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Empire, United paid $11M for unperformed services

Empire Blue Cross Blue Shield and United HealthCare were overpaid by an "unacceptable" $11 million for health services, some of which were never performed, according to two state comptroller audits released Wednesday.

Both insurers process claims for the state's health plan for government employees, commonly known as Empire Plan--worth $4.7 billion and covers more than 1.2 million people, reported the Albany Times Union.

The problem, according to the audits, is that the insurers didn't effectively monitor provider bills, which caused errors in 57 percent of the 194 Empire claims auditors reviewed and that 12 percent of United's 214 payments for procedures special patient evaluations were unwarranted, according to the Associated Press.

"While most New Yorkers are watching their spending, Blue Cross Blue Shield and United HealthCare are not monitoring bills and are letting the state overpay health providers," comptroller Tom DiNapoli said. "An error rate showing that nearly 6 of every 10 claims are billed incorrectly is simply unacceptable and cannot continue."

Examples of the overpayments include Empire paying one hospital $34,542 when it only should have paid $7,979. United also paid a doctor $561 for a lesion removal and $204 for evaluation and management services, even though there was no record of any evaluation or management services provided, the New York Post reported.

To learn more:
- read the NY audits of Empire (.pdf) and United (.pdf)
- see the Albany Times Union article
- read the Associated Press article
- check out the New York Post article

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