Department of Civil Service

New York State Health Insurance Program: Claims by Radiologists

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 $2.9 billion a year.

We examined payments made by the Empire Plan over a 45-month period for services provided by radiologists. We found that some of the payments were erroneous because the services provided by the radiologists either were covered by other Empire Plan payments or were not reimbursable under the Empire Plan. We estimated that the erroneous payments totaled about $415,877. The payments were made because errors in bills submitted by the radiologists were not detected by the Empire Planís insurance carrier. We recommended that the overpayments be recovered, and improvements be made in the bill processing procedures of the insurance carrier.

For a complete copy of Report 2002-S-26 click here.
For a copy of the 90-day response click here.