Department of Civil Service

New York State Health Insurance Program: Selected Surgical Claims (Follow-Up Review)

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 about $1.6 billion a year. In our prior audit report 95-S-88, we examined certain surgical claims paid over a three-year period by the Empire Plan. We estimated that at least $865,000 in claims were overpaid because multiple claims were submitted for complex medical procedures, rather than a single claim as required. We recommended that the overpayments be recovered and improvements be made in the procedures designed to detect such erroneous claims. In our follow-up review, we found that the overpayments have not been recovered and the procedures have not been improved.

For a complete copy of Report 98-F-49 click here.