Department of Civil Service

New York State Health Insurance Program: Hospital Inpatient Claims

The Department of Civil Service administers health insurance programs for State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing more than $1.6 billion a year. We examined the hospitalization claims paid over a two-year period by the Empire Plan and found that certain claims were overpaid because incorrect reimbursement rates were used by the hospitals. We estimate that these overpayments totaled $705,895. Since the incorrect reimbursement rates should have been detected by the Empire Plan's insurance carrier (Empire Blue Cross Blue Shield), we recommend that the overpayments be recovered from the insurance carrier.

For a complete copy of 95-S-87 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.