Department of Civil Service

New York State Health Insurance Program: Coordination of Medicare Coverage for Mental Health and Substance Abuse Services in 2003

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 the claims paid during the year 2003 for mental health services and substance abuse services by the Empire Plan on behalf of people who were eligible for Medicare and estimated that $269,345 of these claims should have been paid by Medicare. We recommended that these payments be recovered, and improvements made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare.

For a complete copy of Report 2004-S-28 click here.
For a copy of the 90-day response click here.