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Anthem Blue Cross – Coordination of Benefits With Medicare
… plan. This process determines which insurance plan pays first as primary and which insurance plan pays secondary. Because the insurance company which pays primary typically pays the majority of the claim, it is …
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
… 1, 2014 through December 31, 2019. About the Program The New York State Health Insurance Program (NYSHIP), …
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)
… Remitted to the Department of Civil Service (Report 2022-S-1 ). About the Program The New York State Health Insurance … year. In accordance with the contracts, CVS Caremark was required to negotiate agreements with drug manufacturers for … The objective of our initial audit, issued on June 21, 2023, was to determine whether CVS Caremark appropriately …
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)
… a Commercial Plan for members and their dependents who do not qualify for Medicare, and the Empire Plan Medicare Rx … Rx Plan) for retired members and their dependents who do qualify for Medicare. Claims paid under the Medicare Rx …
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
… Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), is one of the nation’s largest public sector health insurance … were incorrectly paid under the Commercial Plan instead of the Medicare Rx Plan. We found the misprocessing of claims …
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
… Key Findings We reviewed the rebate revenue generated from agreements with six drug manufacturers and found that … invoice drug manufacturers for rebates, collect rebates from the manufacturers, or remit all rebate revenue to Civil … rebate-eligible drug utilization is invoiced, collected from the manufacturers, and remitted in a timely manner to …
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
… 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 … period January 1, 2014 through December 31, 2018. The cost of the prescription drug program averaged $2.4 billion per …
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
… January 2019 through December 2022. About the Program The New York State Health Insurance Program (NYSHIP), …
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
To determine if CVS Health remitted to the State Department of Civil Service all commercial drug rebate revenue attributable to eligible prescription drug claims
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
… the period from January 2019 through December 2023. About the Program The New York State Health Insurance Program … public sector health insurance programs. NYSHIP covers about 1.2 million active and retired State, participating … During the audit period, CVS Caremark recovered or saved about $63.1 million as a result of the audits conducted. Key …
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
… Drugs (Follow-Up) (2024-F-34) The New York State Health Insurance Program (NYSHIP) is administered by the Department … plan for NYSHIP, and Civil Service contracts with Anthem Blue Cross (Anthem), formerly Empire BlueCross, to administer the …
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
… role in a long-term scheme to defraud the New York State Insurance Plan (NYSHIP) out of over $12,000 by submitting … role in a longterm scheme to defraud the New York State Insurance Plan out of over $12000 by submitting fraudulent …
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
… State and participating organization employers and members pay their respective share of those premiums. However, while participating organizations are required to pay a minimum employer share of the cost, some may pay a higher rate of contribution up to the full cost of …
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)
… of implementation of the two recommendations included in our initial audit report, New York State Health Insurance … their spouse/domestic partner are both eligible to enroll in NYSHIP, only one may elect Family coverage (the other may … Civil Service officials addressed the issues identified in the initial audit, officials cited Health Insurance …
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
… and includes prescription drug coverage. The Department of Civil Service (Department) contracts with United … to administer the prescription drug benefit portion of the Plan. Based on the primary contract, the Department … Davis, a licensed pharmacist. Pursuant to allegations of improper billing practices, there have been several …
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
… She was arrested in September 2023 following a joint investigation by Comptroller DiNapoli, the Ulster County … of Investigations (FBI) – Hudson Valley White Collar Crime Task Force, and the New York State Police. “Ms. … agencies that are part of the Hudson Valley White Collar Crime Task Force, as well as between our Office and the New …
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)
… Purpose To determine the extent of implementation of the three recommendations included in our initial audit … determined that Davis Ethical likely fabricated nearly all of the improper claims. Davis Ethical processed many of the … Determine extent of implementation of 3 recommendations included in our …
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
… (DCS) to process payments to employees with proof of other health insurance who elect to opt-out of State health insurance. Affected Employees Employees currently … beginning January 1, 2012, employees with proof of other health insurance may elect to opt-out of State health …
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 out our Retirement Online tools and tips for …
https://www.osc.ny.gov/retirement/retirees/annual-statement