Department of Health

Oversight of the Family Health Plus Program (Follow-Up Report)

The Family Health Plus Program provides health insurance to low-income individuals with no other health insurance who are not eligible for Medicaid. The Program is overseen by the Department of Health and administered by local social services districts (57 counties and New York City). Program recipients must enroll in local managed care organizations (plans). The plans provide recipients with access to covered health services and pay the service providers. The Department pays the plans a monthly premium for each Program recipient enrolled in the plans by the local districts.

In audit report 2004-S-17, we identified a number of instances in which duplicate monthly premiums were paid because recipients were enrolled in two different plans in two different local districts. We also found indications many ineligible individuals may have been enrolled in the Program. We identified an estimated $1.9 million in overpayments during our 30-month testing period, and found indications a significant portion of another $32.5 million in monthly premiums and another $1.5 million in fee-for-service payments may also have been overpaid. We recommended all overpayments be recovered and improvements made in the Departmentís oversight of the local districts and in the automated information system containing Program data. When we followed up on these matters with Department officials, we found they had implemented some of our audit recommendation, but had not fully implemented others.

For a complete copy of Report 2007-F-5 click here.
For a copy of the 90-day response click here.