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An Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… The New York State Health Insurance Program (NYSHIP), administered by the State Department of Civil Service (Civil Service), is one of the nation’s largest public sector health insurance … The New York State Health Insurance Program NYSHIP administered by the State Department …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… Purpose To determine if Empire BlueCross BlueShield: implemented sufficient controls … and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The Empire Plan covers a comprehensive range of services …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsDiNapoli: Middletown Chiropractor Sentenced to Nine Years for Insurance Fraud
… announced James “Jay” Spina was sentenced in federal court for running a large-scale health care insurance fraud scheme. … systematically double-billed insurers, charged for services never rendered, created shell companies and … Spina and three others were charged with billing insurers for medically unnecessary services and procedures, submitting …
https://www.osc.ny.gov/press/releases/2021/04/dinapoli-middletown-chiropractor-sentenced-nine-years-insurance-fraudPlainview-Old Bethpage Central School District - Retiree Health Insurance (2018M-148)
Plainview-Old Bethpage Central School District - Retiree Health Insurance (2018M-148)
https://www.osc.ny.gov/files/local-government/audits/pdf/plainview-old-bethpage.pdfCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… 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 January 1, … and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, …
https://www.osc.ny.gov/state-agencies/audits/2019/06/06/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service
… invoiced drug manufacturers and remitted corresponding rebate revenue to the Department of Civil Service for prescription drugs provided under the Empire Plan … invoiced drug manufacturers and remitted corresponding rebate revenue to the Department of Civil Service for …
https://www.osc.ny.gov/state-agencies/audits/2023/06/21/cvs-health-accuracy-empire-plan-medicare-rx-drug-rebate-revenue-remitted-department-civilEmpire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011
… Purpose To determine whether Empire BlueCross BlueShield's (Empire) … for certain special items were reasonable in relation to the hospitals' actual purchase and acquisition costs. … To determine whether Empire BlueCross BlueShields Empire …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2011-throughComptroller DiNapoli Releases Municipal Audits
… local government audits have been issued. Village of Arkport – Information Technology (Steuben County) Auditors … provide IT security awareness training to employees. Town of Geddes – Account Clerk’s Salary and Benefits and Cash … and received an unauthorized retroactive buyout payment of $2,000 for 2016. Madison County – Claims Audit and Payment …
https://www.osc.ny.gov/press/releases/2020/01/comptroller-dinapoli-releases-municipal-audits-1Geddes Town Clerk Charged in $30K Swindle
… Clerk Shannon Carhart for allegedly pocketing $30,000 in a health care coverage scam. Carhart, 43, of Syracuse, enrolled in the town’s health insurance after telling officials and falsifying records that she had declined the coverage in order to fraudulently receive $6,000 from the town meant …
https://www.osc.ny.gov/press/releases/2019/04/geddes-town-clerk-charged-30k-swindleCVS Health – Temporary Holding Account Rebate Revenue
… health insurance coverage to over 1.2 million active and retired State, local government, and school district employees and their dependents. The Empire Plan is the primary health …
https://www.osc.ny.gov/state-agencies/audits/2019/10/17/cvs-health-temporary-holding-account-rebate-revenueUnitedHealthcare: Improper Payments for Acupuncture and Acupuncture-Related Services
… The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. Civil Service … dollars, that were not supported by documentation. Based on a projection of the sample to the audit population for the … $223,765 in duplicate payments for services already paid on another claim, including $18,663 confirmed by United and …
https://www.osc.ny.gov/state-agencies/audits/2021/10/27/unitedhealthcare-improper-payments-acupuncture-and-acupuncture-related-servicesState Agencies Bulletin No. 307
… the use of the new deduction code 321, MedAmerica Long Term Care Insurance Program. Affected Employees All employees who are eligible to participate in the New York State Health Insurance Program. Effective Date March 21, 2002 OSC Actions … the use of the new deduction code 321 MedAmerica Long Term Care Insurance Program …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/307-new-insurance-program-medamerica-long-term-care-insuranceState Comptroller DiNapoli Releases Audits
… today the following audits have been issued. Department of Health – Improper Medicaid Payments for Outpatient … Medicaid recipients were discharged within 24 hours of admission, indicating a high risk that a portion of these … EOP operated on 28 State-operated SUNY campuses and served 5,969 EOP participants. While SUNY is monitoring EOP, and …
https://www.osc.ny.gov/press/releases/2025/04/state-comptroller-dinapoli-releases-auditsHealth Insurance Coverage in New York State
Public policies over the last decade have had a significant impact in reducing the number of uninsured people nationally and especially in New York, where the share of those without health insurance declined to 5.2 percent in 2021, well below the national average of 8.6 percent.
https://www.osc.ny.gov/files/reports/pdf/health-insurance-coverage-in-new-york-state.pdfVillage of Clayton – Claims Auditing (2021M-81)
… and ensured written quotes were obtained for purchases and public works contracts. Key Findings The Board did not … and ensured written quotes were obtained for purchases and public works contracts …
https://www.osc.ny.gov/local-government/audits/village/2021/09/03/village-clayton-claims-auditing-2021m-81Empire BlueCross BlueShield – Selected Payments for Special Items for the Period April 1, 2011 Through June 30, 2011 (Follow-Up)
… Payments for hospital services are generally based on standard fee schedules. However, hospitals may be entitled … for special items, while agreements with other hospitals do not have such limitations. From April 1, 2011 to June 30, 2011, …
https://www.osc.ny.gov/state-agencies/audits/2014/10/30/empire-bluecross-blueshield-selected-payments-special-items-period-april-1-2011-throughNew York State Health Insurance Program – Empire Plan Members With Dual Family Coverage (Follow-Up)
… included in our initial audit report, New York State Health Insurance Program: Empire Plan Members With Dual … (Report 2019-S-23 ). About the Program The New York State Health Insurance Program (NYSHIP), administered by the … has Family coverage. We issued our initial audit report on January 7, 2021. The audit objective was to determine …
https://www.osc.ny.gov/state-agencies/audits/2022/09/26/new-york-state-health-insurance-program-empire-plan-members-dual-family-coverage-followUnited HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… Purpose To determine whether Long Island Laparoscopic Surgery, PLLC … Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare … To determine whether Long Island Laparoscopic Surgery PLLC …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgeryUnited HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare … LLC waived Empire Plan members outofpocket costs and if so to quantify the overpayments made …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-eastern-orange-ambulatory-surgery-centerUnited HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
… waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare … PC waived Empire Plan members outofpocket costs and if so to quantify the overpayments made by United …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialists