Department of Civil Service
New York State Health Insurance Program: Duplicate Outpatient Claim Payments (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 and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing about $4.0 billion a year.
In the Empire Plan, insurance coverage for medical, surgical and hospital services is provided by two insurance carriers. In audit report 2004-S-12, 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 four years covered by our audit, these duplicate payments totaled $889,240. We recommended improvements in the practices used to process these types of claims and to coordinate the coverage provided by the two insurance carriers. When we followed up on these matters, we found that our audit recommendations had been implemented and progress had been made in the recovery of the overpayments identified by our audit.
For a complete copy of Report 2006-F-36 click here.
For a copy of the 90-day response click here.