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Attorney General’s Office Informs Senior Citizens About Health Care Fraud

Brian Herrington, assistant director of Intergovernmental Affairs for New York State Attorney General (AG) Andrew Cuomo, spoke at the Port Washington Senior Center about how the AG’s Health Care Bureau helps to protect consumer rights. Herrington began by explaining that the AG’s office has many different structures that act to protect consumers, one of which is the Health Care Bureau. In addition, the AG’s office is responsible for providing legal representation for state agencies.

“The Health Care Bureau,” Herrington said, “has been set up to answer questions and to advocate for you.” For example, they can answer questions about which benefits the consumer is entitled to under his or her existing health insurance contract; they will mediate disputes about coverage or billing; and they will investigate when a person has lost insurance coverage. Herrington gave examples. One was helping a cancer patient get reimbursed for chemotherapy treatment after the insurance company repeatedly denied the claim. Another was resolving a situation where a consumer found out, for the first time, about an ambulance bill that the insurance company had never paid when it showed up on his credit report. The patient had never seen the invoice. Herrington said, “We got the bill handled and corrected the credit report.”

The hot line to call for information or help is 1-800-428-9071; fax 518-402-2163. The hot line is available 24 hours a day; after hours you will be put through to a voice mail system, and someone will get back to you. He said, “We want you to be able to get in touch with a human being.”

The AG’s office also targets practices in the health care industry that they consider to be deceptive or fraudulent. One example Herrington gave was a report that exposed how “conflicts of interest and a lack of transparency have created a system of out-of-network reimbursement that is unfair, unclear, and needs to be reformed.” (Citation from the AG web site – http://www.oag.state.ny.us) The AG’s office determined that the company that set the rates was owned by United Health Care. The report recommended that the usual and customary or market rates for health care charges should be determined by an independent third party free of conflicts of interest, using a fair, objective, and reliable database. It also asserted that, before choosing their doctors, consumers should have access to information about how they will be reimbursed. Another example of AG advocacy in health care that Herrington cited was exposing the fact that the so-called “doctor ranking” by the insurance companies was not based on any qualitative measures, but rather was based on cost to the insurance companies. (The lower the cost, the higher the ranking.)

During the question-and-answer period, Herrington was asked about the proposed federal health care plan. He took no position, but did comment, “A lot of emotions are coming out. People are very frustrated.” One participant asked rhetorically, “Why does it all have to be so complicated?” Sue Lucatorto, program coordinator, commented that one of the most important things a health care consumer can do is to read and understand the explanation of benefits. Herrington agreed, saying, “If you are uncertain about a doctor or hospital, call up and ask questions. If you see something in your bill that you don’t recognize, say something. Raise questions. If we ask a lot more questions, we can do a much better job of monitoring.” Lucatorto wondered if it is necessary to give the doctor or hospital your Social Security number. Herrington said that he was not sure, but would get back with an answer. (Editor’s note: On a recent visit to a local hospital, we were told that their policy is that the Social Security number is optional.)

The Port Washington Senior Community Center is a private, nonprofit organization operated under the auspices of the Educational and Assistance Corporation (EAC). The Center, whose funding comes primarily from the Nassau County Department of Senior Citizen Affairs, operates a variety of programs for persons 60 and over. It is housed in the parish hall of St. Stephen’s Episcopal Church at Carlton Avenue and Main Street. Lucatorto invited anyone who is interested to stop by between 9 and 6, Monday through Friday, or call 944-9654.