Twenty medical providers have allegedly submitted inflated claims to the New York State Health Insurance Program (NYSHIP), costing the state nearly $14 million.
Auditors overseen by Mr. DiNapoli’s office initiated a series of audits in 2007, examining 22 providers not participating in the state’s Empire Plan, the primary health insurance plan for state and local employees. These providers can receive reimbursement rates up to 80 percent higher than participating providers. When Empire Plan members receive services from a non-participating provider, they are responsible for paying a larger portion of their medical bill.
The auditors found that 20 of the 22 providers were waiving these out-of-pocket costs for patients and then submitting inflated bills to the Empire Plan to cover these costs.
Under New York State law, submitting an insurance claim with false information may constitute insurance fraud.
Four providers have paid fines and signed agreements to become participating providers in the Empire Plan:
- Endoscopy Center of Long Island in Garden City, which reimbursed the state $3,135,834 and paid a civil penalty of $31,358;
- Capital Region Ambulatory Surgery Center in Albany, which reimbursed repaid $2,225,015 and paid $22,250 in fines;
- Digestive Health Center of Huntington, which repaid $1,332,120 and paid $13,321 in fines; and
- Day Op of North Nassau in Great Neck, which repaid $1,162,232 and paid $11,622 in fines.
The fifth facility, Day-Op Center of Long Island in Mineola, repaid the state $1.165 million, but has not agreed to discontinue the practice of waiving out-of-pocket expenses. As such, it may still be subject to further enforcement action. The remaining 15 providers identified in the audits are still under review.
View the list of the audited New York providers (pdf) and their inflated billings.
View Mr. DiNapoli’s report on auditing NYSHIP (pdf).
