Department of Civil Service
New York State Health Insurance Program: Administration of the Empire Plan The Department of Civil Service is responsible for administering the New York State Health Insurance Program (NYSHIP), which provides hospital, medical, and mental health/substance abuse and prescription drug coverage for active and retired employees and dependents of the State and local governments that elect to participate in the State program. In 1991, the Department and the Office of the State Comptroller (OSC) entered into an agreement to use dedicated OSC staff to provide comprehensive audit coverage of NYSHIP insurance companies. Under this arrangement, the Department and OSC agreed to coordinate their audit efforts to ensure comprehensive audit coverage and to optimize savings to employers and enrollees. However, we found that the longstanding agreement between the Department and OSC has not worked as intended, and there are significant opportunities to improve the administration of the Empire Plan. We recommended that the Department solicit competition for all Empire Plan contracts as soon as is practicable. In addition, the Department needs to work with the OSC auditors to address the many unresolved issues that are precluding recovery of overpayments identified by the OSC audits. We also found that the Department needs to improve its operating practices relating to its own audits of expenses charged to the Empire Plan.
For a complete copy of Report 97-S-35 click here.
For a copy of the 90-day response click here.