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Selected Payments for Special Items Made to Albany Medical Center from January 1, 2011 through March 31, 2011
… if BlueCross BlueShield’s (Empire’s) payments to Albany Medical Center (AMC) for special items were made according to … Insurance Program: Payments Made to Stony Brook University Medical Center (2009-S-27) New York State Health Insurance … if BlueCross BlueShields Empires payments to Albany Medical Center AMC for special items were made according to …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-albany-medical-center-january-1-2011-through-march-31UnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59
… members. United’s payments to medical providers are based, in part, on procedure codes billed on claims that indicate … United will not pay for certain procedure codes billed in combination with other procedure codes unless the provider … for claims preparation and submission. Recover the $39,345 in overpayments identified by our audit. As priorities and …
https://www.osc.ny.gov/state-agencies/audits/2015/01/08/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59CUNY Bulletin No. CU-478
… Purpose To inform agencies of the change related to the taxation of imputed income for a … refunds. Agency Actions Inform impacted employees of the change. Questions Questions regarding this bulletin may be … To inform agencies of the change related to the taxation of imputed income for a …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/city-university-new-york/cu-478-changes-taxation-imputed-incomeUnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and Acupuncture-Related Services (Follow-Up)
… audit report, UnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and … Services (Report 2020-S-7 ). About the Program The New York State Health Insurance Program (NYSHIP), … contracts with UnitedHealthcare Insurance Company of New York (United) to administer the Empire Plan’s …
https://www.osc.ny.gov/state-agencies/audits/2023/07/20/unitedhealthcare-insurance-company-new-york-improper-payments-acupuncture-and-acupunctureSelected Payments for Special Items Made to St. Luke's Cornwall 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 … $9,327 from St. Luke’s 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/selected-payments-special-items-made-st-lukes-cornwall-hospital-january-1-2011-throughSelected Payments for Special Items Made to St. Peter's 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 … $4,836 from St. Peter’s 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/selected-payments-special-items-made-st-peters-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to Mount Sinai Hospital from January 1, 2011 through March 31, 2011
… determine if BlueCross BlueShield's (Empire's) payments to Mount Sinai Hospital (Mount Sinai) for special items were made according to the provisions of the agreement between Empire and Mount Sinai. Background The New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mount-sinai-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to Arden Hill 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 … from Stony Brook 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/selected-payments-special-items-made-arden-hill-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to Stony Brook University Hospital from January 1, 2011 through March 31, 2011
… Purpose To determine if Empire BlueCross BlueShield's (Empire's) payments to State University of New York's Stony Brook University … To determine if Empire BlueCross BlueShields Empires payments …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-stony-brook-university-hospital-january-1-2011-throughEmpire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… plan for NYSHIP. Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital services according to contracts it negotiates with … rate schedules for the payment of inpatient and outpatient hospital services. Hospitals may be entitled to additional …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
… Remitted to the Department of Civil Service (Report 2018-S-50 ). About the Program The New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2021/02/08/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service-followCVS Health - Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
… in our initial audit report, CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service … with drug manufacturers for rebates and remit the rebate revenue to Civil Service. Our initial audit report, … determine if CVS Health invoiced and remitted commercial rebate revenue related to Empire Plan drug utilization in …
https://www.osc.ny.gov/state-agencies/audits/2020/12/29/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service-followUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… (Civil Service), provides health insurance coverage to over 1.2 million active and retired State, local government … reimbursement for certain out-of-network claims is 80 percent of the R&C rate for the service. R&C rates are … January 1, 2017 through December 31, 2018, United paid over $416 million for 255,807 out-of-network claims based on …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsEmpire BlueCross – Improper Payments for Special Items Billed by Hospitals Within Long Island Health Network
… Recover the remaining $3,335,221 out of $3,597,688 in special item claim overpayments. Develop a corrective … with LIHN hospitals to prevent these errors from occurring in the future. …
https://www.osc.ny.gov/state-agencies/audits/2019/11/29/empire-bluecross-improper-payments-special-items-billed-hospitals-within-long-island-healthCVS Health – Temporary Holding Account Rebate Revenue (Follow-Up)
To determine the extent of implementation of the two recommendations included in our initial audit report Temporary Holding Account Rebate Revenue 2019S27
https://www.osc.ny.gov/state-agencies/audits/2020/10/15/cvs-health-temporary-holding-account-rebate-revenue-followUnitedHealthcare Insurance Company of New York – Overpayments for Physician-Administered Drugs
… New York appropriately reimbursed physician-administered drugs. The audit covered the period from January 2017 through … a range of services, including physician-administered drugs, which are also covered under the Empire Plan’s … paid approximately $878 million for physician-administered drugs. Key Findings We identified $5,536,537 in actual and …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/unitedhealthcare-insurance-company-new-york-overpayments-physician-administered-drugsUnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services (Follow-Up)
… there are different billing levels (e.g., level 1, 5-minute visit and level 5, 40-minute visit). The higher the level billed, the greater …
https://www.osc.ny.gov/state-agencies/audits/2020/01/03/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesEmpire BlueCross – Improper Payments for Intraocular Lens Claims Billed by Hospitals
… June 30, 2019. About the Program The New York State Health Insurance Program (NYSHIP) provides health insurance coverage … district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, covering … for special items, such as implants, which are not covered by fee schedules. Intraocular lenses are used in the …
https://www.osc.ny.gov/state-agencies/audits/2019/12/20/empire-bluecross-improper-payments-intraocular-lens-claims-billed-hospitalsNew York State Health Insurance Program – Payments by Empire BlueCross for Hospital Services for Ineligible Members (Follow-Up)
… of the five recommendations included in our initial audit report, Payments by Empire BlueCross for Hospital Services for Ineligible Members (Report 2019-S-32 ). About the Program The New York State … of the five recommendations included in our initial audit report Payments by Empire BlueCross for Hospital Services for …
https://www.osc.ny.gov/state-agencies/audits/2021/12/27/new-york-state-health-insurance-program-payments-empire-bluecross-hospital-servicesCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… Purpose To determine if CVS Health invoiced and remitted commercial rebate revenue … 2014 through June 30, 2017. Background The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance coverage to active and retired State, …
https://www.osc.ny.gov/state-agencies/audits/2019/01/28/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service