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July 28, 2009

DiNapoli Finds More Abusive Practices in
New York State Health Insurance Program

Overbilling by Medical Facilities in Rockland, Albany and
Warren Counties Costs Taxpayers $1.3 Million

Click here for Audio Feed speaker icon from DiNapoli

Three health care providers overcharged the New York State Health Insurance Program (NYSHIP) $1.3 million, according to audits released today by State Comptroller Thomas P. DiNapoli. The medical providers gave patients routine physical therapy services, but billed NYSHIP for a much higher costing pain control procedure called Transcutaneous Electrical Nerve Stimulation (TENS). In some instances, the state paid up to $260 for a procedure that should have cost $8.50.

“These medical facilities over billed, and taxpayers footed the bill,” DiNapoli said. “This kind of abuse drives up everyone’s health care costs. Now more than ever, we need to make every dime count, especially when they’re taxpayer dimes. These overpayments should immediately be recovered and United HealthCare should tighten up its procedures. My office will keep on working to catch providers who abuse the system, and we’ll keep on working to prevent abuse before it happens.”

Civil Service Commissioner Nancy G. Groenwegen said, “The Department of Civil Service helps to fund these Comptroller audits because we know that billing abuse by providers is all too common. United Healthcare must develop more sophisticated controls to identify fraudulent or miscoded claims since it is unlikely that individual patients would ever spot them. We will continue to partner with the Comptroller to rid the system of waste and abuse.”

The audits released today are part of DiNapoli’s effort to examine whether medical providers were complying with reimbursement requirements under NYSHIP. Since 2007, DiNapoli’s office has completed 35 audits of NYSHIP, finding a range of problems that have resulted in nearly $38 million in actual recoveries and potential cost savings for taxpayers.

DiNapoli’s auditors examined payments made by United HealthCare for TENS services from January 1, 2006 through November 30, 2008. Auditors found that these providers gave patients regular physical therapy services but billed for these services under the much higher reimbursement code for TENS services.

The providers were:

If these non-participating providers had appropriately billed for these routine physical therapy services, they would have received considerably less money for the procedures, ranging from $6.50 to $8.50 rather than the $100 to $260 they received.

New York State provides health insurance coverage to active and retired state, local government and school district employees and their dependents. United HealthCare is responsible for administering several major components of the Empire Plan, the primary health plan of NYSHIP. The New York State Department of Civil Service is responsible for overseeing the program.

State Government Accountability
The Office of the State Comptroller regularly audits state agencies, public authorities and New York City agencies. Auditors ensure that programs achieve their established goals, funds are used efficiently and assets are adequately protected against fraud, waste and abuse. DiNapoli’s office completes approximately 200 state audits annually and identifies hundreds of millions in savings and fraud each year.

Click here for the DiNapoli audio feed. (1.61MB, mp3)

Click here for the Nanuet Medical Services audit.

Click here for the Albany Multi-Medicine Group audit .

Click here for the TotalCare Medical PC audit.



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