Department of Civil Service

New York State Health Insurance Program: Coordination of Medicare Coverage for Mental Health and Substance Abuse Services in 2003 (Follow-Up Report)

In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for active and retired State, local government and school district employees and their dependents. The primary such program is the Empire Plan, which provides services costing about $4.0 billion a year.

Medicare is a federal health insurance program for the disabled and people aged 65 or older. When Empire Plan enrollees become eligible for Medicare, their medical expenses should generally be paid by Medicare. In audit report 2004-S-28, we examined the claims paid during the year 2003 for mental health services and substance abuse services by the Empire Plan on behalf of people who were eligible for Medicare and estimated that $269,345 of these claims should have been paid by Medicare. We recommended that these payments be recovered, and improvements made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare. When we followed up on our recommendations, we found that they had, for the most part, been implemented.

For a complete copy of Report 2006-F-34 click here.