Purpose

Our Office examined $1.4 billion in payments for more than 17 million in medical and other service charges the New York State Insurance Fund (NYSIF) made on behalf of nearly 215,000 claimants during the period January 2014 through February 2017. We matched the payments to the New York State Department of Corrections and Community Supervision Under Custody files from September 2016 through March 2017. We also matched the payments to the Social Security Administration Death Master File as of April 5, 2017. Our objective was to determine if payments NYSIF made were appropriate.

Background

According to Workers’ Compensation Law Section 10(4), any person incarcerated upon conviction of a felony shall be deemed ineligible for all benefits. Furthermore, NYSIF will not pay for medical and other service charges that occur subsequent to a claimant’s date of death.

Key Findings

Both payment matches yielded minimal exceptions. In addition to conducting the matches, we observed NYSIF’s process for identifying and preventing inappropriate payments made for claimants who were either incarcerated or deceased. Based on the match results and our observations of the payment process, we conclude NYSIF has established reasonable controls to minimize the risk of improper payments in these areas.

Key Recommendations

N/A