Previously Published in The Messenger
By Cait Crudden
Suffolk County Comptroller John M. Kennedy, Jr. (R-Nesconset) has announced the successful recovery of nearly $1.7 million in overpaid medical expenses following the completion of an audit of Anthem BlueCross BlueShield, the former administrator of the County’s self-insured employee medical health plan.
The audit, which focused on medical claims processed during the 2022 calendar year, uncovered widespread billing errors that led to Anthem reimbursing Suffolk County $1,668,138. The audit is the latest in a series of financial reviews spearheaded by the Comptroller’s Office aimed at ensuring fiscal accountability within one of the largest public medical plans in the region.
Covering more than 45,000 individuals including active employees, spouses, dependents, and retirees from both Suffolk County government and Suffolk County Community College; the County’s health plan represents a significant share of local taxpayer-funded healthcare expenses.
“This is yet another example of how rigorous oversight and detailed audits protect taxpayers and ensure that public funds are being spent appropriately,” said Comptroller Kennedy. “Auditing the County’s self-insured employee medical health plan has been a priority of mine since I took office in 2015. These efforts have now returned over $10 million to the people of Suffolk County.”
The audit was conducted by the Segal Group, a leading benefits consulting firm, in partnership with the County’s Labor Management Committee. Together, they reviewed Anthem’s administration of claims from January 1 through December 31, 2022.
Among the most notable findings were copayment mismanagement, duplicate and incorrect claims, benefit limit overpayments, and Medicare coordination failures. Anthem repeatedly undercharged members for required copayments, and in some cases failed to collect any copayments at all. This resulted in the County absorbing higher-than-necessary costs. Several claims were processed twice or contained pricing errors that inflated the County’s reimbursement responsibility. Services such as acupuncture, chiropractic care, and physical therapy were reimbursed beyond established plan limits, and there was systemic failure to properly coordinate with Medicare claims led to the largest category of financial errors, significantly overcharging the County for expenses that should have been covered in part by federal benefits.
In light of these recurring errors and ongoing audit results, the County officially terminated its administrative services contract with Anthem on December 31, 2024, ending a 19-year relationship. In January 2025, Suffolk County transitioned to Aetna as the new administrator of the medical and hospital benefits plan.
Audits of the 2023 and 2024 claim years are currently underway, and Comptroller Kennedy expects that additional recoveries will be identified as part of those reviews. “Our audits send a clear message: Suffolk County will not tolerate mismanagement of public funds, especially when it comes to healthcare,” Kennedy added. “Every dollar we recover is a dollar that goes back into supporting essential services for our residents.”
County officials say the move to Aetna is part of a broader effort to modernize the health plan’s administration and improve accuracy, cost-effectiveness, and service delivery for plan members. The transition also includes enhanced performance monitoring and audit protocols to ensure that similar issues do not arise in the future.
With the health of tens of thousands of County employees and retirees at stake, Comptroller Kennedy reaffirmed his office’s commitment to holding vendors accountable and maintaining transparency in public spending. “Vigilance and accountability are not just buzzwords in my office; they are the cornerstone of how we serve Suffolk County. The creed we live by is to identify and eliminate fraud, waste, and abuse,” Kennedy concluded.