIP) made improper payments totaling $137,459 to Davis … Davis Ethical routinely submitted fraudulent claims to NYSHIP and received payments for those claims. We coordinated … of $231,919 to the State, of which $137,459 was paid to NYSHIP for the improper payments identified in the initial …
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
… Affected Employees Employees currently enrolled in NYSHIP as of April 1 of the preceding year Effective Date(s) … statement. Additional Pay Earnings Codes Description NBO NYSHIP Buyout ANB Adjust NYSHIP Buyout OSC will process a weekly input file from DCS …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1140-new-york-state-health-insurance-plan-nyship-opt-out-paymentsAn 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 … nation’s largest public sector health insurance programs. NYSHIP covers over 1.2 million active and retired State, …
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
… The New York State Health Insurance Program (NYSHIP), administered by the State Department of Civil … nation’s largest public sector health insurance programs. NYSHIP covers over 1.2 million active and retired State, … school district employees, and their dependents. In 2017, NYSHIP cost the State, other government employers, and NYSHIP …
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
… fiscal years ended December 31, 2010. Background The New York State Department of Civil Service (Civil Service) is responsible for administering the New York State Health Insurance Program (NYSHIP). NYSHIP … center staff. Other Related Audit/Report of Interest New York State Health Insurance Program - United HealthCare: …
https://www.osc.ny.gov/state-agencies/audits/2013/04/10/united-healthcare-compensation-and-benefit-costs-empire-plan-period-january-1-2008-through