According to Suffolk County Comptroller John M. Kennedy, Jr.’s office, the longtime local representative recently oversaw a successful audit of overpaid medical sentences.
Comptroller Kennedy settled yet another audit with Anthem BlueCross BlueShield that revealed a massive billing error. The former administrator of hospital benefits for the County’s self-insured employee medical health plan was paying the County $1,688,138. This plan covers 45,000 active or former employees or dependents.
Kennedy and Company deployed the Segal Group to perform the medical claims audit. The audit centered on January 1st through December 31st, 2022.
Says Kennedy’s Office: Anthem repeatedly undercharged members for copayments, thereby overcharging the County for benefits assigned. Instances of duplicate claims were also detected, in addition to overpaid plan benefit limits for acupuncture, chiropractor and physical therapy services.
Mistakes revolved around the process of coordinating benefits with medicare claims were found to have been a systemic issue above all else.
“Auditing the County’s self-insured employee medical health plan has been a priority of mine since becoming County Comptroller in 2015,” said Kennedy. “As a result of these audits, my administration has recouped over $10 million in misspent medical costs for the taxpayers of Suffolk County.”
The County ended its administrative service agreement and 19-year partnership with Anthem at the conclusion of last year, choosing to go into contract with Aetna moving forward.