New York receives $2.4 million from providers who inflated health claims

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Six medical providers have reimbursed state officials more than $2.4 million to cover the cost of inflated billings submitted to the New York State Health Insurance Program (NYSHIP).

Among those paying the fines and agreeing to stop improper waivers were Edward Fryman, a podiatrist operating the Seaford Foot Care Center in Seaford, N.Y, who paid the largest fine in the group – $10,889 – and the largest reimbursement to the state at a little more than $1 million.

According to the New York State Insurance Department, in addition to paying a combined $39,107 in fines and $2.4 million in restitution, the providers have agreed to stop waiving out-of-pocket fees that should be charged to state and local government employees filing health insurance claims.

The inflated billings occurred when the providers charged the state for the cost of out-of-pocket fees, which were waived to attract patients who would not otherwise pay higher costs, according to officials. The claims were uncovered following audits by the New York State Comptroller’s Office, which regularly audits the NYSHIP program, administered by the state’s department of civil service through UnitedHealthcare. NYSHIP, which also goes by the name The Empire Plan, is the largest public-employer health insurance program in the nation outside of the federal government, providing coverage to more than 1.2 million current and former state and local government employees.

In 2007, auditors initiated a series of reviews looking into the practices of individual medical providers and uncovered widespread problems, according to the NYSID, including passing on the costs of out-of-pocket costs by inflating bills to NYSHIP.

Over the last two years, the state has recovered about $11.4 million from providers who were inappropriately submitting inflated claims.

In addition to Fryman, the other providers agreeing to fines and reimbursements are: South Shore Ambulatory Surgery of Lynbrook, N.Y. ($8,218 fine/$821,834 reimbursement); Fifth Avenue Surgery Center of New York City ($5,000 fine/$178,633 reimbursement); Mount Kisco Surgery Center d/b/a The Ambulatory Surgery of Mount Kisco, N.Y. ($5,000 fine/$137,340 reimbursement); Mount Kisco Medical Group of Mount Kisco, N.Y. ($5,000 fine/$130,645 reimbursement); and Eye Surgery Center of Westchester, located in New Rochelle, N.Y. ($5,000 fine/$115,934 reimbursement).

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