New York Auditors Cite Medical Insurance Overpayments

April 13, 2012

State auditors say the New York State Health Insurance Program erroneously paid up to $11 million for special items like implants, drugs and evaluation procedures for public employees that were not provided.

Comptroller Thomas DiNapoli says Wednesday the two audits show contract insurers Blue Cross and Blue Shield and United Health Care failed to effectively monitor bills, with one showing Empire overpayments in 57 percent of claims reviewed and another showing 12 percent of United payments for special patient evaluations were unwarranted.

The state program contracts with the insurers for hospitalization, medical and surgical coverage for active and retired state, local government and school district employees and dependents.

Auditors faulted hospital and provider billing. Both insurers reviewed audited claims.

Empire recovered some payments but disputes overpaying an estimated $3.2 million.

Topics New York

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