Audit nets Suffolk County nearly $1M

Suffolk County will recover nearly $1 million after a comptroller's audit released Tuesday found $1.2 million in billing errors by its health plan administrator, Empire BlueCross BlueShield.

Comptroller Joseph Sawicki, in a prepared statement, praised Empire for its willingness "to step up to the plate and reduce its administrative fees over the next 18 months by $952,000 to compensate the county for erroneous charges." County officials say Empire makes between $8 million and $9 million a year from the county for administering health plan claims.

The comptroller called the county's review "a clean audit" where Empire's error rate was "extremely minimal" -- less than 1 percent of the $446 millions in claims. Sawicki's audit used two outside companies, Seneca Consulting Group and Health Care Horizons, which specialize in reviewing health insurance claims. Sawicki conducted the audit at the request of the Employee Medical Health Plan board, which consists of county managers and union representatives.

Among the problems the audit found were payments to those ineligible because they no longer worked for the county, incorrect charges when the county is the secondary insurer and overcharges when patients received services at different facilities on the same date.

Sawicki added that his office also will seek recovery of $250,000 in claims paid out incorrectly to current or past employees. He also said his office will conduct a follow-up audit of health plan billing for 2009, 20010 and 2011.

The audit occurred while the county undertook a competitive process for a new contract to administer the health plan. Empire, which has had the contract since 2005, was among six companies vying for the county's business.

Jeff Tempera, the health plan board's co-chairman, said the selection committee last May recommended Empire's contract to be renewed, but only if it made a settlement on the audit findings. In the wake of the settlement, Tempera said he sent a letter informing Empire of its new three-year contract with options for two, one-year renewals.

"It was a fair process," said Thomas Canty, an Empire vice president. "I think the county is very happy with the findings. We were happy with the finding of errors of less than 1 percent. That's super and we'll work hard to help the county get the best deal they can."

Christina Capobianco, Sawicki's top aide, said the county has begun receiving savings on the reduced fees, and that revenue is already included in County Executive Steve Levy's $2.7 billion proposed budget for next year.