Department of Civil Service

New York State Health Insurance Program: Coordination of Medicare 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. 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 95-S-92, we reviewed the hospitalization and major medical claims paid over a one-year period by the Empire Plan to people aged 65 or older and estimated that about $3.2 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 most of the erroneous payments have yet to be recovered, and while some improvements have been made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare, further improvements are needed.

For a complete copy of Report 97-F-36 click here.
For a copy of the 90-day response click here.