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Payments by Beacon Health Options for Mental Health and Substance Abuse Services for Ineligible Members
… Objective To determine whether Beacon Health Options paid mental health and substance abuse (MHSA) … claims for Empire Plan members who were not eligible for coverage. The audit covered the period from January 2015 …
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 CVS Health for Pharmacy Services for Ineligible Members
… about 1.1 million members. Since 2014, the Department of Civil Service (Civil Service) has contracted with CVS … in NYBEAS. Civil Service sends CVS Health daily files of NYBEAS member eligibility changes, and CVS Health has … members are disenrolled promptly and to prevent payment of ineligible claims on their behalf. Key Findings For the …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/new-york-state-health-insurance-program-payments-cvs-health-pharmacy-services-ineligibleNew York State Health Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services for Ineligible Members
… To determine whether UnitedHealthcare Insurance Company of New York paid claims for Empire Plan members who were not … serving about 1.1 million members. The Department of Civil Service (Civil Service) contracts with UnitedHealthcare …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/new-york-state-health-insurance-program-payments-unitedhealthcare-medicalsurgical-servicesUnited HealthCare – Empire Plan Drug Rebate Revenue
… revenue to the Department of Civil Service (Department) as required by the contract between United and the Department. … district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving … to administer the Empire Plan’s prescription drug program from January 1, 2008 through December 31, 2013. In accordance …
https://www.osc.ny.gov/state-agencies/audits/2016/11/01/united-healthcare-empire-plan-drug-rebate-revenueCost-Saving Ideas: Monitoring Health Insurance Premiums for Retirees
… and school districts, employees have the option to receive health insurance coverage after retirement. Among other things, the retirees may be: allowed …
https://www.osc.ny.gov/local-government/publications/cost-saving-ideas-monitoring-health-insurance-premiums-retireesState Agencies Bulletin No. 1100
… Purpose To inform agencies of the new Earnings Codes to be used by the NYS Department of Civil Service to process imputed income transactions for the value of the employer contribution for health insurance benefits …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1100-new-imputed-income-earnings-codes-health-benefits-provided-marriedUnited HealthCare – Empire Plan Drug Rebate Revenue (Follow-Up)
… Empire Plan Drug Rebate Revenue (2016-S-7). Background The New York State Health Insurance Program (NYSHIP) provides … plan for NYSHIP, serving about 1.1 million members. The New York State Department of Civil Service (Department) … to the Department. Other Related Audit/Report of Interest New York State Health Insurance Program: United HealthCare …
https://www.osc.ny.gov/state-agencies/audits/2017/05/15/united-healthcare-empire-plan-drug-rebate-revenue-followState Agencies Bulletin No. 1287
… of imputed income for a non-employee same-sex spouse’s health coverage and of the potential tax impact for non-residents of …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1287-changes-taxation-imputed-incomeSelected Payments for Special Items Made to St. Francis Hospital of Poughkeepsie from January 1, 2011 through March 31, 2011
… BlueShield’s (Empire’s) payments to St. Francis Hospital of Poughkeepsie (St. Francis) for special items were made according to the provisions of the agreement between Empire and St. Francis. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-francis-hospital-poughkeepsie-january-1-2011UnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services
To determine whether UnitedHealthcare sufficiently monitors outofnetwork providers who routinely bill for higherlevel Evaluation and Management services and
https://www.osc.ny.gov/state-agencies/audits/2018/12/31/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesDiNapoli: Former Pharmacist Charged In $232,000 Medical Claims Fraud
… The former owner of a Long Island pharmacy was arrested Thursday for allegedly … resides in Lake Ariel, Pennsylvania, was arraigned in Nassau County District Court. “Thanks to our joint efforts with law enforcement, …
https://www.osc.ny.gov/press/releases/2015/09/dinapoli-former-pharmacist-charged-232000-medical-claims-fraudSelected Payments for Special Items Made to Mary Imogene Bassett Hospital from January 1, 2011 through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and Bassett. Background The … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mary-imogene-bassett-hospital-january-1-2011-throughSelected Payments for Special Items Made to St. Mary's Hospital from January 1, 2011 through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and St. Mary’s. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-marys-hospital-january-1-2011-through-march-31-2011Empire BlueCross BlueShield Special Items Made to Englewood Hospital and Medical Center from January 1, 2011 through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and Englewood. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/empire-bluecross-blueshield-special-items-made-englewood-hospital-and-medical-centerEmpire BlueCross BlueShield – Selected Payments for Special Items Made to Saratoga Hospital From January 1, 2011 Through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and Saratoga. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/empire-bluecross-blueshield-selected-payments-special-items-made-saratoga-hospital-januarySelected Payments for Special Items Made to Albany Medical Center from January 1, 2011 through March 31, 2011
… agreement between Empire and AMC. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government and school district … AMC. Empire’s payments to AMC are generally based on standard fee schedules. However, AMC is entitled to …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-albany-medical-center-january-1-2011-through-march-31CUNY Bulletin No. CU-478
… of imputed income for a non-employee same-sex spouse’s health coverage and of the potential tax impact for non-residents of …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/city-university-new-york/cu-478-changes-taxation-imputed-incomeUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59
… health benefits plan for NYSHIP. The State Department of Civil Service administers the NYSHIP program and contracts … with modifier 59. Key Findings For 13 (5.3 percent) of the 245 claims we tested, a distinct or independent … service was not provided despite the service’s designation of modifier 59. The overpayments on the 13 claims totaled …
https://www.osc.ny.gov/state-agencies/audits/2015/01/08/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59Selected Payments for Special Items Made to St. Peter's Hospital from January 1, 2011 through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and St. Peter's. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-peters-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to Mount Sinai Hospital from January 1, 2011 through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and Mount Sinai. Background … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mount-sinai-hospital-january-1-2011-through-march-31