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Reimbursement of Social Services Costs (2013MS-3)
… - pdf] We also released 7 letter reports to the following Counties: Franklin [pdf] , Genesee [pdf] , Greene [pdf] , … of Audit The purpose of our audit was to determine if counties were maximizing the reimbursement of costs related … the DSS) that are directly billed to the DSS. In addition, counties are reimbursed for the indirect costs they incur …
https://www.osc.ny.gov/local-government/audits/county/2013/12/13/reimbursement-social-services-costs-2013ms-3An Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… non-participating (out-of-network) providers. United bases payment for most services provided by out-of-network …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesEmpire 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-followIncorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan (Follow-up)
… Objective To assess the extent of implementation of the three … million members. Civil Service contracts with CVS Caremark to administer the prescription drug program for the Empire … of our initial audit, issued on September 13, 2023, was to determine whether CVS Caremark paid claims under the …
https://www.osc.ny.gov/state-agencies/audits/2025/06/18/incorrect-payments-cvs-caremark-medicare-rx-drug-claims-were-improperly-paid-underAnthem Blue Cross – Effectiveness of the Recovery Process
… where Anthem initially identified that a portion of the payment had been made incorrectly. Key Recommendations Review …
https://www.osc.ny.gov/state-agencies/audits/2026/01/06/anthem-blue-cross-effectiveness-recovery-processImproper Payments Related to the Center of Excellence for Cancer Program
… in payments still require a review to determine which payment (Anthem’s or United’s) should be remitted to Civil …
https://www.osc.ny.gov/state-agencies/audits/2026/01/27/improper-payments-related-center-excellence-cancer-programUnitedHealthcare – 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-ambulatoryDual Employment
… resulting in payroll payments of at least $17,336 for time not worked during the audit period. Another UCS … of salary payments and adjustment of service credits for pension purposes. Provide pertinent time and attendance … Court Administration: Controls Over Overtime Costs (2011-S-2) …
https://www.osc.ny.gov/state-agencies/audits/2013/12/18/dual-employmentEmpire 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-followReview of the American Academy of Pediatrics
… to determine whether payments made to American Academy of Pediatrics, District II (AAP) for various immunization … to determine whether payments made to American Academy of Pediatrics District II AAP for various immunization initiative …
https://www.osc.ny.gov/state-agencies/audits/2015/09/29/review-american-academy-pediatricsProperty Tax Freeze Credit
… objective of our examination was to determine whether the Property Tax Freeze Credit (PTF Credit) payments approved by … Credit for tax year 2015, homeowners must receive the STAR property tax exemption (i.e., the property must be the homeowner’s primary residence and the …
https://www.osc.ny.gov/state-agencies/audits/2016/11/08/property-tax-freeze-creditCollection and Use of the Motor Vehicle Law Enforcement Fee
… insured in the State. The Fee is collected by the insurance companies and remitted to the Department. Between April 2008 and March 2012, insurance carriers remitted $384.8 million to the Department. … fraud. The State Police uses Fee revenue to fund its Auto Theft Unit (ATU) and to detect and reduce motor vehicle …
https://www.osc.ny.gov/state-agencies/audits/2013/07/12/collection-and-use-motor-vehicle-law-enforcement-feeUnited HealthCare – Empire Plan Drug Rebate Revenue
… To determine if United HealthCare (United) remitted all drug rebate revenue to the Department of Civil Service … with United to administer the Empire Plan’s prescription drug program from January 1, 2008 through December 31, 2013. … contract, United is required to negotiate agreements with drug manufacturers for rebates, discounts, and other …
https://www.osc.ny.gov/state-agencies/audits/2016/11/01/united-healthcare-empire-plan-drug-rebate-revenueOversight of School Safety Planning Requirements (Follow-Up)
… of implementation of the five recommendations included in our initial audit report, Oversight of School Safety … building level emergency response plans (Building Plans). Our initial audit report, which covered the period September … significant progress in addressing the issues noted in our initial report. Of the five recommendations from our …
https://www.osc.ny.gov/state-agencies/audits/2021/01/13/oversight-school-safety-planning-requirements-followAnthem Blue Cross – Coordination of Benefits With Medicare
… Objective To determine whether Anthem Blue Cross coordinated benefits to properly pay claims … 1.1 million of the members. Civil Service contracts with Anthem Blue Cross (Anthem) to administer the Hospital Program … To determine whether Anthem Blue Cross coordinated benefits to properly pay claims …
https://www.osc.ny.gov/state-agencies/audits/2024/08/19/anthem-blue-cross-coordination-benefits-medicareSelected Wage Investigation Procedures (Follow-Up)
… including conducting outreach to claimants about case status and recovered wages. During that audit, we found … make first contact with the employer within 60 days of the case being created in DOL’s WPM system (i.e., docketing), as …
https://www.osc.ny.gov/state-agencies/audits/2024/02/16/selected-wage-investigation-procedures-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-andImplementation of the Dignity for All Students Act (Follow-Up)
… orientation, weight) and required schools to designate a trained Dignity Act Coordinator (DAC). An amendment effective …
https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-follow