Department of Civil Service
New York State Health Insurance Program: Coding Fragmentation Review Program (Surgical 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 $1.6 billion a year. We examined certain surgical claims paid over a three-year
period by the Empire Plan and found that some of the claims were overpaid. The claims
were overpaid because multiple claims were submitted for complex medical procedures, rather
than a single claim as required. We estimate that these overpayments totaled at least
$865,000. We recommend that the overpayments be recovered and improvements be made in
the procedures designed to detect such erroneous claims.
For a complete copy of Report 95-S-88 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.