New York State Health Insurance Program

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NYS Comptroller

THOMAS P. DiNAPOLI

Taxpayers' Guide to State and Local Audits

New York State Health Insurance Program
UnitedHealthcare: Empire Plan Drug Rebate Revenue (Follow-Up)


Issued: May 15, 2017
Link to full audit report 2017-F-5

Purpose
To determine the implementation status of the recommendation made in our audit report, United HealthCare: Empire Plan Drug Rebate Revenue (2016-S-7).

Background
The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to about 1.2 million active and retired State, participating local government, 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 New York State Department of Civil Service (Department) contracted with United HealthCare (United) to administer the Empire Plan’s prescription drug program from January 1, 2008 through December 31, 2013. In accordance with the contract, United was required to negotiate agreements with drug manufacturers for rebates, discounts, and other considerations and pass 100 percent of the value of the agreements on to the Department.

Our initial audit report, which was issued on November 1, 2016, found that United did not remit $1,498,719 in rebate revenue to the Department. We made one recommendation to United to remit the $1,498,719 in rebates to the Department.

Key Finding

  • United officials fully implemented the recommendation made in our initial audit report. On December 1, 2016, United remitted $1,498,719 in rebate revenue to the Department.

Key Recommendations

  • None

Other Related Audit/Report of Interest

New York State Health Insurance Program – United HealthCare: Empire Plan Drug Rebate Revenue (2016-S-7)


State Government Accountability Contact Information:
Audit Director: Andrea Inman
Phone: (518) 474-3271; Email: StateGovernmentAccountability@osc.state.ny.us
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236