State Audits by Agency or Authority

CVS Health – Accuracy of Empire Plan Medicare Rx Drug Rebate Revenue Remitted to the Department of Civil Service
Issued: 06/21/23

CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
Issued: 11/16/21

UnitedHealthcare: Improper Payments for Acupuncture and Acupuncture-Related Services
Issued: 10/27/21

CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
Issued: 02/08/21

CVS Health - Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
Issued: 12/29/20

CVS Health – Temporary Holding Account Rebate Revenue (Follow-Up)
Issued: 10/15/20

CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
Issued: 08/21/20

An Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
Issued: 04/01/20

Empire BlueCross – Controls Over Payments for Special Items (Follow-Up)
Issued: 02/25/20

UnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services (Follow-Up)
Issued: 01/03/20

Empire BlueCross – Improper Payments for Intraocular Lens Claims Billed by Hospitals
Issued: 12/20/19

UnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
Issued: 12/12/19

Empire BlueCross – Improper Payments for Special Items Billed by Hospitals Within Long Island Health Network
Issued: 11/29/19

UnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers (Follow-Up)
Issued: 11/18/19

CVS Health – Temporary Holding Account Rebate Revenue
Issued: 10/17/19

CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
Issued: 06/06/19

CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service
Issued: 01/28/19

UnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services
Issued: 12/31/18

UnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers
Issued: 08/13/18

Preventing Inappropriate and Excessive Costs in the New York State Health Insurance Program
Issued: 05/09/18

UnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
Issued: 12/27/17

Empire BlueCross BlueShield – Controls Over Payments for Special Items
Issued: 06/22/17

United HealthCare Insurance Company of New York – Empire Plan Drug Rebates (Follow-Up)
Issued: 05/24/17

United HealthCare – Empire Plan Drug Rebate Revenue (Follow-Up)
Issued: 05/15/17

United HealthCare – Overpayments for Services Provided by Long Island Bone and Joint, LLP
Issued: 03/01/17

United HealthCare – Empire Plan Drug Rebate Revenue
Issued: 11/01/16

United HealthCare – Overpayments for Services Provided by Hudson Valley Bone and Joint Surgeons, LLP
Issued: 09/08/16

United HealthCare – Overpayments for Services Provided by Dr. John Gomes
Issued: 05/05/16

United HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
Issued: 05/05/16

United HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
Issued: 05/05/16

United HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
Issued: 05/05/16

United HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
Issued: 05/05/16

United HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
Issued: 02/18/16

Empire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)
Issued: 12/28/15

Empire BlueCross BlueShield – Selected Payments for Special Items for the Period July 1, 2012 Through December 31, 2012 (Follow-Up)
Issued: 12/28/15

United HealthCare – Empire Plan Drug Rebates
Issued: 12/28/15

United Healthcare – Empire Plan Drug Rebate Revenue (Follow-Up)
Issued: 12/03/15

UnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59
Issued: 01/08/15

Empire BlueCross BlueShield – Selected Payments for Special Items for the Period April 1, 2011 Through June 30, 2011 (Follow-Up)
Issued: 10/30/14

Selected Payments for Special Items for the Period July 1, 2012 Through December 31, 2012 (Empire BlueCross and BlueShield)
Issued: 01/16/14

Empire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012
Issued: 12/13/13

New York State Health Insurance Program – Upcoding of Selected Evaluation and Management Services (Follow-Up)
Issued: 09/05/13

United HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy
Issued: 08/13/13

Empire BlueCross BlueShield – Payments to John T. Mather Memorial Hospital (Follow-Up)
Issued: 06/04/13

Empire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011
Issued: 05/09/13

United HealthCare – Compensation and Benefit Costs for the Empire Plan for the Period January 1, 2008 through December 31, 2010
Issued: 04/10/13

Empire BlueCross BlueShield Selected Payments for Special Items for the Period January 1, 2011 Through March 31, 2011
Issued: 02/01/13

Empire BlueCross BlueShield Special Items Made to Englewood Hospital and Medical Center from January 1, 2011 through March 31, 2011
Issued: 02/01/13

Empire BlueCross BlueShield – Selected Payments for Special Items Made to Saratoga Hospital From January 1, 2011 Through March 31, 2011
Issued: 02/01/13

Selected Payments for Special Items Made to Albany Medical Center from January 1, 2011 through March 31, 2011
Issued: 02/01/13