Objective

To determine the extent of implementation of the four recommendations included in our initial audit report, UnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and Acupuncture-Related Services (Report 2020-S-7).

About the Program

The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance coverage to over 1.2 million active and retired State, local government, and school district employees, and their dependents. The Empire Plan is the primary health insurance plan for NYSHIP, covering 1.1 million members

Civil Service contracts with UnitedHealthcare Insurance Company of New York (United) to administer the Empire Plan’s medical/surgical benefits. Medical/surgical benefits cover a range of services, including acupuncture and acupuncture-related services such as heat and massage therapy.

We issued our initial audit report on October 27, 2021. The audit objective was to determine whether United appropriately reimbursed acupuncture and acupuncture-related services. The audit covered the period January 1, 2015 through December 31, 2019. We identified $7.3 million in actual and potential overpayments for services that were not supported by provider documentation and for duplicate payments.

Key Finding

United made minimal progress in addressing the issues identified in the initial audit. At the time of our follow-up, United had recovered only $14,281. Further, United was not able to provide evidence of additional control enhancements designed to prevent duplicate payments. Of the initial report’s four recommendations, one was implemented, two were partially implemented, and one was not implemented.

Key Recommendation

Officials are given 30 days after the issuance of this report to provide information on any actions that are planned to address the unresolved issues discussed in this follow-up.