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February 14, 2014

Maragos: Audit of County Employees Health Plan Recovers $101,000 in Overpayments

Mineola, NY- Nassau County Comptroller George Maragos released an internal audit of the County’s Health Insurance unit and found the County may have overpaid almost $400,000 for the health insurance costs of its current and retired employees. The over payments were due to premiums being paid for ten ineligible former employees, a deceased retiree, and one duplicate payment. The errors went as far back as 2003. As a result of the audit, the County will be able to recover approximately $101,000. The remainder cannot be recovered due to time limits by the insurance companies. The Health Insurance Unit is a part of the Office of the Comptroller and administers the health plans of almost 50,000 employees, retirees and their dependents with health insurance expenditures of $250.3 million in 2012 and expenditures of $252.4 million in 2013.

“The Health Insurance unit has the responsibility to ensure that almost 50,000 employees, retirees and their dependents have uninterrupted insurance coverage,” Comptroller Maragos said. “Although no errors are acceptable, it is commendable that so few errors were found during the audit. The Health Insurance Unit has already implemented procedures to ensure that similar errors never again occur.”

The specific issues identified during the audit included;

  • ten former employees who should have had their coverage terminated still had Empire health insurance coverage.  Although termination information was entered into the County Health Insurance System, the enrollment database of the New York State provider system was not updated,

  • one former employee requested a change in plan from HIP to Empire however the employee’s enrollment in HIP  was not canceled resulting in double billing from HIP and Empire,

  • one current employee was listed twice in the enrollment database of the New York State provider system resulting in double billing by Empire, and

  • The County was paying insurance premiums for one deceased retiree for approximately two and half years totaling $19,940 subsequent to a retiree’s death in 2010, because the Health Insurance Unit had not received a death certificate.

Based on the results of the audit, the Comptroller’s Office Health Insurance Unit has implemented steps to eliminate errors and recover overpayments, including;

  • the County’s health insurance database will be reconciled, at least quarterly with New York State’s Health Insurance enrollment database to ensure that enrollment is current, and that the monthly invoices of all health, dental, and vision providers are accurate,

  • NYSHIP reports will be crosschecked with an outside service to assist in identifying deceased retirees; and

  • retirees who do not respond to either the original or second annual attestation letter requesting verification of their current enrollment will be reviewed to determine if they  should have their health insurance cancelled,

pdf file CLICK HERE for the full version of our report

Connect with Nassau County Comptroller Maragos Online:
http://www.nassaucountyny.gov/agencies/Comptroller/index.html

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