Department of Civil Service

New York State Health Insurance Program: Coordination of Medicare Coverage for Hospital Services in 2003 (Follow-Up Report)

Medicare is a federal health insurance program for the disabled and people aged 65 or older. When Empire Plan enrollees become eligible for Medicare, their medical expenses should generally be paid by Medicare. In audit report 2004-S-26, we examined the hospitalization claims paid during the year 2003 by the Empire Plan on behalf of people who were eligible for Medicare and estimated that $1.3 million of these claims should have been paid by Medicare. After we presented our audit findings to the Empire Planís insurance carrier for hospitalization services, we were informed that about $1.5 million in overpayments had been recovered for 2003. We recommended that improvements be made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare, and when we followed up on our recommendation, we found that it had been implemented.

For a complete copy of Report 2006-F-35 click here.