New York State Health Insurance Program
Empire Blue Cross and Blue Shield Payments Made to Stony Brook University Hospital (Follow-Up)
Issued: August 13, 2012
Link to full audit report 2012-F-14
Purpose
To determine the extent of implementation of the two recommendations included in our initial audit report, Payments Made to Stony Brook University Hospital (Report 2009-S-27).
Background
Our initial audit report, which was issued on October 28, 2010, examined whether the payments made by Empire BlueCross BlueShield to Stony Brook University Hospital were made in accordance with Empire’s Certificate of Insurance and Empire’s hospital agreement with Stony Brook. We identified 94 errors on 79 (44 percent) of the 179 random sample claims we selected for review. With few exceptions, the errors led to overpayments, many of which were significant. The net overpayment from the claims that we reviewed totaled $872,105. A projection of these overpayments to our population of claims paid, using statistically valid sampling methods and a 95 percent single-sided confidence level, resulted in a projected overpayment of $3,695,102.
Key Findings
- Empire officials made some progress in addressing the issues identified on our initial audit. Additional efforts, however, are still needed to adequately address certain issues from the initial audit that have not been completely resolved. The two recommendations from the initial audit were partially implemented.
Key Recommendations
- Officials are given 30 days after the issuance of the follow-up review to provide information on any actions that are planned to address the unresolved issues discussed in this review.
Other Related Audits/Reports of Interest
New York State Health Insurance Program: Payments Made to Stony Brook University Medical Center Report 2009-S-27
State Government Accountability Contact Information:
Audit Director: Brian Mason
Phone: (518) 474-3271; Email: StateGovernmentAccountability@osc.state.ny.us
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236
