Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage for Services Relating to Mental Health and Substance Abuse (Follow-Up Review) 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.
When Empire Plan enrollees become eligible for Medicare, their medical expenses should generally be paid by Medicare. In our prior audit report 2001-S-17, we examined the claims for services relating to mental health and substance abuse that were paid during the year 2000 by the Empire Plan on behalf of people who were eligible for Medicare, and estimated that $329,539 of these claims should have been paid by Medicare. 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. In our follow-up review, we found that our prior audit recommendations generally had not been implemented.
For a complete copy of Report 2003-F-27 click here.
For a copy of the 90-day response click here.