Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage for Medical and Surgical Services in 2001 In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for active and retired State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing more than $2.5 billion a year. Medicare is a federal health insurance program for disabled people and people aged 65 or older. When Empire Plan enrollees become eligible for Medicare, their medical expenses should generally be paid by Medicare. We examined the major medical claims paid during the year 2001 by the Empire Plan on behalf of people who were eligible for Medicare and estimated that as much as $1.0 million of these claims should have been paid by Medicare. We also determined that an additional $1.2 million in claims may have been overpaid, because the claims related to individuals who were eligible for, but not enrolled in, Medicare Part B. We recommended that these payments be investigated, all overpayments recovered, and improvements made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare.
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