Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage for Medical and Surgical Services in 1999 (Follow-Up Review) In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for active and retired State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing more than $2.5 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 2000-S-65, we examined the major medical claims paid during 1999 by the Empire Plan on behalf of people who were eligible for Medicare and estimated that as much as $1.3 million of these claims should have been paid by Medicare. We recommended that these payments be recovered from the appropriate parties, and 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 some of the overpayments had been recovered and steps were being taken to improve the procedures for identifying enrollees who are eligible for Medicare.
For a complete copy of Report 2002-F-54 click here.