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DiNapoli: Contractor Failed to Turn Over $1.5 Million in Prescription Drug Rebates to NYS
… A company that was supposed to collect rebates from drug manufacturers on behalf of the New York State Health Insurance Plan (NYSHIP) failed to turn over nearly $1.5 million in rebates to the state over a four-year period, according to an audit …
https://www.osc.ny.gov/press/releases/2016/11/dinapoli-contractor-failed-turn-over-15-million-prescription-drug-rebates-nysPayments by Beacon Health Options for Mental Health and Substance Abuse Services for Ineligible Members
… paid mental health and substance abuse (MHSA) claims for Empire Plan members who were not eligible for coverage. The audit covered the period from January 2015 … The Empire Plan is the primary health insurance plan for NYSHIP, serving about 1.1 million members. Civil Service …
https://www.osc.ny.gov/state-agencies/audits/2022/05/13/payments-beacon-health-options-mental-health-and-substance-abuse-services-ineligibleUnited 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-throughNew York State Health Insurance Program – Payments by CVS Health for Pharmacy Services for Ineligible Members
… To determine whether CVS Health paid pharmacy claims for Empire Plan members who were not eligible. The audit … The Empire Plan is the primary health insurance plan for NYSHIP, serving about 1.1 million members. Since 2014, … Civil Service maintains eligibility and enrollment records for NYSHIP members in the New York Benefits Eligibility and …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/new-york-state-health-insurance-program-payments-cvs-health-pharmacy-services-ineligibleCost-Saving Ideas: Monitoring Health Insurance Premiums for Retirees
… paid $239,000 in health insurance benefits for deceased or ineligible retirees. Seek Competition Review … coverage. Seek Reimbursement for Premiums Paid for Deceased Retirees Local officials should immediately contact … their health insurance provider to stop coverage for deceased individuals and seek reimbursement for any premiums …
https://www.osc.ny.gov/local-government/publications/cost-saving-ideas-monitoring-health-insurance-premiums-retireesState Agencies Bulletin No. 1100
… of Civil Service to process imputed income transactions for the value of the employer contribution for health insurance benefits provided to an employee’s … value of employer provided health benefits to an employee for a domestic partner. Historically, marriages between …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1100-new-imputed-income-earnings-codes-health-benefits-provided-marriedNew York State Health Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services for Ineligible Members
… UnitedHealthcare Insurance Company of New York paid claims for Empire Plan members who were not eligible. The audit … The Empire Plan is the primary health insurance plan for NYSHIP, serving about 1.1 million members. The Department … Civil Service maintains eligibility and enrollment records for NYSHIP members in the New York Benefits Eligibility and …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/new-york-state-health-insurance-program-payments-unitedhealthcare-medicalsurgical-servicesUnited HealthCare – Empire Plan Drug Rebate Revenue
… The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The Department … required to negotiate agreements with drug manufacturers for rebates, discounts, and other considerations and pass 100 … of the agreements on to the prescription drug program. For the audit period, January 1, 2010 through December 31, …
https://www.osc.ny.gov/state-agencies/audits/2016/11/01/united-healthcare-empire-plan-drug-rebate-revenueUnited HealthCare – Empire Plan Drug Rebate Revenue (Follow-Up)
… The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The New York … required to negotiate agreements with drug manufacturers for rebates, discounts, and other considerations and pass 100 …
https://www.osc.ny.gov/state-agencies/audits/2017/05/15/united-healthcare-empire-plan-drug-rebate-revenue-followState Agencies Bulletin No. 1287
… the value of such health coverage will not be reported on Form W-2s. If the spouse resides (for tax purposes) outside of …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1287-changes-taxation-imputed-incomeUnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services
… monitors out-of-network providers who routinely bill for higher-level Evaluation and Management services and to … if out-of-network providers billed UnitedHealthcare for higher-paying Evaluation and Management services than … The Empire Plan is the primary health benefits plan for NYSHIP, covering a comprehensive range of services for …
https://www.osc.ny.gov/state-agencies/audits/2018/12/31/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesDiNapoli: Former Pharmacist Charged In $232,000 Medical Claims Fraud
… the state of $232,000 after the scam was uncovered in two audits by State Comptroller Thomas P. DiNapoli’s … Davis, 62, the former owner of Davis Ethical Pharmacy in Rockville Centre, was charged with grand larceny in the second degree, a class C felony, for allegedly sending …
https://www.osc.ny.gov/press/releases/2015/09/dinapoli-former-pharmacist-charged-232000-medical-claims-fraudSelected Payments for Special Items Made to St. Francis Hospital of Poughkeepsie from January 1, 2011 through March 31, 2011
… Plan. Empire processes Plan claims for hospital services in accordance with agreements they negotiate with member …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-francis-hospital-poughkeepsie-january-1-2011Retiree Annual Statement
… printed Statements by the end of February. Email Delivery (Online Availability): We make Statements available in Retirement Online sooner than printed copies are mailed—we will notify … benefit. Alternate Payee Deductions The amount deducted to pay to your ex-spouse per the terms of your Domestic …
https://www.osc.ny.gov/retirement/retirees/retiree-annual-statementUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59
… submission. Recover the $39,345 in overpayments identified by our audit. As priorities and resources permit, review the …
https://www.osc.ny.gov/state-agencies/audits/2015/01/08/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59CUNY Bulletin No. CU-478
… same-sex spouse in the New York State Health Insurance Plan (NYSHIP) or City of New York Health Insurance Plan Effective Date(s) Immediately Background Following New … spouse under the City of New York Health Insurance plan, and resides for tax purposes in a state that neither …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/city-university-new-york/cu-478-changes-taxation-imputed-incomeSelected Payments for Special Items Made to St. Mary's Hospital from January 1, 2011 through March 31, 2011
… (Empire’s) payments to St. Mary’s Hospital (St. Mary’s) for special items were made according to the provisions of … The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. The Department of Civil Service contracts with … portion of the Plan. Empire processes Plan claims for hospital services in accordance with agreements they …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-marys-hospital-january-1-2011-through-march-31-2011Empire BlueCross BlueShield Special Items Made to Englewood Hospital and Medical Center from January 1, 2011 through March 31, 2011
… to Englewood Hospital and Medical Center (Englewood) for special items were made according to the provisions of … The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. The Department of Civil Service contracts with … portion of the Plan. Empire processes Plan claims for hospital services in accordance with agreements they …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/empire-bluecross-blueshield-special-items-made-englewood-hospital-and-medical-centerEmpire BlueCross BlueShield – Selected Payments for Special Items Made to Saratoga Hospital From January 1, 2011 Through March 31, 2011
… Plan. Empire processes Plan claims for hospital services in accordance with agreements they negotiate with member … $37,717 from Saratoga for the overpayments we identified in this audit. Develop and implement the controls necessary …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/empire-bluecross-blueshield-selected-payments-special-items-made-saratoga-hospital-januarySelected Payments for Special Items Made to Mary Imogene Bassett Hospital from January 1, 2011 through March 31, 2011
… payments to Mary Imogene Bassett Hospital (Bassett) for special items were made according to the provisions of … The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. The Department of Civil Service contracts with … portion of the Plan. Empire processes Plan claims for hospital services in accordance with agreements they …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mary-imogene-bassett-hospital-january-1-2011-through