ATTORNEY GENERAL MARTHA COAKLEY OBTAINS $31,000 AND RESTITUTION FROM MEDICAL SERVICE PROVIDER FOR EXCESSIVE BILLING OF GIC MEMBERS
The Attorney General's Office began an investigation in March 2006 after receiving consumer complaints. According to information Raytel provided to the Attorney General's Office, since January 1, 2003, Raytel invoiced 259 out of approximately 5,100 total GIC members beyond the applicable co-payments and deductibles. Raytel wrongfully collected approximately $2,000 in total from GIC members. The GIC provides and administers health insurance and other benefits to the Commonwealth's employees and retirees, as well as their dependents and survivors.
Under state law, health care providers may not bill a GIC member in excess of any applicable co-payments or deductibles. This practice is known as "balanced billing." According to today's court filing, Raytel balance billed GIC members for pacemaker and cardiac monitoring services.
"Providers are allowed to collect co-payments and deductibles that are listed in member policies," said Attorney General Martha Coakley. "However, it is a clear violation of state law when a service provider double dips in order to profit from GIC members."
Under the terms of the agreement, Raytel will refund the money wrongfully collected from the GIC members and pay $31,000 to the Attorney General's Local Consumer Aid Fund. Additionally, Raytel must take corrective action to reform its policies going forward.
This matter was handled by Division Chief Quentin Palfrey and Legal Assistant Danielle Wood of Attorney General Martha Coakley's Health Care Division.