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State: No fix yet on hospital's $3.7M overbilling

Stony Brook University Hospital. (June 24, 2009)

Stony Brook University Hospital. (June 24, 2009) Credit: James Carbone

Stony Brook University Hospital has only partially made changes stemming from a 2008 state audit that found it overbilled almost $3.7 million for services provided to Empire Plan members, the state comptroller's office said Monday.

The services were provided between 2004 to 2008 to patients who are active and retired employees of school districts and local and state government covered by the plan.

The update from the comptroller's office released Monday said Stony Brook had also not fully cooperated with a separate corporate audit by Empire, that only a portion of the overpayment has been recovered and that the hospital has not developed financial controls to ensure that all its payments conformed with its agreement with Empire.

A spokesman for the comptroller's office, Brian Butry, said the overbilling found in the original comptroller's audit in 2008 dealt with a number of medical procedure and products, often involving high-cost procedures like implants and other surgeries.

Stony Brook said in a statement that it was "committed to ensuring that all billings are accurate and reimbursements are valid." Empire BlueCross BlueShield, which runs the Empire Plan, could not be reached for comment.

The original audit sampled 179 claims between Jan. 1, 2004, and Dec. 31, 2008, and found 94 errors on 79 of the claims. "With few exceptions, the errors led to overpayments, many of which were significant," the audit said.

Empire overpaid Stony Brook almost $360,000, the audit said. Empire paid 169,912 claims totaling $249.7 million for services Stony Brook provided its members during that period."A projection of these overpayments to our population of claims paid, using statistically valid sampling methods and a 95 percent single-sided confidence level, results in a projected overpayment of $3,695,102," the comptroller's audit said.

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