Suffolk County Comptroller Joseph Sawicki, seen here on July 22,...

Suffolk County Comptroller Joseph Sawicki, seen here on July 22, 2013. Credit: Newsday / Jeffrey Basinger

Suffolk Comptroller Joseph Sawicki said he will seek to recover nearly $923,000 from Empire BlueCross BlueShield, the county health insurance administrator, after an audit found overcharges for hospital readmissions, the use of assistant surgeons and uncollected Medicare co-payments.

The audit, which covers the years 2011 and 2012, found overcharges by going through $368.4 million in billings. Empire agrees with the recovery of $113,173 but disputes the remainder of the audit findings.

"I am confident that Empire will do the right thing . . . and negotiate a full settlement," Sawicki said. While the overcharges were less than 1 percent of the billings, he said, "That money belongs to Suffolk County taxpayers and our job is to ensure that those expenses are accurate and prudent."

The audit, which cost $50,000, was conducted by Seneca Consulting Group of Hauppauge, which reviewed all employee claims by computer and sampled 350 claims auditors believed to have potential errors.

The audit found that the county overpaid $305,235 for 19 claims involving hospital readmissions less than three days after initial treatment. County consultants say the county only has to pay for the more expensive admission. Empire officials said the claims for coverage of readmission were proper and that it has a "robust program" to investigate readmissions.

The county also found $250,114 paid for secondary surgeons that exceeded the allowed maximum of 20 percent of fees paid to the primary surgeon. In other cases, the audit found a secondary surgeon was unneeded. In one case, the audit found what it termed a case of "possible abusive billing," where the assistant surgeon was paid $16,500 for an emergency appendectomy, while the primary surgeon received $445.

Empire said that claim was paid correctly because it involved a "nonparticipating, non-negotiating provider."

Empire also maintains that secondary surgeons were correctly reduced to 50 percent of the primary surgeon's allowance.

The audit also found there were $157,500 in uncollected office visit co-payments, ranging from $20 to $25 for more than 7,000 claims processed as secondary to Medicare.

Sawicki said a letter was sent to Empire Wednesday demanding repayment within 30 days, but he offered the company a chance to propose a repayment plan by Dec. 3. Such repayment plans permit a contractor to make refunds to the county over 12 to 18 months by reducing future billings.

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