Department of Civil Service

New York State Health Insurance Program: Payments for Mental Health and Substance Abuse Services (Follow-Up Report)

At the time of our prior audit, a private contractor, Group Health Incorporated (GHI), paid medical service providers for the mental health and substance abuse services provided under the Empire Plan, and the State reimbursed GHI for these payments. In audit 2007-S-12, we reviewed about $1.4 million in payments that had reportedly been made by GHI and reimbursed by the State. We determined that $96,178 of this amount should be refunded to the State, either because the payments were inappropriate (i.e., duplicates) and should not have been made in the first place or because the payments were either voided or recovered by GHI and thus should not have been reimbursed by the State. When we followed up on our audit findings with GHI officials, we found that the payments had been refunded to the State, but certain other recommended improvements had not been made.

For a complete copy of Report 2008-F-43 click here.