New York Attorney General Letitia James announced a significant settlement with Fidelis Care, a prominent health insurer based in New York. The settlement comes after an investigation revealed that Fidelis improperly required patients to pay for COVID-19 testing visits and certain HIV screening services that should have been free under both state and federal laws. Many New Yorkers were hit with bills amounting to hundreds of dollars for services that were legally mandated to be provided at no cost.
In response to the investigation by the Office of the Attorney General (OAG), Fidelis has agreed to reprocess tens of thousands of claims and has provided over $2.8 million in payments to affected healthcare providers. The company has confirmed that it will also cancel the bills to consumers and issue refunds for out-of-pocket payments. Additionally, Fidelis updated its internal systems to avoid similar issues in the future and has incurred a penalty of $175,000 to be paid to the state.
Attorney General James emphasized the importance of protecting consumers from unexpected medical bills. “No New Yorker should ever face a surprise medical bill for care the law says must be free,” she stated, highlighting the undue financial stress placed on families during the ongoing health crisis.
The investigation found that between October 2021 and August 2022, there were over 38,000 improperly billed office visits related to COVID-19 testing impacting more than 18,000 consumers. Similarly, from January 2022 to May 2023, providers mistakenly charged for over 2,800 HIV screening services, affecting more than 2,100 individuals. Both types of services are legally required to be provided without direct costs to the patients during the federal Public Health Emergency.
As part of the settlement terms, Fidelis is mandated to halt any attempts to collect improper fees for the specified services and must continue to monitor its claims process for additional errors. Should further processed claims be identified, Fidelis is required to rectify them, inform affected consumers, and guarantee that any erroneous bills are annulled, alongside ensuring refunds are properly issued. Furthermore, Fidelis must remain compliant with OAG’s requests regarding consumer complaints and provide documentation demonstrating adherence to the settlement.
For patients who believe they have encountered deceptive billing practices, the OAG encourages them to reach out through its Health Care Bureau’s online platforms or by calling 1-800-428-9071. This matter was managed by Assistant Attorneys General Eve Woodin and Brant Campbell, supervised by Deputy Bureau Chief Leslieann Cachola and Bureau Chief Darsana Srinivasan. The Health Care Bureau operates under the Division for Social Justice, overseen by Chief Deputy Attorney General Meghan Faux and First Deputy Attorney General Jennifer Levy.
This agreement not only rectifies past errors but also aims to improve the integrity of healthcare billing, ensuring that patients receive the necessary medical services without added financial burdens, particularly in these challenging times.