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CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… 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 audit covered the period … in commercial drug rebates. Key Findings We reviewed the rebate revenue generated from agreements with six drug …
https://www.osc.ny.gov/state-agencies/audits/2019/01/28/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCUNY Bulletin No. CU-356
… A, B or C Adjunct Instructor Adjunct Lecturer Adjunct College Laboratory Technician Non-Teaching Adjunct I and II … from the New York State Department of Civil Service to start, cancel or change rates for individual employees. Agencies will not have PayServ access to start, cancel or change rates for these deduction codes. The …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/city-university-new-york/cu-356-certain-cuny-employees-eligible-new-york-state-healthEmpire Plan Drug Rebate Revenue
… from six drug manufacturers. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, and school district … and pass 100 percent of the value of the agreements on to the prescription drug program. United subcontracted key …
https://www.osc.ny.gov/state-agencies/audits/2014/09/26/empire-plan-drug-rebate-revenueMadrid-Waddington Central School District - Claims Audit Process (2019M-1)
… purposes and were properly audited and approved prior to payment. Key Findings We reviewed 100 claims totaling … to the claims auditor for audit and approval prior to payment. Ensure no claims, other than those allowed by Law, … purposes and were properly audited and approved prior to payment …
https://www.osc.ny.gov/local-government/audits/school-district/2019/03/08/madrid-waddington-central-school-district-claims-audit-process-2019m-1United HealthCare – Empire Plan Drug Rebate Revenue (Follow-Up)
… Purpose To determine the implementation status of the recommendation made in our audit report, United HealthCare: Empire Plan Drug Rebate Revenue (2016-S-7). Background The New York State … To determine the implementation status of the recommendation made in our …
https://www.osc.ny.gov/state-agencies/audits/2017/05/15/united-healthcare-empire-plan-drug-rebate-revenue-followUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy
… to allegations of improper billing practices, there have been several investigations of Davis Ethical by … resulted from efforts by Davis Ethical that appear to have been designed to defraud NYSHIP. The improper payments … by this audit. Formally assess the payments we did not test and determine the extent to which Davis Ethical …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyUnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services
… for higher-paying Evaluation and Management services than what were actually performed. The audit covered the period … district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, covering a … each category, there are either three or five levels of care that providers bill. The amount of United’s …
https://www.osc.ny.gov/state-agencies/audits/2018/12/31/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesUnion Springs Central School District – Retiree Health Insurance Contributions (2016M-75)
… our audit was to assess the controls over retiree health insurance contributions for the period July 1, 2014 through … change, the District will pay more than it should for the insurance coverage. Key Recommendation Enhance procedures to … all retirees and their spouses/dependents receiving health insurance coverage. Such procedures could include regularly …
https://www.osc.ny.gov/local-government/audits/school-district/2016/06/10/union-springs-central-school-district-retiree-health-insuranceUnited HealthCare – Overpayments for Services Provided by Hudson Valley Bone and Joint Surgeons, LLP
… Bone and Joint Surgeons, LLP waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments … 1, 2011 through October 31, 2015. Background The New York State Health Insurance Program (NYSHIP) provides health … it will result in United making an excessive payment on the claim. Our audit focused on claims submitted to United …
https://www.osc.ny.gov/state-agencies/audits/2016/09/08/united-healthcare-overpayments-services-provided-hudson-valley-bone-and-joint-surgeons-llpDiNapoli Proposes Option to Help State & Local Governments Pay for Retiree Health Care
… data. When a public employee retires, the individual is often eligible for benefits including a pension and health … Fund, so that New York state and its local governments can, at their option, help fund their OPEB liabilities; … Under DiNapoli’s proposal, there is no limit on how much or how little a government can deposit into the …
https://www.osc.ny.gov/press/releases/2015/04/dinapoli-proposes-option-help-state-local-governments-pay-retiree-health-careUnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and Acupuncture-Related Services (Follow-Up)
… included in our initial audit report, UnitedHealthcare Insurance Company of New York: Improper Payments for … 2020-S-7 ). About the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance coverage to over 1.2 million active and retired …
https://www.osc.ny.gov/state-agencies/audits/2023/07/20/unitedhealthcare-insurance-company-new-york-improper-payments-acupuncture-and-acupunctureCUNY Bulletin No. CU-799
… of this bulletin is to notify agencies of health benefit rate changes. Affected Employees: CUNY employees with health … Program are affected. Effective Dates: The health benefit rate changes are effective in paychecks dated October 31, … automatically implement the bi-weekly health insurance rate changes as requested by the City of New York, Office of …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/city-university-new-york/cu-799-city-new-york-health-benefit-rate-changesPayments by Beacon Health Options for Mental Health and Substance Abuse Services for Ineligible Members
… 2015 through December 2020. About the Program The New York State Health Insurance Program (NYSHIP), administered by the … insurance coverage to over 1.2 million active and retired State, local government, and school district employees, and … disenrollment. There is a risk that claims submitted on the disenrolled member’s behalf during this interim period …
https://www.osc.ny.gov/state-agencies/audits/2022/05/13/payments-beacon-health-options-mental-health-and-substance-abuse-services-ineligibleNew York State Health Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services for Ineligible Members
… Objective To determine whether UnitedHealthcare Insurance Company of New York paid claims for Empire Plan members who were not eligible. The audit … 31, 2019. About the Program The New York State Health Insurance Program (NYSHIP) provides health insurance coverage …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/new-york-state-health-insurance-program-payments-unitedhealthcare-medicalsurgical-servicesUnited HealthCare Insurance Company of New York – Empire Plan Drug Rebates (Follow-Up)
… Purpose To determine the implementation status of the two recommendations made in our audit report, United … Empire Plan Drug Rebates (Report 2014-S-62). Background The New York State Health Insurance Program (NYSHIP) provides … To determine the implementation status of 2 recommendations made in our …
https://www.osc.ny.gov/state-agencies/audits/2017/05/24/united-healthcare-insurance-company-new-york-empire-plan-drug-rebates-followDiNapoli: Former Village of Chatham Clerk-Treasurer Pleads Guilty to Defrauding Village
… State Police announced that Barbara Henry, the Village of Chatham’s former clerk-treasurer, has pleaded guilty to … premiums at the town’s expense. “Ms. Henry took advantage of her public position to have the taxpayers fully fund her insurance costs,” said DiNapoli. “This kind of corruption drives up costs and erodes the public trust. …
https://www.osc.ny.gov/press/releases/2021/09/dinapoli-former-village-chatham-clerk-treasurer-pleads-guilty-defrauding-villageUnited Healthcare – Empire Plan Drug Rebate Revenue (Follow-Up)
… Drug Rebate Revenue ( 2013-S-41 ). Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, and school district … acquired Medco. Our initial audit report, which was issued on September 26, 2014, identified $694,227 in drug rebate and …
https://www.osc.ny.gov/state-agencies/audits/2015/12/03/united-healthcare-empire-plan-drug-rebate-revenue-followEmpire BlueCross – Overpayments for Physician-Administered Drugs (Follow-Up)
… 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-followOyster Bay Water District – Payments in Lieu of Health Insurance (2017M-43)
… Purpose of Audit The purpose of our audit was to review payments in lieu of health insurance coverage for … the Town of Oyster Bay in Nassau County and provides water to about 8,800 customers. The District is governed by an … by $37,179. District officials do not require participants to certify on an annual basis that they are still eligible to …
https://www.osc.ny.gov/local-government/audits/district/2017/06/02/oyster-bay-water-district-payments-lieu-health-insurance-2017m-43Public Health – 2021 Financial Condition Report
… necessary to ensure compliance with the global cap limit for SFY 2020-21. Pandemic Brings Jump in Medicaid Enrollment … DOH data, in February 2021, enrollment surpassed 7 million for the first time in the history of the program, with … during the public health emergency. Children and adults represented 75.5 percent of all average monthly DOH …
https://www.osc.ny.gov/reports/finance/2021-fcr/public-health