Department of Civil Service
New York State Health Insurance Program: Payments Made to Albany Medical Center Hospital Under the Empire Plan
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 more than $5 billion a year.
The Department contracts with an insurer (Empire BlueCross BlueShield) to administer the hospitalization portion of the Empire Plan. The insurer processes claims for hospital services in accordance with agreements between the insurer and participating hospitals. One of these participating hospitals is the Albany Medical Center Hospital (Albany Med). Between January 1, 2004 and June 30, 2008, Albany Med was paid a total of $112.9 million for health care services provided to Empire Plan members. We reviewed a sample of these payments and found that the payments were generally appropriate. However, we identified errors which resulted in a net overpayment of $58,029 to Albany Med (overpayments of $88,563 less underpayments of $30,534). We recommended that the net overpayment be recovered and controls be strengthened to prevent such overpayments in the future.
For a complete copy of Report 2008-S-95 click here.
For a copy of the 90-day response click here.