Department of Civil Service
New York State Health Insurance Program: Duplicate Payments for Inpatient Professional Fees
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.
We examined the payments made by the Empire Plan over a four-year period for physician fees relating to mental health and substance abuse inpatient services. We examined a total of about $872,000 in such payments and determined that about $101,700 of the payments were duplicate payments. The payments were duplicates because the services were already covered by all-inclusive inpatient reimbursement rates. We recommended that the payments be recovered and actions be taken to prevent such duplicate payments in the future.
For a complete copy of Report 2007-S-93 click here.
For a copy of the 90-day response click here.