Whistleblowers Sue City’s Top Health Insurance Providers. Exposing Misconduct.

Whistleblowers Sue City’s Top Health Insurance Providers

March 16, 2018

Three whistleblowers representing New York City employees and retirees are suing the city’s top health insurance providers for defrauding taxpayers of more than a billion dollars.

The lawsuit unsealed in New York Supreme Court last month alleges that GHI, along with parent company EmblemHealth and their partner, Empire Blue Cross Blue Shield, engaged in a long-running scheme that provided inadequate healthcare to city employees and retirees — while collecting $3 billion in premiums from the city each year. The GHI-Empire plan covers 600,000 people — about 75 percent of city workers, retirees and families.

In a 63-page complaint, the plaintiffs say the companies filed false claims to overstate their expenses by an average of $55 million dollars a year between 2008 and 2014. And instead of returning that money to the city, as required under their contract, the suit says they kept it. In addition, the claim alleges that the companies failed to deliver the insurance coverage mandated under their contract, and therefore taxpayers are entitled to a portion of those billions in premiums paid annually by the city.

Read more here.
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