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Selected Payments for Special Items Made to St. Mary's Hospital from January 1, 2011 through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and St. Mary’s. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
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 determine if BlueCross BlueShields Empires payments to Englewood Hospital and Medical Center …
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
… Empire and Saratoga. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage … dependents. The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. The Department of Civil Service …
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
… for special items were made according to the provisions of the agreement between Empire and Bassett. Background The … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mary-imogene-bassett-hospital-january-1-2011-throughUnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and Acupuncture-Related Services (Follow-Up)
… acupuncture and acupuncture-related services such as heat and massage therapy. We issued our initial audit report … United was not able to provide evidence of additional control enhancements designed to prevent duplicate payments. …
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 Stony Brook University Hospital from January 1, 2011 through March 31, 2011
… BlueShield's (Empire's) payments to State University of New York's Stony Brook University Hospital (Stony Brook) … for special items were made according to the provisions of the agreement between Empire and Stony Brook. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-stony-brook-university-hospital-january-1-2011-throughSelected Payments for Special Items Made to Arden Hill Hospital From January 1, 2011 Through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and Arden Hill. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
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 St. Luke's Cornwall Hospital from January 1, 2011 through March 31, 2011
… and St. Luke's. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage … Program /Department of Civil Service : Empire BlueCross Blue Shield - Payments for Selected Items to Selected Hospitals …
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
… for special items were made according to the provisions of the agreement between Empire and St. Peter's. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
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
… for special items were made according to the provisions of the agreement between Empire and Mount Sinai. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mount-sinai-hospital-january-1-2011-through-march-31Empire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… Items (Report 2016-S-57 ). About the Program The New York State Health Insurance Program (NYSHIP) covers active and retired State, participating local government and school district … have such limitations. Our initial audit report, issued on June 22, 2017, examined whether Empire implemented …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followUnitedHealthcare Insurance Company of New York – Overpayments for Physician-Administered Drugs
… To determine whether UnitedHealthcare Insurance Company of New York appropriately reimbursed physician-administered … Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance … Service contracts with UnitedHealthcare Insurance Company of New York (United) to administer the Medical/Surgical …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/unitedhealthcare-insurance-company-new-york-overpayments-physician-administered-drugsCVS 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 … 31, 2018. In accordance with the contract, CVS Health was required to negotiate agreements with drug manufacturers for … days after the issuance of the follow-up review to provide information on any actions that are planned to address the …
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)
… Remitted to the Department of Civil Service (Report 2016-S-41 ). About the Program The New York State Health Insurance … 31, 2018. In accordance with the contract, CVS Health was required to negotiate agreements with drug manufacturers for … days after the issuance of the follow-up review to provide information on any actions that are planned to address the …
https://www.osc.ny.gov/state-agencies/audits/2020/12/29/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service-followCVS Health – Temporary Holding Account Rebate Revenue (Follow-Up)
… Purpose To determine the extent of implementation of the two recommendations included in our initial audit … Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance … To determine the extent of implementation of the two recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2020/10/15/cvs-health-temporary-holding-account-rebate-revenue-followEmpire BlueCross – Improper Payments for Special Items Billed by Hospitals Within Long Island Health Network
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Civil Service …
https://www.osc.ny.gov/state-agencies/audits/2019/11/29/empire-bluecross-improper-payments-special-items-billed-hospitals-within-long-island-healthUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
To determine whether UnitedHealthcare paid claims using reasonable and customary reimbursement rate schedules that did not correlate
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsCVS 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 related to Empire Plan drug utilization in accordance with its contract with the Department of Civil Service. Our … To determine if CVS Health invoiced and remitted commercial …
https://www.osc.ny.gov/state-agencies/audits/2019/01/28/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceNew York State Health Insurance Program – Payments by Empire BlueCross for Hospital Services for Ineligible Members (Follow-Up)
… in our initial audit report, Payments by Empire BlueCross for Hospital Services for Ineligible Members (Report 2019-S-32 ). About the Program … The Empire Plan is the primary health benefits plan for NYSHIP, covering 1.1 million members. Civil Service … in our initial audit report Payments by Empire BlueCross for Hospital Services for Ineligible Members Report 2019S32 …
https://www.osc.ny.gov/state-agencies/audits/2021/12/27/new-york-state-health-insurance-program-payments-empire-bluecross-hospital-servicesUnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services (Follow-Up)
… of implementation of the two recommendations included in our initial audit report, Out-of-Network Providers … improvements. Key Finding United officials made progress in addressing the problems we identified in the initial audit. In particular, United saved the Empire …
https://www.osc.ny.gov/state-agencies/audits/2020/01/03/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-services