New York Attorney General Letitia James announced a settlement Thursday with Fidelis Care, a New York-based health insurer, following an investigation that found the company improperly charged New Yorkers for certain COVID-19 testing visits and HIV screening services that should have been provided at no cost under state and federal law.
The Office of the Attorney General determined that some consumers received bills totaling hundreds of dollars for services that were legally required to be free. As part of the settlement, Fidelis has reprocessed tens of thousands of claims, paid more than $2.8 million to affected health care providers, ensured improper bills were canceled, refunded consumers who paid out of pocket, corrected internal systems, and agreed to pay a $175,000 penalty to the state.
“No New Yorker should ever face a surprise medical bill for care the law says must be free,” Attorney General James said. “Fidelis’ practices placed unnecessary financial stress on families who were simply trying to stay healthy during a public health crisis.”
According to the investigation, between October 2021 and August 2022, providers charged patients for more than 38,000 office visits related to COVID-19 testing, affecting over 18,000 consumers. Between January 2022 and May 2023, more than 2,800 HIV screening services were improperly billed, impacting more than 2,100 consumers. Both services were required by law to be covered with no out-of-pocket costs.
As a result of the investigation, Fidelis paid approximately $2.6 million for COVID-19 testing visits and more than $157,000 for HIV screening services, including interest. The insurer also sent corrected explanations of benefits to impacted consumers and updated its billing systems to prevent future errors.
Under the agreement, Fidelis is prohibited from charging patients for HIV screening services and must stop attempts to collect charges related to COVID-19 testing visits during the federal Public Health Emergency. The company is also required to fix any additional improperly processed claims, notify affected consumers, ensure refunds are issued, and cooperate with the Attorney General’s Office on future complaints.
In addition to the $175,000 penalty, Fidelis may be fined up to $500 for each future violation.
Consumers who believe they were affected by improper or misleading medical billing practices are encouraged to contact the Attorney General’s Health Care Bureau online or by calling 1-800-428-9071.
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