Department of Civil Service

New York State Health Insurance Program: Duplicate Payments for Extracorporeal Shock Wave Therapy (Follow-Up Report)

In the New York State Health Insurance Program, the Department of Civil Service administers health insurance programs for active and retired State, local government and school district employees and their dependents. The primary such program is the Empire Plan, which provides services costing about $4.0 billion a year.

In audit report 2006-S-54, we examined the payments made over a 15-month period by the Empire Plan to a particular neurosurgeon to determine whether the payments were appropriate. The payments were for extracorporeal shock wave therapy that had supposedly been provided by the neurosurgeon to treat plantar faciitis (an inflammation of the foot). We found that the neurosurgeon was inappropriately paid nearly $1.8 million during this period, because the services claimed by the neurosurgeon were actually provided by other practitioners (generally podiatrists) and these practitioners were fully reimbursed by the Empire Plan for those services. We recommended that the payments to the neurosurgeon be recovered by the Empire Planís insurance carrier and remitted to the State. When we followed up on this matter with the insurance carrier, we found that the carrier had stopped reimbursing the neurosurgeon and other providers for this type of treatment (for annual savings of about $4.3 million) and was negotiating with the neurosurgeon to recover past reimbursements.

For a complete copy of Report 2007-F-14 click here.
For a copy of the 90-day response click here.