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| Kami Barker |
Socked with more than a quarter-million dollars in medical bills despite having full health coverage, a city lawyer decided to take action — and discovered that two of New York’s biggest insurance providers may have scammed roughly $1 billion out of taxpayers, a newly unsealed lawsuit charges.
Kami Barker brought the whistleblower case against Empire Blue Cross-Blue Shield and its partner Emblem Health under the state’s False Claims Act, which provides incentives to citizens who expose fraud — offering up to 30 percent of any payout.
The 37-year-old Emory Law grad says she was shocked when the insurers stuck her with a roughly $260,000 bill for medical expenses tied to four hospitalizations between February 2012 and November 2013.
Barker, then an attorney for the city Law Department, visited in-network hospitals while battling trigeminal neuralgia, a chronic pain condition that led to recurring septic infections. The illness was unrelated to her disability. She’s been in a wheelchair since age 11.
When Empire — which covers 600,000 city employees, retirees and their families — left her holding the bag for such a huge cut of the total $1.26 million in care, she became suspicious.
“So my room and board was paid for but my doctors were not, my surgical procedures were not, and my medicine was not,” Barker told The Post on Tuesday. “That’s how I ended up getting footed with all these bills.”
After some digging with the help of attorney Steve Cohen she discovered the insurer “deliberately exaggerated the benefits available under the plan, while understating the uncovered costs that must be paid by members,” her suit in state Supreme Court in Manhattan says.
For example, a summary of Barker’s plan said that if she chose in-network hospitals she “will save money.”
What the material didn’t disclose was that many of the doctors working within those hospitals were out-of-network.
Of Barker’s total $1.26 million in claims, Empire and Emblem only paid the hospitals and doctors a combined $625,000.
