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Practice Management Alert

Payer Updates:

State Comptroller Audits Show UHC, Empire Were Overpaid $11 Million

Published on Wed Apr 18, 2012

Plus, Excellus BCBS will send refunds for incorrectly denied lead screening tests.Two state comptroller audits released in April 2012 show that Empire Blue Cross Blue Shield (BCBS) and United Healthcare (UHC) were overpaid by a combined total of $11 million for healthcare services, some of which were never even performed. Both payers process claims for the New York's government employee health plan, known as the Empire Plan. The audits suggest that neither payer appropriately or effectively monitored provider claims. There were errors in 111 (57 percent) of the 194 claims in Empire review sample, resulting in a net overpayment of $387,772 for the sample, according to the audit. In the UHC audit report, the reviewers stated: "For 27 (12.6 percent) of the 214 claims we tested, a significant and separately identifiable E/M service was not provided. On one claim, for example, United paid a provider $561 for a lesion removal [...]
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