New York Attorney General Settles Balance Billing and Overpayment Disputes

New York State Attorney General Eric Schneiderman announced on Tuesday that it had reached settlements with Group Health Inc. (“GHI”) and a New York City health care provider regarding overpayments to consumers.

GHI has agreed to repay consumers for approximately three years of overbilling.  GHI purportedly charged its assureds out-of-network rates for certain medical providers, including radiologists, pathologists, and anesthesiologists.  This practice was contrary to GHI’s policy.  Reportedly, GHI assureds sometimes paid in the thousands of dollars for services that GHI should have covered.  Attorney General Schneiderman’s office reached an agreement with GHI to return the overbilled amounts, which are thought to total nearly $500,000.  GHI has also agreed to pay a penalty, assist consumers who were subject to debt-collection as a result of GHI’s overbilling, and train its employees to avoid this practice in future.

New York Medical & Diagnostic Center, Inc. (“NYMDC”), a New York City health care provider, agreed to cease its practice of balance billing.  When a health care provider “balance bills” a patient, it sends the patient a bill for any amount of its charge that an insurer did not cover—despite the fact that the provider is required to accept the insurer’s payment as payment in full.  The Attorney General’s office characterized this practice as prohibited both under New York State law and NYMDC’s contractual obligations.

NYMDC has agreed to refund affected patients, pay a penalty, and retrain its staff to cease this practice.  It will also retain an auditor and assist patients whose credit was negatively-affected by NYMDC’s action.

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