Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage (Follow-Up Review) In our prior audit report 97-S-20, we found that weaknesses in the Empire Plan's system for identifying Medicare eligibility had caused Empire Blue Cross and UHC to pay claims totaling $3.2 million that should have been paid by Medicare. In our follow-up review, we found that Empire Blue Cross and UHC officials have recovered only a small portion of the overpayments we identified. We also found that the Department of Civil Service has made progress in establishing an agreement with the Federal Health Care Financing Administration to acquire Medicare eligibility data, but until this agreement is finalized and eligibility data are exchanged, the Plan's carriers will continue to pay claims that should be paid by Medicare.
For a complete copy of Report 99-F-19 click here.