Stop Those Audits! Court Concludes NYS Comptroller Lacks Authority To Audit Out-Of-Network Medical Providers


In our December 2009 Alert, we wrote about the New York Comptroller’s State-wide practice of auditing financial records of out-of-network providers that treat individuals insured by the State’s Empire Plan as the basis for recovering millions of dollars from these providers.

RMF was recently retained by an orthopedic practice to challenge the results of such an audit, which concluded that the practice “routinely waived” patients’ out-of-pocket costs and therefore overcharged the Empire Plan for its services. The audit further recommended that United Healthcare undertake efforts to recoup the overcharges. RMF’s Health Law and Litigation Departments argued that the State Constitution does not empower the Comptroller to audit private, out-of-network providers.

Please see full alert below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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