Department of Civil Service
New York State Health Insurance Program: Coordination of
Medicare Coverage for Hospital Services in 2000 (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.
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. In our prior audit report 2001-S-15, we examined the hospitalization claims paid during the year 2000 by the Empire Plan on behalf of people who were eligible for Medicare and estimated that about $2.3 million 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 most of the overpayments had been recovered, and steps had been taken to improve the procedures for identifying enrollees who are eligible for Medicare.
For a complete copy of Report 2003-F-28 click here.