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ASCs in the news: New York fines ASCs for overcharging state insurance program

Ambulatory Surgery Reimbursement Update, November 4, 2008

New York has fined ASCs it found overbilling the state employees’ health insurance program, according to an October 27 article in the Albany Times-Union. State officials say the overcharges totaled $13.8 million.

An audit involving the state comptroller, insurance department and civil service department disclosed that the ASCs had been manipulating the New York State Health Insurance Program (NYSHIP), reports the Times-Union.

Although physicians at the ASCs were plan participants, the ASCs were not, and they billed NYSHIP at the out-of-network rate. NYSHIP members have a 20% copay for out-of-network services, but the ASCs waived the copay, the newspaper says. This left NYSHIP paying higher fees, while plan members had no additional costs.

NYSHIP superintendent Eric Dinallo says that the practice borders on fraud. "This is only a small sample of the universe of providers.… The abuse could be much more widespread,” adds state comptroller Thomas P. DiNapoli.

Twenty of the 22 ASCs that billed the most out-of-network claims were overcharging, the Times-Union says. Four of them became NYSHIP participating providers after paying fines and reimbursing the state for $9 million in overcharges.

To read the article, click here.

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