Audit: Fraud, Improper Billing at State Health Insurance Program

ALBANY, N.Y. -- A Long Island surgery center submitted inflated bills that cost the state $1 million, according to an audit released in a press release Friday on the New York State Health Insurance Program (NYSHIP) by state Comptroller Thomas P. DiNapoli.

Click here for the pdf report. Click here for the full press release.

Auditors found Lynbrook, N.Y.-based South Shore Ambulatory Surgery Center routinely waived out-of-pocket costs for medical services provided to state and local government employees who are covered under NYSHIP’s Empire Plan. Under New York state Insurance law, submitting an insurance claim with false information may constitute insurance fraud.

DiNapoli said this audit is part of his continued examination of potential abuse in the state health insurance program that started last year. So far, nine DiNapoli audits have identified nearly $33 million in overpayments and fraud.

New York state provides health insurance coverage to active and retired state, local government and school district employees and their dependents. This coverage is provided under several benefit plans, including the Empire Plan. The New York State Department of Civil Service is responsible for overseeing these plans. The Department of Civil Service contracts with United HealthCare to pay claims and administer the medical surgical component of the Empire Plan.

Auditors recommended that the United HealthCare recover this money and take appropriate action against South Shore.

-- NYSSCPA.org News Staff

Posted on 4/25/08