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Empire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011
… for certain special items were reasonable in relation to the hospitals' actual purchase and acquisition costs. Background The New York State Health Insurance Program … for special items, while agreements with other hospitals do not have such limitations. From January 1, 2011 to March …
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
… payments and public authority data. Visit the Reading Room for contract FOIL requests, bid protest decisions and …
https://www.osc.ny.gov/press/releases/2020/01/comptroller-dinapoli-releases-municipal-audits-1CVS Health – Temporary Holding Account Rebate Revenue
… Objective To determine if CVS Health remitted to the State Department of Civil Service all … health insurance coverage to over 1.2 million active and retired State, local government, and school district …
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
… 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 … that United made overpayments of $7,010,427. $223,765 in duplicate payments for services already paid on another …
https://www.osc.ny.gov/state-agencies/audits/2021/10/27/unitedhealthcare-improper-payments-acupuncture-and-acupuncture-related-servicesState Agencies Bulletin No. 307
… Purpose To explain the use of the new deduction code 321, MedAmerica Long Term … who are eligible to participate in the New York State Health Insurance Program. Effective Date March 21, 2002 OSC … OSC will process a weekly file from MedAmerica to start and/or cancel deductions for this 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
… Billed as Inpatient Claims (Follow-Up) (2024-F-26) A recipient’s status in a hospital—inpatient versus outpatient—affects Medicaid’s … York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides …
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.pdfEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period April 1, 2011 Through June 30, 2011 (Follow-Up)
… June 30, 2011 (2011-S-42). Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, …
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)
… Insurance Program: Empire Plan Members With Dual Family Coverage (Report 2019-S-23 ). About the Program The New York … coverage. We issued our initial audit report on January 7, 2021. The audit objective was to determine whether …
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
… 2011 through March 31, 2015, United paid claims totaling $16 million for services provided by Long Island Laparoscopic …
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
… costs, and if so, to quantify the overpayments made by United HealthCare resulting from this practice. The audit … is the primary health benefits plan for NYSHIP, covering a range of services from inpatient hospital care to … medical services to Empire Plan members. Members pay a nominal co-payment to the participating provider for the …
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
… Spine Specialists, P.C. waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made … primary health benefits plan for NYSHIP, covering a range of services from inpatient hospital care to outpatient … HealthCare - Overpayments for Services at the South Shore Ambulatory Surgery Center (2008-S-11) … To …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialistsCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
… (Report 2019-S-51 ). 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 …
https://www.osc.ny.gov/state-agencies/audits/2021/11/16/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service-followEssential Plan – Federal Funding and New York
… New York is one of three states to have a “basic health plan,” as authorized … to 250 percent of the poverty level (approximately $37,650 for an individual in 2024) that are not eligible for … from Medicaid to the EP, which resulted in a significant increase in coverage in 2025. As of March 2025, the EP …
https://www.osc.ny.gov/reports/budget/fed-funding-ny/essential-planNew York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan
… 2015 through March 2022. About the Program The New York State Health Insurance Program (NYSHIP), administered by the … NYSHIP covers over 1.2 million active and retired State, participating local government, and school district … controls, as needed, to prevent the processing and payment of claims under the incorrect plan and continue to …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/new-york-state-health-insurance-program-incorrect-payments-cvs-caremark-medicare-rx-drugManaged Care Premium Payments for Recipients With Comprehensive Third-Party Insurance (Follow-Up)
… Payments for Recipients With Comprehensive Third-Party Insurance (Report 2016-S-60 ). About the Program … Medicaid recipients may have additional sources of health care coverage (i.e., third-party health insurance, or TPHI), such as health insurance offered …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/managed-care-premium-payments-recipients-comprehensive-third-party-insurance-followDiNapoli: Former Clerk Treasurer for the Village of Speculator Charged With Larceny
… village clerk-treasurer Bonnie Page was charged with grand larceny and corrupting the government for allegedly scamming the village out of $25,988 for health … village clerktreasurer Bonnie Page was charged with grand larceny and corrupting the government …
https://www.osc.ny.gov/press/releases/2020/02/dinapoli-former-clerk-treasurer-village-speculator-charged-larcenyProgram Oversight and Monitoring of the Maximus Contract for the New York State of Health (Insurance Marketplace) Customer Service Center
… Purpose To determine whether the Department of Health (Department) is providing sufficient oversight to … that Maximus is implementing the contract deliverables and meeting specified performance standards. The audit covers …
https://www.osc.ny.gov/state-agencies/audits/2016/06/16/program-oversight-and-monitoring-maximus-contract-new-york-state-health-insuranceEmpire BlueCross – Improper Payments for Special Items Billed by Hospitals Within Long Island Health Network
… according to the terms of its contract with Long Island Health Network and, if not, whether Empire BlueCross made … 31, 2017. About the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of …
https://www.osc.ny.gov/state-agencies/audits/2019/11/29/empire-bluecross-improper-payments-special-items-billed-hospitals-within-long-island-healthMedicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance
… Objective To determine whether Medicaid overpayments for pharmacy services on behalf of managed care recipients … pays managed care organizations (MCOs) a monthly premium for each enrolled recipient, and in turn, the MCOs are … in addition to Medicaid (e.g., employer-based coverage or Medicare Part D). Medicaid is considered the payer of last …
https://www.osc.ny.gov/state-agencies/audits/2022/07/13/medicaid-program-recovering-managed-care-overpayments-pharmacy-services-behalf-recipients