Fidelis Care Hit With $175K Penalty for Bogus COVID & HIV Bills

NEW YORK – New Yorkers seeking free COVID-19 tests and vital HIV screenings were instead hit with hefty bills thanks to the predatory practices of Fidelis Care, a New York-based health insurer. Attorney General Letitia James today announced a settlement forcing Fidelis to cough up refunds and pay a $175,000 penalty after a Grimy Times-style investigation revealed the insurer was systematically overcharging vulnerable patients.

The Office of the Attorney General (OAG) uncovered a scheme where Fidelis wrongly demanded out-of-pocket payments for services legally mandated to be free. Between October 2021 and August 2022, providers sent bills for over 38,000 COVID-19 testing visits, impacting over 18,000 New Yorkers. The scam continued with over 2,800 HIV screening services improperly billed between January 2022 and May 2023, affecting more than 2,100 consumers. We’re talking bills for hundreds of dollars for tests people were promised wouldn’t cost a dime.

Fidelis isn’t just getting a slap on the wrist; they’re shelling out serious cash. The insurer has already reprocessed over $2.8 million in claims, paying affected providers $2.6 million for COVID-19 testing and over $157,000 for HIV screenings – with interest. But the money doesn’t stop there. Fidelis was ordered to contact every provider involved, ensuring those bogus bills were canceled and refunds were issued to the victims. Corrected explanations of benefits have been sent out, and internal systems have been “updated” – let’s see if that actually sticks.

“No New Yorker should ever face a surprise medical bill for care the law says must be free,” Attorney General James stated, a sentiment that rings true for anyone who’s been nickel-and-dimed by a predatory insurance company. “Fidelis’ practices placed unnecessary financial stress on families who were simply trying to stay healthy during a public health crisis. My office will always stand up for New Yorkers when insurers fail to follow the law.” This isn’t just about the money; it’s about holding these corporations accountable for preying on people during a time of crisis.

The agreement doesn’t just address past wrongs. Fidelis is now prohibited from charging for HIV screenings and attempting to collect on bills from the COVID-19 Public Health Emergency. Any further improperly processed claims will be met with swift action, with Fidelis facing potential fines of up to $500 per violation. The OAG will also be watching closely, requiring Fidelis to cooperate with consumer complaints and provide documentation of compliance.

If you believe you were wrongly billed by Fidelis Care, don’t suffer in silence. Contact the OAG’s Health Care Bureau online or call 1-800-428-9071. Assistant Attorney Generals Eve Woodin and Brant Campbell, under the supervision of Deputy Bureau Chief Leslieann Cachola and Bureau Chief Darsana Srinivasan, handled this case. This investigation was part of the Division for Social Justice, led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.