Audit Finds Empire BlueCross BlueShield Overpaid Hospitals

According to an audit conducted by the State Comptroller, New York State health insurance provider Empire BlueCross BlueShield overpaid hospitals by nearly $490,000 for special medical items such as implants, drugs and blood, including more than $77,000 to just one hospital, over a six month period.

DiNapoli says New York State cannot afford to be squandering money and paying excessive amounts for these types of items. DiNapoli’s auditors found that the over payments included 52 claims from hospitals with contracts limiting the amounts they should have charged for special items.

Auditors also found Empire’s average payment to hospitals with reimbursement limits exceeded the hospitals’ estimated costs for cardiac devices by $2,818. For the hospitals without reimbursement limits, Empire’s average payment exceeded the estimated costs for the devices by $13,140 – more than four times the amount collected by hospitals with contract limitations.