Department of Civil Service
Overpayments for Services Provided by Dr. Handler and Dr. Moschetto
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 more than $5 billion a year.
Dr. Handler and Dr. Moschetto (Handler and Moschetto) are cardiologists located in Great Neck, New York. Handler and Moschetto do not participate in the Empire Plan. Accordingly, if an Empire Plan member is treated by Handler and Moschetto, the Empire Plan will not reimburse Handler and Moschetto for their full charges. Rather, it will only reimburse a portion of these charges (generally 80 percent), and the member will have to pay the balance. However, we found that Handler and Moschetto were routinely waiving Empire Plan members’ out-of-pocket expenses. Such a practice may constitute billing fraud, as the Empire Plan was reimbursing 80 percent of what it understood to be Handler and Moschetto’s actual charges. We recommended the Empire Plan recover the inflated portion of Handler and Moschetto’s bills, an amount we calculated to be $903,563 for the five-year period we audited (about 18 percent of the total $4.9 million that Handler and Moschetto billed to Empire Plan members during this period). We also referred the matter to the Department of Civil Service for appropriate follow-up action, because this billing practice results 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 2009-S-23 click here.