Fidelis Care, a prominent health insurance company based in New York City, has been compelled to repay millions of dollars to both healthcare providers and patients following an extensive investigation by the state Attorney General’s Office. The investigation revealed that Fidelis Care had improperly charged patients for crucial medical screenings, including COVID-19 tests and certain HIV screenings, which are mandated to be free under state and federal law.

Attorney General Letitia James announced on Thursday that Fidelis Care reached a comprehensive settlement with the state. The Attorney General’s investigation specifically found that the company “wrongly required” patients across New York State to pay “hundreds of dollars” for these essential services. Officials from Fidelis Care declined to comment on the matter following requests.

In a strong statement, Attorney General James emphasized the importance of consumer protection, stating, “No New Yorker should ever face a surprise medical bill for care the law says must be free.” She further criticized Fidelis’ practices, noting they “placed unnecessary financial stress on families who were simply trying to stay healthy during a public health crisis.”

Under the terms of the settlement, Fidelis Care is now obligated to undertake several corrective actions. These include reprocessing “tens of thousands of claims” to ensure that healthcare providers cancel any charges wrongly levied against patients. The insurer must also pay over $2.8 million to the impacted healthcare providers, specifically $2.6 million for COVID test visits and more than $157,000 for HIV screening visits, in addition to accrued interest. Furthermore, Fidelis Care is required to issue refunds to any consumers who had already paid for these services and must pay a penalty of $175,000 to the state.

The investigation uncovered specific periods and numbers of wrongful charges. Between October 2021 and August 2022, Fidelis Care mandated healthcare providers to bill patients for over 38,000 office visits related to COVID-19 tests. These visits, affecting approximately 18,000 New Yorkers, should have been free during the federal public health emergency. Additionally, more than 2,100 patients seeking HIV screening services between January 2022 and May 2023 were also wrongly charged for services that are legally required to be free.

To prevent future occurrences, the settlement also stipulates that Fidelis Care must notify healthcare providers and customers if any other wrongly processed claims are discovered. The company faces significant fines of up to $500 for any subsequent violations. New Yorkers, particularly Long Islanders, who believe they may have been wrongly charged for medical tests that should have been free, are encouraged to contact the Attorney General’s Health Care Bureau. Assistance can be sought online or by calling 800-428-9071.