Department of Civil Service
New York State Health Insurance Program: Duplicate Inpatient Claim Payments (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 $2.2 billion a year. In the Empire Plan, insurance coverage for medical, surgical and hospital services is provided by two insurance carriers. In our prior audit report 98-S-14, we examined certain types of medical claims paid by one of the insurance carriers to determine whether these payments duplicated payments made by the other insurance carrier. We identified a number of duplicate payments and estimated that, during the three years covered by our audit, these duplicate payments totaled between $3.5 and $4.0 million. We recommended improvements in the practices used to process these types of claims and to coordinate the coverage provided by the two insurance carriers. In our follow-up review, we found that some actions had been taken to implement these recommendations, but additional actions were still needed.
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For a copy of the 90-day response click here.