Department of Civil Service

New York State Health Insurance Program: Payment of Facility Fees for Mobile Service Providers

In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for active and retired State, local government and school district employees and their dependents. The primary such program is the Empire Plan, which provides services costing about $4 billion a year.

Under the Empire Plan, specialized medical facilities, such as ambulatory surgery centers, may be paid a fee for the use of their facilities, personnel and equipment (facility fee) that is separate from the professional fee of the physicians providing the medical services. However, mobile service providers that deliver portable devices for use in physicians’ offices are not eligible for facility fees. Rather, the mobile service providers should be paid by the physicians. We examined Empire Plan payments over a 44-month period to determine whether facility fees were inappropriately being paid to certain mobile service providers, and found that they were. We identified a total of $2.1 million in such payments, which were made to two particular mobile service providers. We recommended that the payments be recovered and controls be improved to prevent such payments in the future.

For a complete copy of Report 2006-S-85 click here.