One year after Kaleida Health was formed in 1998, the health system created a program that provided discounts on health care to its employees and their family members who were covered by Kaleida’s insurance plan as long as they received those services at a Kaleida facility.
The program was expanded four times between 1999 and 2018, intended to bolster Kaleida’s employee benefit package to help attract and retain workers in a competitive labor market.
But at one point along the way, the discount program expanded too much to include other individuals who were not enrolled in or covered by Kaleida’s insurance plan. That included extended family members, volunteers and retirees age 65 and older – some of whom were already enrolled in a federal health care program.
And that overexpansion to federal health care program beneficiaries, and a similar issue at Upper Allegheny Health System, has cost Kaleida this year about $2.7 million – the amount of a settlement that Western New York’s largest health system agreed to in May with the federal government after it self-disclosed that it may have violated the Civil Monetary Penalties Law.
Source: Kaleida Health paying $2.7 million to feds in self-disclosed insurance violation / Buffalo News