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.