Department of Civil Service
New York State Health Insurance Program: Medicare Eligibility for Disabled Empire Plan Enrollees
The Department 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.
Medicare is a federal health
insurance program for disabled people and people aged 65 or
older. When Empire Plan
enrollees become eligible for Medicare, their medical expenses
should generally be paid by
Medicare. In our prior audit report 94-S-64, we reviewed the
hospitalization claims paid over
a three-year period by the Empire Plan to certain disabled
individuals and determined that
$7.2 million of these claims should have been paid by Medicare.
We recommended that these
payments be recovered from Medicare and that improvements be made
in the Empire Plan's
procedures for identifying enrollees who are eligible for
Medicare. In our follow-up review,
we found that $3.5 million has been recovered from Medicare to
date and the Empire Plan's
procedures have either been improved, or are in the process of
being improved, as we had
For a complete copy of Report 96-F-7 click here.
For a copy of the 90-day response click here.