Department of Civil Service

New York State Health Insurance Program: Payments for Services Provided by Weill Cornell Medical College

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 more than $5 billion a year.

The Weill Cornell Medical College is a physician organization located in New York City. Weill Cornell Medical College does not participate in the Empire Plan. Accordingly, if an Empire Plan member is treated by Weill Cornell Medical College, the Empire Plan may not reimburse Weill Cornell Medical College for its full charges. Rather, it may only reimburse a portion of these charges (generally 80 percent), with the member paying the balance. We examined whether Weill Cornell Medical College was routinely waiving Empire Plan membersí out-of-pocket expenses, a practice that may constitute billing fraud, and found that it was not. Accordingly, we made no recommendations regarding the Empire Planís payments to Weill Cornell Medical College.

For a complete copy of Report 2009-S-98 click here.