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CVS 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 … 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-serviceDiNapoli: Former Pharmacist Pleads Guilty In $232,000 Fake Prescriptions Scam
… in the second degree in Nassau County District Court for sending phony prescription records for reimbursement to Medicaid and the New York State Health … state Medicaid Program provides prescription drug coverage for enrollees. To read the two audit reports, visit: …
https://www.osc.ny.gov/press/releases/2015/12/dinapoli-former-pharmacist-pleads-guilty-232000-fake-prescriptions-scamEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period April 1, 2011 Through June 30, 2011 (Follow-Up)
… Purpose To determine the extent of implementation of the three … Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government … contracts with Empire BlueCross BlueShield (Empire) to administer the hospitalization benefit portion of the …
https://www.osc.ny.gov/state-agencies/audits/2014/10/30/empire-bluecross-blueshield-selected-payments-special-items-period-april-1-2011-throughCVS 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 … audit report, Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Report 2019-S-51 ). About … To assess the extent of implementation of the two …
https://www.osc.ny.gov/state-agencies/audits/2021/11/16/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service-followNew York State Health Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services for Ineligible Members (Follow-Up)
… Objective To assess the extent of implementation of the three recommendations included in our initial audit … Services for Ineligible Members (Report 2020-S-34 ). About the Program The New York State Health Insurance Program … To assess the extent of implementation of the three recommendations …
https://www.osc.ny.gov/state-agencies/audits/2023/01/18/new-york-state-health-insurance-program-payments-unitedhealthcare-medicalsurgical-servicesEmpire 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-drugsState Comptroller DiNapoli Releases State Audits and Examinations
… Program (NYSHIP): United HealthCare: Overpayments for Services Provided by Long Island Bone and Joint LLP … members' required out-of-pocket cost-sharing obligations for services provided. The Empire Plan is the primary health benefits plan for NYSHIP. The New York State Department of Civil Service …
https://www.osc.ny.gov/press/releases/2017/03/state-comptroller-dinapoli-releases-state-audits-and-examinationsEmpire BlueCross – Overpayments for Physician-Administered Drugs (Follow-Up)
… medical/surgical coverage. Civil Service contracts with Anthem Blue Cross (Anthem), formerly Empire BlueCross, to administer the …
https://www.osc.ny.gov/state-agencies/audits/2025/06/04/empire-bluecross-overpayments-physician-administered-drugs-followUnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers
… To determine whether UnitedHealthcare overpaid for out-of-network anesthesia services provided at Ambulatory Surgery … Program (NYSHIP), administered by the State Department of Civil Service (Civil Service), provides health insurance … The Empire Plan provides its members with four types of health insurance coverage: medical/surgical, hospital, …
https://www.osc.ny.gov/state-agencies/audits/2018/08/13/unitedhealthcare-overpayments-out-network-anesthesia-services-provided-network-ambulatoryEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)
… of the Plan. Empire processes and pays Plan claims for hospital services in accordance with agreements Empire negotiates with member hospitals. Payments for hospital services are generally based on standard fee …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2012-throughEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period July 1, 2012 Through December 31, 2012 (Follow-Up)
… of the three recommendations made in our audit report, New York State Health Insurance Program: Empire BlueCross BlueShield …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-july-1-2012-throughUnited Healthcare – Empire Plan Drug Rebate Revenue (Follow-Up)
… Of the initial report’s three audit recommendations, one was partially implemented, one was not implemented and one was no longer applicable. Key Recommendation Officials …
https://www.osc.ny.gov/state-agencies/audits/2015/12/03/united-healthcare-empire-plan-drug-rebate-revenue-followNew York State Health Insurance Program – Payments by Beacon Health Options for Mental Health and Substance Abuse Services for Ineligible Members (Follow-Up)
… four recommendations included in our initial audit report, New York State Health Insurance Program – Payments by Beacon … Members (Report 2021-S-18 ). About the Program The New York State Health Insurance Program (NYSHIP), … Plan. Civil Service is responsible for maintaining the New York Benefits Eligibility and Accounting System (NYBEAS), …
https://www.osc.ny.gov/state-agencies/audits/2024/01/03/new-york-state-health-insurance-program-payments-beacon-health-options-mental-health-andState Comptroller DiNapoli Releases Audits
… allocation costs. New York State Health Insurance Program (NYSHIP): Preventing Inappropriate and Excessive … of the official station for an employee in calendar years 2013 and 2014 was not made in accordance with the state’s … to commute between his residence and an alternate work location. New York City Department of Social Services (DSS): …
https://www.osc.ny.gov/press/releases/2018/06/state-comptroller-dinapoli-releases-auditsUnited HealthCare Insurance Company of New York – Empire Plan Drug Rebates (Follow-Up)
… The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The New York … required to negotiate agreements with drug manufacturers for rebates, discounts, and other considerations and pass 100 … review the $710,284 in rebates and credit the Department for the rebates, as appropriate. We also recommended that …
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
… acupuncture service. Key Findings We identified $7,331,458 in actual and potential overpayments for services not … payments during our audit period. We found: $210,068 in overpayments from a random sample of 836 services, from 10 … in duplicate payments for services already paid on another claim, including $18,663 confirmed by United and $205,102 …
https://www.osc.ny.gov/state-agencies/audits/2021/10/27/unitedhealthcare-improper-payments-acupuncture-and-acupuncture-related-servicesState Agencies Bulletin No. 2232
… Purpose: The purpose of this bulletin is to inform agencies of OSC’s automatic processing of the PEF 2024 Dental Stipend and to provide agency … The purpose of this bulletin is to inform agencies of OSCs automatic processing of the PEF 2024 Dental Stipend …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/2232-public-employees-federation-pef-2024-dental-stipendUnitedHealthcare Insurance Company of New York – Overpayments for Physician-Administered Drugs (Follow-Up)
… A physician-administered drug is a drug (other than a vaccine) that is administered by a health care provider in a …
https://www.osc.ny.gov/state-agencies/audits/2025/05/21/unitedhealthcare-insurance-company-new-york-overpayments-physician-administered-drugsUnited HealthCare – Empire Plan Drug Rebates
… Purpose To determine if United HealthCare Insurance Company of New York (United) credited the … drug manufacturers. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating … Determine if United HealthCare Insurance Company of NY credited Department of Civil Service …
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)
To determine if the recommendations made in our initial audit reportNew York State Health Insurance P Payments to John T Mather Memorial Hospital 2010S51
https://www.osc.ny.gov/state-agencies/audits/2013/06/04/empire-bluecross-blueshield-payments-john-t-mather-memorial-hospital-follow