Department of Civil Service

New York State Health Insurance Program: Coordination of Medicare Coverage for Hospital Services in 2003

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 $2.9 billion a year. We examined the hospitalization claims paid during the year 2003 by the Empire Plan on behalf of people who were eligible for Medicare and estimated that $1.3 million of these claims should have been paid by Medicare. After we presented our audit findings to the Empire Planís insurance carrier for hospitalization services, we were informed that about $1.4 million in overpayments had been recovered for 2003. We recommended that improvements be made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare.

For a complete copy of Report 2004-S-26 click here.
For a copy of the 90-day response click here.