Department of Civil Service

New York State Health Insurance Program: Coordination of Hospitalization Benefits (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 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. In our prior audit report 97-S-1, we identified about $511,000 in hospitalization claims that should have been, and were, paid by other insurers, but were also paid by the Empire Plan. We recommended that these duplicate payments be recovered and procedures be improved to prevent such payments by the Empire Plan in the future. In our follow-up review, we found that the duplicate payments have been recovered and the procedures have been improved.

For a complete copy of Report 98-F-61 click here.