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Anthem Blue Cross – Coordination of Benefits With Medicare
… Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), is one of the nation’s largest public sector health insurance … health benefits plan for NYSHIP, serving about 1.1 million of the members. Civil Service contracts with Anthem Blue …
https://www.osc.ny.gov/state-agencies/audits/2024/08/19/anthem-blue-cross-coordination-benefits-medicareCVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service
… for prescription drugs provided under the Empire Plan Medicare Rx drug benefit. Our audit covered the period … the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service …
https://www.osc.ny.gov/state-agencies/audits/2023/06/21/cvs-health-accuracy-empire-plan-medicare-rx-drug-rebate-revenue-remitted-department-civilNew York State Health Insurance Program – Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan
… the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service … for the Empire Plan. This program includes the Empire Plan Medicare Rx drug plan (Medicare Rx Plan) for retired members and their dependents …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/new-york-state-health-insurance-program-incorrect-payments-cvs-caremark-medicare-rx-drugCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… in accordance with its contract with the Department of Civil Service. Our audit covered the period January 1, 2014 through June 30, 2018. About the Program The New York State Health Insurance Program (NYSHIP), administered by the …
https://www.osc.ny.gov/state-agencies/audits/2019/06/06/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
… between the drug rebates that CVS Health invoiced versus collected from drug manufacturers and found CVS Health …
https://www.osc.ny.gov/state-agencies/audits/2020/08/21/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-serviceCVS Caremark – Accuracy of Empire Plan Commercial Rebate Revenue Remitted to the Department of Civil Service
… remitted corresponding rebate revenue to the Department of Civil Service for prescription drugs provided under the Empire … 2019 through December 2022. About the Program The New York State Health Insurance Program (NYSHIP), administered by the …
https://www.osc.ny.gov/state-agencies/audits/2025/03/18/cvs-caremark-accuracy-empire-plan-commercial-rebate-revenue-remitted-department-civilCVS Health – Temporary Holding Account Rebate Revenue
… million active and retired State, local government, and school district employees and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Civil …
https://www.osc.ny.gov/state-agencies/audits/2019/10/17/cvs-health-temporary-holding-account-rebate-revenueAnthem Blue Cross – Coordination of Benefits with Medicare (2023-S-30)
To determine whether Anthem Blue Cross coordinated benefits to properly pay claims for NYSHIP Empire Plan members with Medicare coverage.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2024-23s30.pdfDiNapoli: Former Medical Office Manager Arrested for Scheme to Defraud the New York State Health Insurance Plan
… investigation between Comptroller DiNapoli, Ulster County District Attorney Clegg, and the FBI Hudson Valley White … to my long-standing partnerships with Ulster County District Attorney Clegg and the Federal Bureau of …
https://www.osc.ny.gov/press/releases/2023/09/dinapoli-former-medical-office-manager-arrested-scheme-defraud-new-york-state-health-insurance-planNew York State Health Insurance Program - Empire Plan Members With Dual Family Coverage
… was established under Article XI of the New York State Civil Service Law (Law) for the purpose of providing health … covering nearly 1.1 million members. The Department of Civil Service (Civil Service) is responsible for …
https://www.osc.ny.gov/state-agencies/audits/2021/01/07/new-york-state-health-insurance-program-empire-plan-members-dual-family-coverageNew York State Health Insurance Program – Empire Plan Members With Dual Family Coverage (Follow-Up)
… 30, 2019. The audit concluded there were 696 employees and retirees of participating organizations who had dual Family …
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 – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy
… health benefits plan for NYSHIP and includes prescription drug coverage. The Department of Civil Service (Department) … United HealthCare (United) to administer the prescription drug benefit portion of the Plan. Based on the primary … (Davis Ethical) is an independently owned pharmacy located in Rockville Centre, New York. For the period from January 1, …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyDiNapoli: Former Medical Office Manager Pleads Guilty to Defrauding New York State Health Insurance Plan
… White Collar Crime Task Force, and the New York State Police. “Ms. Bradshaw thought she could game New York State’s … with District Attorney Nneji, the FBI, and the State Police, her scheme was exposed and she has been held … by filing a complaint online at investigations@osc.ny.gov , or by mailing a complaint to: Office of the State …
https://www.osc.ny.gov/press/releases/2024/05/dinapoli-former-medical-office-manager-pleads-guilty-defrauding-new-york-state-health-insurance-planState Agencies Bulletin No. 1140
… To inform agencies of new Earnings Codes to be used by the NYS Department of Civil Service (DCS) to process payments to employees with proof of …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1140-new-york-state-health-insurance-plan-nyship-opt-out-paymentsUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… 13, 2011, the New York State Health Insurance Plan (NYSHIP) made improper payments totaling $137,459 to Davis … Davis Ethical routinely submitted fraudulent claims to NYSHIP and received payments for those claims. We coordinated … of $231,919 to the State, of which $137,459 was paid to NYSHIP for the improper payments identified in the initial …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyAn Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… Program (NYSHIP), administered by the State Department of Civil Service (Civil Service), is one of the nation’s largest … Program NYSHIP administered by the State Department of Civil Service Civil Service is one of the nations largest publ …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesPreventing Inappropriate and Excessive Costs in the New York State Health Insurance Program
… Program (NYSHIP), administered by the State Department of Civil Service (Civil Service), is one of the nation’s largest …
https://www.osc.ny.gov/state-agencies/audits/2018/05/09/preventing-inappropriate-and-excessive-costs-new-york-state-health-insurance-programUnited HealthCare – Compensation and Benefit Costs for the Empire Plan for the Period January 1, 2008 through December 31, 2010
… health insurance coverage to more than 1.2 million active and retired State employees, participating local … contract. The State’s contract with United requires all administrative costs charged to the State to be related to … to support the charges for time worked by claims and call center staff assigned to the Empire Plan. United did not …
https://www.osc.ny.gov/state-agencies/audits/2013/04/10/united-healthcare-compensation-and-benefit-costs-empire-plan-period-january-1-2008-throughState Agencies Bulletin No. 1506
… employee health insurance eligibility records in the payroll system. Affected Employees All employees Effective … Date(s) September 14, 2016 Background As stated in Payroll Bulletin #1492 New Employer Federal Reporting …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1506-updating-employee-health-insurance-eligibility-payservDiNapoli: Contractor Failed to Turn Over $1.5 Million in Prescription Drug Rebates to NYS
… turn over all rebates,” DiNapoli said. “The Department of Civil Service and United HealthCare need to make sure this money is … Insurance Program, administered by the Department of Civil Service, provides health insurance coverage to …
https://www.osc.ny.gov/press/releases/2016/11/dinapoli-contractor-failed-turn-over-15-million-prescription-drug-rebates-nys