State Insurance Fund

Excess Payments for Medical Services

The State Insurance Fund provides workers' compensation and disability benefit insurance coverage to about 45 percent of the employers in New York State. According to State Law, if the Fund does not contest a bill from a medical provider within 45 days of receiving the bill, the Fund must pay the full amount billed. We examined a statistical sample of bills received by the Fund in 1996 and determined that some of the bills were questioned by Fund staff, but had to be paid in full, because the bills were not formally contested within 45 days of receipt. We also identified a number of payments to medical providers that exceeded the amounts authorized by the Fund's fee schedule. We estimate that, because of these two weaknesses, a total of about $572,000 was overpaid by the Fund on bills received in 1996. To prevent such overpayments in the future, we recommend improvements in the Fund's automated bill payment system.

For a complete copy of Report 96-S-11 click here.
For a copy of the 90-day response click here.