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DiNapoli: Former Pharmacist Pleads Guilty In $232,000 Fake Prescriptions Scam
… for reimbursement to Medicaid and the New York State Health Insurance Program (NYSHIP) from 2008 through 2011. … around $7 million in claims paid to Davis. NYSHIP provides health insurance to some state and local government and … involving taxpayer money by calling the toll-free Fraud Hotline at 1-888-672-4555, by filing a complaint online at …
https://www.osc.ny.gov/press/releases/2015/12/dinapoli-former-pharmacist-pleads-guilty-232000-fake-prescriptions-scamNew York State Health Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services for Ineligible Members (Follow-Up)
… information. Our initial audit report, issued on September 29, 2021, sought to determine whether United paid … implemented. Key Recommendation Officials are given 30 days after the issuance of this follow-up to provide …
https://www.osc.ny.gov/state-agencies/audits/2023/01/18/new-york-state-health-insurance-program-payments-unitedhealthcare-medicalsurgical-servicesEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period April 1, 2011 Through June 30, 2011 (Follow-Up)
… extent of implementation of the three recommendations made in our audit report, Empire BlueCross BlueShield: Selected … accordance with agreements Empire negotiates with member hospitals. Payments for hospital services are generally based …
https://www.osc.ny.gov/state-agencies/audits/2014/10/30/empire-bluecross-blueshield-selected-payments-special-items-period-april-1-2011-throughState Comptroller DiNapoli Releases State Audits and Examinations
… Thomas P. DiNapoli announced today the following audits and examinations have been issued: Office of Temporary and … problems identified in the initial audit. New York State Health Insurance Program (NYSHIP): United HealthCare: … offs were isolated in nature and largely attributable to human error or changes to the billing system, and thus not …
https://www.osc.ny.gov/press/releases/2017/03/state-comptroller-dinapoli-releases-state-audits-and-examinationsCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
… Objective To assess the extent of implementation of the two recommendations … included in our initial audit report, Accuracy of Drug Rebate Revenue Remitted to the Department of Civil … district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving 1.1 …
https://www.osc.ny.gov/state-agencies/audits/2021/11/16/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service-followEmpire BlueCross – Overpayments for Physician-Administered Drugs
… A physician-administered drug is a drug, other than a vaccine, that is typically administered by a health care …
https://www.osc.ny.gov/state-agencies/audits/2023/09/27/empire-bluecross-overpayments-physician-administered-drugsUnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers
… Purpose To determine whether UnitedHealthcare overpaid for … Surgery Centers that were contractually required to use in-network anesthesia providers. The audit covered the …
https://www.osc.ny.gov/state-agencies/audits/2018/08/13/unitedhealthcare-overpayments-out-network-anesthesia-services-provided-network-ambulatoryState Comptroller DiNapoli Releases Audits
… Thomas P. DiNapoli announced today the following audits and examinations have been issued State Education Department … agency administrative allocation costs. New York State Health Insurance Program (NYSHIP): Preventing Inappropriate and …
https://www.osc.ny.gov/press/releases/2018/06/state-comptroller-dinapoli-releases-auditsNew York State Health Insurance Program – Payments by Beacon Health Options for Mental Health and Substance Abuse Services for Ineligible Members (Follow-Up)
… implementation of the four recommendations included in our initial audit report, New York State Health Insurance Program … Beacon Health Options for Mental Health and Substance Use Services for Ineligible Members (Report 2021-S-18 ). About …
https://www.osc.ny.gov/state-agencies/audits/2024/01/03/new-york-state-health-insurance-program-payments-beacon-health-options-mental-health-andUnited Healthcare – Empire Plan Drug Rebate Revenue (Follow-Up)
… September 26, 2014, identified $694,227 in drug rebate and discount revenue that was not credited to the Department for … the Department was credited with all drug rebate and discount revenue due to the State. We recommended that United remit to the Department the $694,227 in rebate and discount revenue identified by our audit, and fully comply …
https://www.osc.ny.gov/state-agencies/audits/2015/12/03/united-healthcare-empire-plan-drug-rebate-revenue-followEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period July 1, 2012 Through December 31, 2012 (Follow-Up)
… made in our audit report, New York State Health Insurance Program: Empire BlueCross BlueShield Selected Payments for Special Items for the Period July 1, 2012 Through … controls to ensure special items were paid according to contract provisions. As a result, during the six-month period …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-july-1-2012-throughEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations made in our audit report, New … benefits plan for NYSHIP. The New York State Department of Civil Service contracts with Empire BlueCross BlueShield …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2012-throughEmpire BlueCross – Overpayments for Physician-Administered Drugs (Follow-Up)
… of the seven recommendations included in our initial audit report, Empire BlueCross – Overpayments for … the Empire Plan and to process and pay claims for hospital services. Hospital benefits cover a range of services …
https://www.osc.ny.gov/state-agencies/audits/2025/06/04/empire-bluecross-overpayments-physician-administered-drugs-followUnited HealthCare Insurance Company of New York – Empire Plan Drug Rebates (Follow-Up)
… our audit report, United HealthCare Insurance Company of New York: Empire Plan Drug Rebates (Report 2014-S-62). Background The …
https://www.osc.ny.gov/state-agencies/audits/2017/05/24/united-healthcare-insurance-company-new-york-empire-plan-drug-rebates-followUnitedHealthcare: Improper Payments for Acupuncture and Acupuncture-Related Services
… Company of New York appropriately reimbursed acupuncture and acupuncture-related services. The audit covered the … health insurance coverage to over 1.2 million active and retired State, participating local government, and school … Plan and process and pay claims submitted by health care providers. Medical/surgical benefits cover a range of …
https://www.osc.ny.gov/state-agencies/audits/2021/10/27/unitedhealthcare-improper-payments-acupuncture-and-acupuncture-related-servicesUnited HealthCare – Empire Plan Drug Rebates
… Purpose To determine if United HealthCare Insurance Company of New York (United) credited … school district employees and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/united-healthcare-empire-plan-drug-rebatesEmpire BlueCross BlueShield – Payments to John T. Mather Memorial Hospital (Follow-Up)
… if the recommendations made in our initial audit report, Empire BlueCross BlueShield: Payments to John T. Mather … issued on April 23, 2012, were implemented. Background The New York State Health Insurance Program (NYSHIP) provides … Empire has expanded the look back period to six years for New York State claims. Although Empire performed audits of …
https://www.osc.ny.gov/state-agencies/audits/2013/06/04/empire-bluecross-blueshield-payments-john-t-mather-memorial-hospital-followUnitedHealthcare Insurance Company of New York – Overpayments for Physician-Administered Drugs (Follow-Up)
… Insurance Company of New York – Overpayments for Physician-Administered Drugs (Report 2021-S-32 ). About the Program The … district employees, and their dependents. The Empire Plan is the primary health insurance plan for NYSHIP, providing … to develop a process to prevent overpayments on claims where both the Medical/Surgical and Prescription Drug …
https://www.osc.ny.gov/state-agencies/audits/2025/05/21/unitedhealthcare-insurance-company-new-york-overpayments-physician-administered-drugsEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… Purpose To determine if Empire BlueCross BlueShield: implemented sufficient controls … January 1, 2013 through December 31, 2016. Background The New York State Health Insurance Program (NYSHIP) provides …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… diagnosed with ESRD. In particular, the Department does not identify Medicaid recipients with ESRD, notify ESRD … them enrolled, the Medicaid program could have saved as much as $146 million over the six-year audit period. For … Medicaid recipients with ESRD and helped guide them on how to apply for and enroll in Medicare. In response to our …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-disease