NYSHIP contractors wasting millions of dollars


By SHERRY HALBROOK According to two audits by the Office


of the State Comptroller (OSC), the NYS Health Insurance Program (NYSHIP) erroneously paid as much as $11 million for special items such as implants, drugs and blood and evaluation procedures that were not performed. One audit


found 57 percent of the paid claims it reviewed were false or overbilled. That’s bad news for state


taxpayers and NYSHIP enrollees, including PEF members and retirees, who pay the premiums. In an April announcement, state


Comptroller Thomas P. DiNapoli said payments to hospitals accounted for an estimated $3.2 million of the $11 million in overpayments. NYSHIP also paid


medical providers as much as $7.8 million for “phony evaluations.” “While most New Yorkers


are watching their spending, Blue Cross and Blue Shield and United HealthCare are not monitoring bills and are letting the state overpay


health providers,” DiNapoli said. “An error rate showing that nearly six of every 10 claims are billed incorrectly is simply


unacceptable and cannot


continue. These companies have to do a better job watching taxpayer dollars.” NYSHIP provides health


insurance coverage to active and retired state, participating local


government and school district employees and their dependents. The state Department of Civil Service


contracts with Empire Blue Cross and Blue Shield to provide hospitalization coverage under the Empire Plan, the largest insurance option provided by NYSHIP.


Sprint is the only national carrier with truly Unlimited data.


tr ru y U Un i Unliim ted


The Everything Data plan for all phones. No throttling. No metering. No overages. All while on the Sprint network.


Special offer for of New York State


66 66.69 .) are add’l charge /mo.


no e


employees


Unllimitted d a on $


mon Shop here: sprint.com/newy credit approval, sprint.com/ne y


ed data on tthe Ever Price


reement. Roaming and pr nthly


r rges apply ewyorkstate


**Monthly charges exclude taxes, Sprint Surcharges [incl. USF charge of up to 17.4% (varies quarterly), subject to change. Details: sprint.com/taxesandfees.


received. rge of up to 17.4% (varies quarterly), Administrative Charge (up to $1.99/line/mo.),


May require up to a $36 activation fee/line, credit approval, deposit. Up tto $350/line early termination fee (ETF) for advanced devices and up to $200 ET Min./month. Add’l Anytime Min.: Up to $0.45/min. Nights: Mon-Thurs. 7


artial min. national messages sent or received from the U


songs, certain channels, etc.) are add’l charge. Text to 3rd parties to participate in promotions or other may result in add’l charges services are not included. Email includes use of Sprint Mobile Email, Mic


vices are not included. Email includes use of Sprint Mobile Email, Microsoft Direct Push technology via Active Sync™


$29.99 or less. Other Terms: Nationwide Sprint Network reaches over 280 million people. The Sprint 3G network (including roaming) reaches over 282 million people. Coverage not available everywhere. Not combinable with other discounts Other restrictions apply See store or sprint.com for details All rights reserved. Sprint and the logo are trademarks of Sprint. Other marks are the properties of their respective owners.


Sprint and the logo are trademarks of Sprint. Other marks are the properties of their respective owners


verification). m


www.pef.org The Sprint 3G network (including roaming) reaches over 282 million people


numbers as determined when the call is placed using independent third-party and Sprint databases. Standard roaming rates/restrictions apply. Only availab ing: Includes text, picture and video for domestic messages sent or rece certain channels


service if off-network usage in a month exceeds: (1) voice: 800 min. or a majority of minutes; or (2) data: 300 megabytes or a majority of kilobytes. Proh sult in other adverse action. See in-store materials or sprint.com/termsandconditio t®


ne/mo.), Regulatory Charge ($0.40/line/mo.) and sta y Charge ($0.40/line/mo.) and state/local fees (approx. 5%-20%)]. Sprint Surcharges are not taxes or gov’t-required charges and are 5


Up to $350/line early termination fee (ETF) for advanced devices and up to $200 ETF/line for other devices (no ETF for Agreements cancelled in compliance with Sprint’s Return P 7pm-7am; Wknds: Fri. 7pm-Mon. 7am. Partial min. charged as full min. Requires $10 Premium Data add-on for smartphones. Any Mobile,


mined when the call is placed using independent third-party and Sprint databases Standard roaming rates/restrictions apply Only available with select Sprint plans and while on the Nationwide Sprint or Nextel® National Networks (excludes calls to voicemail,l Networks (excludes calls to voicemail, 411 and other indirect methods). Messag- eived. International messages sent or received from the U.S. are $0.20/msg and from outside the U


Requires $10 Premium Data add-on for smartphones Any Mobile, AnytimeSM: Applies when directly dialing/receiving standard voice calls between domestic wireless ble with select Sprint plans and while on the Nationwide Sprint or Nextel


TF/line for other devices (no ETF for Agreements cancelled in compliance with Sprint’ Applies w


ext to 3rd parties to participate in promotions or other may result in add’l charges. Sprint TV® includes select channels crosoft Direct Push technology via Active Sync , Versamail, IBM Lotus Notes


EVDO Rev A coverage areas on the Sprint 3G network. Group Connect : Group Connect (21 max. participants) currently operates between parties on the or organization participating in the discount program (requires ongoing ve


erification). Discounts are subject to change according to the company’s agreeme IBM Lotus Notes Traveler® or BlackBerry® Internet Ser net Service (BIS). Voice/Data Usage Limita


from outside the U.S. are $0.50/msg. SMS voice messages may incur an additional data charge of $0.03/KB ect channels. For full Sprint TV lineup, visit sprintchannels eler


vice if off-network usage in a month exceeds: (1) voice: 800 min. or a majority of minutes; or (2) data: 300 megabytes or a majority of kilobytes Prohibited network use rules apply As advertised, and notwithstanding those restrictions for customers on unlimited data-included plans for phones, but could res


but could result in other adverse action. See in-store materials or sprint.com/termsandconditions for specific prohibited uses Direct Connect®: Nextel and PowerSource™ devices th


hibited network use rules apply. As advertised, and notwithstanding those restrictions ons for specific prohibited uses. Direct Connect he same push-to-talk network platfor


dev s agreement with Sprint and are available upon request for select plans (monthly service charges only). No discounts apply to secondary lines


push-to-talk network platform. International Direct ConnectSM not included. ent with Sprint and are available upon request for select plans (monthly service cha


are $0.50/msg SMS voice messages may incur an additional data charge of $0.03/KB Data: Premium content/downloads (games visit sprintchannels.mobitv.com. Content and channel lineup subject to change ta Usage Limitation: Sprin


nal data charge of $0.03/KB. Content and channel lineup subject to change s, Includes 450


rint’s Return Policy). Everything Data: Offer ends 7/14/12. Includes 450 Anytime when directly dialing/receiving standard voice calls between domestic wireless


me g-


d channel lineup subject to change. GPS reliability varies by environment. International Sprint reserves the right,nt reserves the right, without notice, to deny


Premium content/downloads (games, ringers to deny, terminate, modify, disconnect or suspend


ns, engaging in such uses will not result in throttling (limiting data throughput speeds) vices operate on the Nextel National Network. Sprint devices operate within certain d. Individual-Liable Discount: Available only to eligible employees of the company arges only). No discounts apply to secondary lines, Add-A-Phone lines or add-ons scounts. Other restrictions apply. See store or sprint.com for details. ©2012 Sprint.


any s


nt. N125233 MV1234567


233 567


The Communicator June 2012—Page 11


onal pend eds) n


re


r discount. Reg. $79.99/mo. ($69.99 Everything Data Plan 450 + nondiscountable $10 Premium Data add-on.) Requires a two-year Agreement. Roaming and prohibited network use limitations apply. Othery. Other monthly charges apply. See below.**y. See below.**


e afftter discount. Reg. $79.99/mo. ($69.99 Ever ondiscountable


n.) ed network


e Everythiing D a p a remium Data add-on


ng Data pllan E


k use limitations apply


rything Data Plan 450 res a two


M c


G


Mention this code tto claim your


o r discount.


GASNY_ZZZ ID or oD or other


r iinfoformation w n w be r wiilll be requirired. In addition, Civil Service contracts


separately with United HealthCare (UHC) to process and pay medical and surgical claims for services provided to Empire Plan members. UHC processes more than 21 million claims annually, (totaling about $1.9 billion) for the Empire Plan. DiNapoli called on Empire Blue Cross


and Blue Shield to repay the state the $3.2 million it overpaid hospitals. According to a newspaper report, Empire has begun recovering those overpayments from the hospitals. For example, Empire paid one


hospital $34,542 for a special item that should have been reimbursed at $7,979. The audit of UHC covered 2009 and


found “Because of the large volume of claims, United officials relied extensively on the integrity of providers to submit their claims properly.” DiNapoli reported UHC officials


generally agreed with the audit’s findings and have initiated outreach and education to prevent future mistakes.


Health Notes


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24