Department of Civil Service

New York State Health Insurance Program: Payments for Mental Health and Substance Abuse Services

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 billion a year. A private contractor, Group Health Incorporated (GHI), pays medical service providers for the mental health and substance abuse services provided under the Empire Plan, and the State reimburses GHI for these payments. We reviewed about $1.4 million in payments that had reportedly been made by GHI and reimbursed by the State. We determined that $96,178 of this amount should be refunded to the State, either because the payments were inappropriate (i.e., duplicates) and should not have been made in the first place or because the payments were either voided or recovered by GHI and thus should not have been reimbursed by the State.

For a complete copy of Report 2007-S-12 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.