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. The Department of Civil Service contracts with United HealthCare to process and pay medical claims for services provided to Empire Plan members. Members may choose to receive services from non-participating providers. United HealthCare is contractually obligated to apply cost limits when it pays billings from non-participating providers. In audit report 2007-S-110, we found that United HealthCare did not apply the cost limitations when it processed facility fee claims submitted by non-participating providers until August 1, 2007, resulting on overpayments been made totaling $4.4 million. When we followed up with United HealthCare officials, we found that they implemented the recommendations from our initial report.For a complete copy of Report 2011-F-24 click here.