Department of Civil Service

New York State Health Insurance Program: Medicare Eligibility for Disabled Empire Plan Enrollees (Follow-Up Review)

The Department 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. Medicare is a federal health insurance program for disabled people and people aged 65 or older. When Empire Plan enrollees become eligible for Medicare, their medical expenses should generally be paid by Medicare. In our prior audit report 94-S-64, we reviewed the hospitalization claims paid over a three-year period by the Empire Plan to certain disabled individuals and determined that $7.2 million of these claims should have been paid by Medicare. We recommended that these payments be recovered from Medicare and that improvements be made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare. In our follow-up review, we found that $3.5 million has been recovered from Medicare to date and the Empire Plan's procedures have either been improved, or are in the process of being improved, as we had recommended.

For a complete copy of Report 96-F-7 click here.
For a copy of the 90-day response click here.