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April 25, 2008

DiNapoli Targets Fraud and Improper Billing in
State Health Insurance Program

Long Island Surgery Center Inflated Bills at Cost of $1 Million to State

A Long Island surgery center submitted inflated bills that cost the state $1 million, according to an audit released today on the New York State Health Insurance Program (NYSHIP) by State Comptroller Thomas P. DiNapoli.

Auditors found Lynbrook-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.

“This medical center engaged in improper practices and inflated its bills,” DiNapoli said. “This hurts taxpayers and drives up everyone’s health care costs. We’ll keep looking for the bad actors and root them out. Working with the Department of Civil Service, we’ll make sure taxpayers aren’t paying a dollar more than they should.”

Civil Service Commissioner Nancy G. Groenwegen said: “Health care providers receive fair payment for their services without resorting to manipulating the system. These manipulations deserve to be exposed. In cooperation with the Comptroller, this department will strive to rid the system of such abuse.”

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.

Click here for a copy of the audit.



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