Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage (Exhausted Benefits)
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 45-month period by the Empire
Plan and determined that
$642,684 in claims had already been paid by Medicare, 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, unless their
Medicare benefits are exhausted (as, for example, during a long
hospital stay). In the
duplicate payments we identified, enrollees' medical expenses
were paid both before and after
their Medicaid benefits had been exhausted. We recommend that
the duplicate payments be
recovered and action be taken to prevent such duplicate payments
in the future.
For a complete copy of Report 96-S-56 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.