A recent statewide audit has uncovered twenty New York health care providers that routinely inflate claims for reimbursement made to the state. Eight of those are in Long Island. The practice has cost the state millions of dollars. Most of the targeted providers have been engaged in waiving out-of-network fees for patients covered under the Empire Plan, which is New York’s largest employee health care plan. Instead of requiring patients to pay their share for treatment by doctors not participating in the Empire Plan, the providers would simply charge more for the same procedure, and then bill the state at the higher rate to make up for the fact that the patient’s out-of-network fee had been waived.
Four of the eight Long Island providers have since made restitution to the state and have paid civil fines. Under New York law, the submission of an insurance claim to the state with false information may amount to fraud. According to the New York Insurance Department, the investigation of the health care providers is continuing, though no criminal charges have been filed.
For the full story, go to the New York Times.