Department of Civil Service

New York State Health Insurance Program: Skilled Nursing Facility Claims

The Department of Civil Service administers health insurance programs for State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing more than $1.4 billion a year. If Empire Plan enrollees are eligible for Medicare, their expenses for skilled nursing facility care should generally be paid by Medicare. We reviewed selected claims for skilled nursing facility care paid over a 63-month period by the Empire Plan and determined that about $365,000 of these claims should have been paid by Medicare. We recommend that these payments be recovered from Medicare. We also recommend that improvements be made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare.

For a complete copy of 96-S-26 click here.
For a copy of the associated follow-up report click here.