Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage 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. 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. We examined the hospitalization and major medical claims paid during 1995 by
the Empire Plan on behalf of people who were eligible for Medicare and estimated that about
$2.2 million of these claims should have been paid by Medicare. We recommend that these
payments be recovered from the appropriate parties. We also recommend that improvements
be made in the Empire Plan's procedures for identifying enrollees who are eligible for
For a complete copy of Report 96-S-27 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.