The City Council will probe two of the state’s largest health insurers after The Post reported on a newly unsealed lawsuit claiming the companies pulled a $1 billion scam on taxpayers.
“The scope of what has been alleged is shocking,” said Councilman Justin Brannan.
The Brooklyn Democrat said he’ll scrutinize claims that Empire Blue Cross-Blue Shield and its partner Emblem Health — which covers 600,000 city employees, retirees and their families — exaggerated benefits while understating out-of-pocket costs.
“As chair of the Contracts Committee, I am committed to take allegations like this very seriously. In the coming days and weeks, using our charter-mandated authority, I will investigate and convene an oversight hearing on this issue and take whatever actions are necessary to get to the bottom of this,” Brannan said.
He promised that “there’s gonna be hell to pay” if he discovers the insurers have been cheating New Yorkers as the suit filed by former city lawyer Kami Barker alleges.
Barker brought the whistle-blower case against Empire and Emblem after investigating the insurers when she was hit with over a quarter-million dollars in medical bills despite having full health coverage. The 37-year-old Emory Law grad says a summary of her plan promised that using in-network hospitals would save her money — but didn’t warn that many doctors in those hospitals were considered out-of-network.
She also found that the companies used alleged “old-fashioned accounting fraud” to overcharge the city for insurance services by an average of $55 million a year between 2008 and 2014.
Meanwhile dozens of NYPD and FDNY retirees say that they, too, have been ripped off by the insurers, who refuse to accept out-of-state doctors into their plans while sticking members with staggering bills.
The most egregious is Russ Meinken. The 52-year-old, a former 15-year police veteran now lives in North Carolina with his family. His 11-year-old daughter Julia Meinken was diagnosed with leukemia in 2012.
Emblem subsidiary GHI “didn’t pay out-of-network costs or even close to it,” Meinken told The Post. “I was being billed for hundreds of thousands of dollars of care.
“I would constantly get billed and I would send the bills to GHI and GHI would just refuse to pay the costs and this has been going on for five years,” Meinken said.
He’d even added a rider for extended benefits that was supposed to cover catastrophic care, but it didn’t kick in, he said, adding, “It’s a disgrace they’re actually allowed to get away with this.”
Another North Carolina resident whose husband worked for the NYPD can’t find a single doctor in the state who performs bariatric surgery and also accepts her insurance.
“I’m overweight,” Ann Zaino, 49, said. “It’s my own fault, but I need help. I feel like I shouldn’t be penalized because I left New York.”
Former firefighter Charles Haver, 60, said the closest specialists who accept his plan are 120 miles away from his Fort Myers, Fla. home.
“My wife has lupus and she’s getting killed down here. She needs so many doctors and nobody accepts this insurance at all,” Haver said. When they do find a doctor they pay sky-high bills– $800 for a recent, routine OBGYN visit, he claimed.
An Emblem spokeswoman declined to comment citing pending litigation. “We will vigorously defend ourselves in [court],” she said.
An Empire rep did not return a message.