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DiNapoli: NYSHIP “Wasting Millions In Taxpayer Money”

John Moore, Getty Images

Albany, NY (WIBX) – According to the state Comptroller’s Office, the New York State Health Insurance Program paid up to $11 million for procedures that were not performed.

Two providers, Empire Blue Cross Blue Shield and United HealthCare, are accused of overpaying hospitals and medical providers $3.2 million and $7.8 million, respectively.

In one of the audits, DiNapoli’s auditors found errors in 111 of 194 claims, or nearly 60 percent of the claims reviewed.

DiNapoli says taxpayers are hurt by the spending, saying, quote, “An error rate showing that nearly six out of every 10 claims are billed incorrectly is simply unacceptable and cannot continue.”

To rectify the situation, DiNapoli’s auditors suggested Empire repay more than $3.2 million and to develop a system ensuring payments are supported by the correct documentation.

United is urged to develop a system to clarify and educate providers’ use of evaluation and management services performed before a procedure, also known as modifier 25 coding, and to review claims from higher risk providers to recoup any over-payments found.

For copies of the complete Empire and United audits, click the links provided.

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