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Preventing Inappropriate and Excessive Costs in the New York State Health Insurance Program
… a provider who charges $1,000 for a service and collects $800 in payments by United should collect $200 from the Empire … of $200, it has actually provided a medical service for $800, not $1,000, and United should have paid only $640 (80 percent of $800) of that cost, resulting in an overpayment of $160 ($800 …
https://www.osc.ny.gov/state-agencies/audits/2018/05/09/preventing-inappropriate-and-excessive-costs-new-york-state-health-insurance-programState Agencies Bulletin No. 1506
… which took effect January 1, 2015. As a result, actual dates of eligibility for these individuals do not need be … 42 days 42 days 42 days 42 days 42 days n/a 56 days 43rd day 43rd day 43rd day 43rd day 43rd day 43rd day 1st day 57th day *The …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1506-updating-employee-health-insurance-eligibility-payservUnited HealthCare – Compensation and Benefit Costs for the Empire Plan for the Period January 1, 2008 through December 31, 2010
… worked by claims center staff. Key Recommendations For no less than six years, maintain the source and summary data …
https://www.osc.ny.gov/state-agencies/audits/2013/04/10/united-healthcare-compensation-and-benefit-costs-empire-plan-period-january-1-2008-throughDiNapoli: Contractor Failed to Turn Over $1.5 Million in Prescription Drug Rebates to NYS
… Plan (NYSHIP) failed to turn over nearly $1.5 million in rebates to the state over a four-year period, according to … Express Scripts Holding Company took over those duties in 2012. DiNapoli’s auditors found that on a quarterly basis, … Scripts invoiced drug manufacturers for rebates and, in accordance with its subcontract with United, made …
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
… 2015 through December 2020. About the Program The New York State Health Insurance Program (NYSHIP), administered by the … insurance coverage to over 1.2 million active and retired State, local government, and school district employees, and … disenrollment. There is a risk that claims submitted on the disenrolled member’s behalf during this interim period …
https://www.osc.ny.gov/state-agencies/audits/2022/05/13/payments-beacon-health-options-mental-health-and-substance-abuse-services-ineligibleNew York State Health Insurance Program – Payments by CVS Health for Pharmacy Services for Ineligible Members
… delays, taking an average of 227 days – and in one case 10 years – to cancel coverage. Civil Service relies heavily …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/new-york-state-health-insurance-program-payments-cvs-health-pharmacy-services-ineligibleNew York State Health Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services for Ineligible Members
… disenrolled (when a member is disenrolled from NYBEAS after the date eligibility ended). For contracts that do not … that occurred either before a member was enrolled or after United was notified the member was disenrolled ($1.1 …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/new-york-state-health-insurance-program-payments-unitedhealthcare-medicalsurgical-servicesState Agencies Bulletin No. 1100
… of Civil Service at (518) 457-5754 (Albany Area) or 1 (800) 833-4344 (outside Albany Area). This line is operational …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1100-new-imputed-income-earnings-codes-health-benefits-provided-marriedCost-Saving Ideas: Monitoring Health Insurance Premiums for Retirees
… CostSaving Ideas Monitoring Health Insurance Premiums for Retirees …
https://www.osc.ny.gov/local-government/publications/cost-saving-ideas-monitoring-health-insurance-premiums-retireesUnited HealthCare – Empire Plan Drug Rebate Revenue
… Purpose To determine if United HealthCare (United) remitted all drug rebate revenue to the … Other Related Audits/Reports of Interest United HealthCare Insurance Company of New York: Empire Plan Drug Rebates (2014-S-62) United HealthCare Insurance Company of New York: Empire Plan Drug …
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)
… of the recommendation made in our audit report, United HealthCare: Empire Plan Drug Rebate Revenue (2016-S-7). … of Civil Service (Department) contracted with United HealthCare (United) to administer the Empire Plan’s … Interest New York State Health Insurance Program: United HealthCare - Empire Plan Drug Rebate Revenue ( 2016-S-7 ) …
https://www.osc.ny.gov/state-agencies/audits/2017/05/15/united-healthcare-empire-plan-drug-rebate-revenue-followState Agencies Bulletin No. 1287
… Purpose To inform agencies of the change related to the taxation of imputed income for a non-employee same-sex spouse’s health coverage and of the potential tax impact for non-residents of New York … To inform agencies of the change related to the taxation of imputed income for a …
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
… whether UnitedHealthcare sufficiently monitors out-of-network providers who routinely bill for higher-level … Evaluation and Management services and to determine if out-of-network providers billed UnitedHealthcare for … benefits plan for NYSHIP, covering a comprehensive range of services for about 1.1 million of these members. The State …
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 former owner of a Long Island pharmacy was arrested Thursday for allegedly defrauding the state of $232,000 after the scam was uncovered in two audits by … P. DiNapoli’s office. William Davis, 62, the former owner of Davis Ethical Pharmacy in Rockville Centre, was charged …
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
… to St. Francis Hospital of Poughkeepsie (St. Francis) 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-francis-hospital-poughkeepsie-january-1-2011Retiree Annual Statement
… pension payments for the last calendar year, including the total amount you received and a breakdown of credits, … you call or write NYSLRS. Benefit Amount Base Benefit Your total pension benefit amount before credits, deductions and … contact your former employer. Other Deductions The total amount for dues or fees (for example, union dues or …
https://www.osc.ny.gov/retirement/retirees/retiree-annual-statementSelected Payments for Special Items Made to St. Mary's Hospital from January 1, 2011 through March 31, 2011
… Purpose To determine if BlueCross BlueShield’s (Empire’s) payments to St. Mary’s Hospital (St. Mary’s) for … made according to the provisions of the agreement between Empire and St. Mary’s. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage …
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
… Purpose To determine if BlueCross BlueShield’s (Empire’s) payments to Englewood Hospital and Medical Center … made according to the provisions of the agreement between Empire and Englewood. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage …
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
… school district employees and their dependents. The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. … in accordance with agreements they negotiate with member hospitals, including Saratoga. Empire's payments to Saratoga … costs to acquire them. Key Finding We reviewed one claim payment to Saratoga for special items and determined Empire …
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
… district employees and their dependents. The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. … in accordance with agreements they negotiate with member hospitals, including Bassett. Empire’s payments to Bassett … costs to acquire them. Key Findings We reviewed one claim payment to Bassett for special items and determined Empire …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mary-imogene-bassett-hospital-january-1-2011-through