Department of Civil Service
New York State Health Insurance Program: Overpayments for Services Provided by Dr. Constantinides
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 billion a year.
Dr. Constantinides, a plastic surgeon practicing in New York City, does not participate in the Empire Plan. Accordingly, if an Empire Plan member is treated by Dr. Constantinides, the bills to the Empire Plan are subject to certain restrictions. However, we found these restrictions were not properly applied by the Empire Plan, in part because of questionable billing practices by Dr. Constantinides, and as a result, Dr. Constantinides was overpaid a total of $90,951 on billings of $226,464 (an overpayment of about 40 percent). We recommended the Empire Plan recover the overpayments. We also referred the matter to the Department of Civil Service for appropriate follow-up action, because certain of Dr. Constantinides’ billing practices result in other additional costs to the Empire Plan beyond the inflated portion of the bills, and should be actively discouraged.
For a complete copy of Report 2008-S-10 click here.