Department of Civil Service

New York State Health Insurance Program: Coordination of Workers' Compensation Hospitalization Coverage (Follow-Up Review)

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 $1.5 billion a year. In certain circumstances, the people covered by the Empire Plan may also be covered by other health insurers. In such circumstances, any claims covered by the other insurers should be paid by these insurers rather than by the Empire Plan. For example, as required by State law, employees in New York receive hospitalization coverage from their employers for work-related injuries or illnesses. Therefore, work-related hospitalization claims should not be paid by the Empire Plan. In our prior audit report 95-S-124, we examined the procedures used by the Empire Plan to identify work-related hospitalization claims and found that they were generally adequate. However, we identified improvements that could be made, including the prompt recovery of certain erroneous payments. In our follow-up review, we found that all of our prior audit recommendations have been implemented and most of the erroneous payments have been recovered

For a complete copy of Report 97-F-15 click here.
For a copy of the 90-day response click here.