Department of Civil Service

New York State Health Insurance Program: Coordination of Hospitalization Benefits

In the New York State Health Insurance Program, 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. When the people covered by the Empire Plan are also covered by other health insurers, certain medical claims should be paid by the other insurers rather than by the Empire Plan. However, when we examined the hospitalization claims paid by the Empire Plan over a 50-month period, we identified about $511,000 in claims that should have been, and were, paid by other insurers, but were also paid by the Empire Plan. We recommend that these duplicate payments be recovered and procedures be improved to prevent such payments by the Empire Plan in the future.

For a complete copy of Report 97-S-1 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.