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An Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… The Empire Plan is the primary health benefits plan for NYSHIP, covering 1.1 million of the NYSHIP members. The … (out-of-network) providers. United bases payment for most services provided by out-of-network providers either … rate. The R&C rate is generally based on provider charges for the same or similar service in the same or similar …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesAnthem Blue Cross – Coordination of Benefits With Medicare
… Objective To determine whether Anthem Blue Cross coordinated benefits to properly pay claims for … from January 2020 through June 2023. About the Program The New York State Health Insurance Program (NYSHIP), … and their dependents have other insurance coverage in addition to the Empire Plan such as Medicare, the federal …
https://www.osc.ny.gov/state-agencies/audits/2024/08/19/anthem-blue-cross-coordination-benefits-medicareIncorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan (Follow-up)
… Program (NYSHIP), administered by the Department of Civil Service (Civil Service), is one of the nation’s largest public sector …
https://www.osc.ny.gov/state-agencies/audits/2025/06/18/incorrect-payments-cvs-caremark-medicare-rx-drug-claims-were-improperly-paid-underEmpire BlueCross – Overpayments for Physician-Administered Drugs (Follow-Up)
… Drugs (Report 2021-S-33 ). About the Program The New York State Health Insurance Program (NYSHIP), …
https://www.osc.ny.gov/state-agencies/audits/2025/06/04/empire-bluecross-overpayments-physician-administered-drugs-followPoughkeepsie City School District - Procurement and Claims Auditing (2019M-16)
… Key Findings The Board did not: Seek competition for professional services totaling approximately $1.6 million … a total of $968,545 during the audit period. The Director for Technology: Circumvented the procurement policy and … totaling $71,226 during the audit period, including $4,596 for shipping costs. Key Recommendations Ensure purchases …
https://www.osc.ny.gov/local-government/audits/school-district/2019/12/20/poughkeepsie-city-school-district-procurement-and-claims-auditing-2019mPoughkeepsie City School District - Extra-Classroom Activities and Information Technology Assets (2019M-15)
Determine if the Board provided adequate oversight of extra-classroom activity (ECA) finances and properly safeguarded and secured the District’s IT assets.
https://www.osc.ny.gov/files/local-government/audits/pdf/poughkeepsie-2019-15.pdfNorthport - East Northport Union Free School District - Extra-Classroom Activity Fund - (2021M-167)
Determine if extra-classroom activity (ECA) funds were properly collected, recorded, remitted, deposited, disbursed and reconciled.
https://www.osc.ny.gov/files/local-government/audits/2022/pdf/northport-east-northport-2021-167.pdfNewburgh Enlarged City School District - Financial Management and Information Technology (2017M-169)
Determine whether the Board effectively managed the District’s financial condition whether the District’s information technology (IT) system was adequately secu
https://www.osc.ny.gov/files/local-government/audits/pdf/newburgh-169.pdfHiring Public Retirees – When Employees Retire
… be aware of the laws governing how much retirees can earn in post-retirement employment without affecting their … are limited if they are returning to public employment in New York State. Public employment includes: State of New … to enroll them when the deferral year has ended. We will mail the retiree a membership application just prior to the …
https://www.osc.ny.gov/retirement/employers/when-employees-retire/hiring-public-retireesState Contract and Payment Actions in December
… In December, the Office of the State Comptroller approved … $1.3 million with Niko Development Corp. for basketball court installations at Jones Beach State Park in Nassau … Smart Pill Building in Buffalo. $1.7 million to Martin House Restoration Corporation for construction and renovation …
https://www.osc.ny.gov/press/releases/2019/01/state-contract-and-payment-actions-decemberDiNapoli Announces State Contract and Payment Actions for April 2016
… Office of General Services $11.4 million for hourly-based IT services, including $2.5 million to PSI International …
https://www.osc.ny.gov/press/releases/2016/05/dinapoli-announces-state-contract-and-payment-actions-april-2016State Contract and Payment Actions in September
… In September, the Office of the State Comptroller approved … & Substance Abuse Services $1.9 million with Dulcian Inc. for information technology assistance and updates to the … County. Office of General Services $15.3 million with New York State Industries for the Disabled Inc. for …
https://www.osc.ny.gov/press/releases/2019/10/state-contract-and-payment-actions-septemberFSMS School Districts: School Year 2019-20 Results; 2020-21 Risks
FSMS School Districts: School Year 2019-20 Results; 2020-21 Risks
https://www.osc.ny.gov/files/local-government/fiscal-monitoring/pdf/2021-schools-snapshot-jan.pdfDiNapoli Announces State Contract and Payment Actions for September 2015
… and approved 1.8 million payments worth $13.7 billion in September. His office also rejected 149 contracts and … occurred because contracts and payments were accelerated in order to allow an upgrade of the Statewide Financial … office averaged eight days for contract reviews in September and two days to audit payments. DiNapoli …
https://www.osc.ny.gov/press/releases/2015/10/dinapoli-announces-state-contract-and-payment-actions-september-2015DiNapoli Announces State Contract & Payment Actions for June 2014
… financial officer, DiNapoli’s office reviews contracts for all state agencies and certain contracts for state public authorities and audits all state payments. … monthly notice to provide current information about the number and types of contracts and payments entered into by …
https://www.osc.ny.gov/press/releases/2014/07/dinapoli-announces-state-contract-payment-actions-june-2014Cost-Saving Ideas: Minimizing Unemployment Insurance Costs
… of Labor (DOL) determines who qualifies for benefits and individual employers fund their own programs. Review … yourself: Take the account balance at the beginning of the year, adding to it all the timely normal tax contributions … fiscal crisis and possible layoffs may want to build up an account balance. Otherwise, it risks having to …
https://www.osc.ny.gov/local-government/publications/cost-saving-ideas-minimizing-unemployment-insurance-costsCharter School of Educational Excellence – Middle School Capital Project and Board Oversight of the Management Company (2015M-7)
… of Educational Excellence is a public school, located in the City of Yonkers, that is not under the control of the … did not seek competition for approximately $6.8 million in project-related expenses for the Middle School project. …
https://www.osc.ny.gov/local-government/audits/charter-school/2015/05/08/charter-school-educational-excellence-middle-school-capital-project-andOversight of Chronic Absenteeism (Follow-Up)
… absenteeism is a widespread problem, defined by the State Education Department (Department) as a student missing … 2,620,000 K–12 public school students enrolled in New York State’s 732 public schools. Nationally, 7 million …
https://www.osc.ny.gov/state-agencies/audits/2020/05/06/oversight-chronic-absenteeism-followBrighter Choice Charter School for Girls – Financial Operations (2013M-321)
… compact contract with the Foundation, and the process for developing and monitoring its annual budget for the … fiscal year were approximately $4.14 million. Key Findings On May 27, 2011, the Board approved a compact contract … percent of per pupil revenue from the prior academic year. On January 31, 2013, the Board approved a revised compact …
https://www.osc.ny.gov/local-government/audits/charter-school/2014/02/07/brighter-choice-charter-school-girls-financial-operations-2013m-321United HealthCare Insurance Company of New York – Empire Plan Drug Rebates (Follow-Up)
… the implementation status of the two recommendations made in our audit report, United HealthCare Insurance Company of New York: Empire Plan Drug Rebates (Report 2014-S-62). Background …
https://www.osc.ny.gov/state-agencies/audits/2017/05/24/united-healthcare-insurance-company-new-york-empire-plan-drug-rebates-follow