March 9, 2009                                                            

Weitzman says errors in State health insurance billing means money for school districts and local governments

Nassau County Comptroller Howard Weitzman is reaching out to over 200 school districts, town supervisors, and village and city mayors to alert them to a potential savings opportunity in their New York health insurance plan that can be achieved by exposing errors in the classification of enrollees. According to Weitzman, an internal audit of Nassau County records found that the New York State Health Insurance Program (NYSHIP) has Medicare eligible enrollees miscoded, therefore over-charging the County for these enrollees. Weitzman is recommending that these school districts and municipalities audit their pool of health care enrollees to identify any who NYSHIP should bill as Medicare primary but instead are being billed at full price. 

"An audit of Nassau County’s enrollees turned up 37 errors which translated into an overpayment of approximately $290,000 during the audit period of January 2005-January 2009,” said Weitzman. “At a time when the County is facing a possible $150 million budget gap, exposing billing errors like these becomes crucial.”

In February of 2007 the Manhasset School District discovered errors, totaling about $211,000, in its NYSHIP charges, related to enrollees who NYSHIP should be covering only as secondary insurer since they were Medicare eligible. The district alerted the Nassau County Comptroller’s office to the problem. Upon doing an audit of Nassau County enrollees, the Comptroller identified 37 who should have been listed in NYSHIP records as Medicare primary, but were instead listed as NYSHIP primary.  NYSHIP agreed to correct their records and credited the County for $121,692 overpayments between December 2007 through February 2009. The audit identified a total of $289,027.10 in overpayments retroactive to January 1, 2005. 

This week the Comptroller will be sending out a letter informing all downstate school districts and local governments that participate in NYSHIP to audit their enrollees to determine whether any can be switched to the lower Medicare primary rate. Weitzman is also offering the use of an Excel worksheet to assist anyone with analyzing the NYSHIP data, identifying the relevant enrollees and calculating any overpayments.

Weitzman is also reviewing with the County Attorney’s office whether the County has any further recourse for additional reimbursement of the over-payments.

Weitzman goes on to state in the letter that:

"The most galling part of this exercise is that the insurance companies that contract with NYSHIP were certainly treating these enrollees as Medicare primary for their own purposes, based on the date of birth information. This is another example of the need for an independent, outside review of the NYSHIP program.”

In late 2008, the Comptroller worked successfully with County Executive Suozzi and many school districts and local governments to point out that NYSHIP’s premiums were over-collecting from participating governments. Together, they successfully prevailed on the State to negotiate lower premiums in 2009 and now schools and municipalities are seeing the benefit in their budgets of the reduced level of health premium increase.