Go for the COVID test, get billed for a full office visit. This is reportedly a common practice at Northwell Health-GoHealth Urgent Care. But for some, this is fraud.
That is the word two Upper West Siders used to describe Northwell billing for a full office visit when only a COVID-19 test was performed.
One of these individuals is a former Assistant United States Attorney who made a career out of prosecuting fraud cases. He told ILTUWS that he and two members of his immediate family went to two different Northwell urgent care locations – one at 2628 Broadway, between 99th and 100th streets, the other at 2689 Broadway, between 102nd and 103rd streets — during the peak of the Omicron surge in January and February 2022.
“All we had were Covid tests with no other services.” The attorney explained that he and his family used Northwell urgent care locations only for COVID tests. He said they walked in, took the test, and left. “No one took my daughter’s blood pressure or asked about her health. There is no reason to believe any of us were seen by a doctor. No symptoms were discussed. No medical treatment was rendered.”
He explained that he later received bills from Northwell for more than $1,000 and called the testing provider to ask about the charges. He confirmed that Northwell did go through his insurance and was reimbursed for the COVID tests but that he was still charged for office visits for each time he and his family tested for COVID.
“I’m not paying for medical services I didn’t get. I made multiple calls and told [Northwell] that what they were doing is fraud, against the law, and that the U.S. Attorney’s office might be interested in this. I used to prosecute fraud cases. They’re charging insurers for office visits that didn’t happen. That’s fraud.”
Another Upper West Sider named Martha agrees. She, too, went to a Northwell urgent care (at 199 Amsterdam Avenue at West 69th Street) for a COVID test in July 2022 and was later billed for an office visit that she believes did not occur.
“Northwell billed [insurance provider] $550 for an office visit I never requested nor had. I went for a COVID Test. Apparently, [insurance provider] paid them $169. Now they are billing me for a $65 co-pay.”
When she received the bill, she believed it was an error and emailed Northwell stating the same. A Northwell patient account specialist replied the same day with the following:
“I really understand your concern regarding the Office Visit charge that appears on the bill you received, however, it is very important to mention that each Covid-19 test is submitted to the insurance companies with an Office Visit included, I fully understand that You did not request an Office Visit, however, the Office Visit is part of the Covid-19 test, since the Office Visit includes and determines the procedures and evaluations for the provider to obtain the results and diagnosis of your Covid-19 test. For this reason, the $65.00 charge that your insurance company left is valid as they left it as a copayment, so I recommend you to contact your insurance company one more time.”
Martha has since replied to Northwell twice and used the “F” word both times. “The fact that you are billing for a service never requested is fraud,” she wrote in one email. Dissatisfied with Northwell’s lack of response and determined to keep this from happening to anyone else, she sought the help of City Council Member Gale Brewer who confirmed in an email to Martha that she had experienced the same issue.
“Northwell did the same to me. I called to complain and the charge went away.” ILTUWS also confirmed with Brewer’s office that she had a similar issue and that she intended to assist constituent Martha as best she could.
ILTUWS reached out to Northwell for comment. We received an email with the following statement from Vivek Taparia, Market President of Northwell Health-GoHealth Urgent Care:
“At Northwell Health-GoHealth Urgent Care, we offer COVID-19 testing and care, and take each encounter seriously to ensure we are helping to prevent the spread of the virus and keep our patients and communities safe, which is why visits at our centers are treated as urgent care visits. These visits include an evaluation with one of our providers to check vitals and medical history, and discuss needs, so that we may advise on appropriate test types and treatment options. Our providers evaluate every patient in the office or virtually prior to administering COVID-19 tests.
We are in network with most major insurance plans and patient responsibility, or out-of-pocket cost, for COVID-19 testing is based on specific insurance coverage. We always recommend patients contact their insurance carrier for details about your specific plan, including copays and other associated fees for COVID-19 before a visit to be sure of the costs as we are not able to determine that at the time of visit. More information can be found on our website: https://www.gohealthuc.com/northwell/covid-19-test.”
When ILTUWS received this statement, we replied to ensure those included in that email who were issuing the statement on Northwell’s behalf understood what was being alleged. Specifically, we informed those parties that the individuals we spoke to “were all clear that Northwell provided no other services aside from the COVID test, they were not told they’d be charged for an office visit, and believe they had no reason to suspect they would because there was no medical consultation, or even checking of vitals. Symptoms were also not discussed.”
Northwell was also informed that these individuals “feel they’ve been the victims of fraud including one who is a former US attorney who prosecuted fraud.” A second emailed statement was provided in response on Taparia’s behalf:
“Due to privacy laws, we cannot comment on individual cases. But we can confirm that our COVID-19 tests are administered in our centers by providers who are evaluating the patient’s condition and health care needs. Our providers consult the patient’s medical history, engage directly with the patient including asking questions about symptoms, recent travel or known exposures and observe and document any symptoms. If there is a patient that has questions, our providers are available to review personal information with the patient directly. Additionally, we may inform patients that we do not collect co-payments at the time of the visit as many insurers cover the full cost of office visits for COVID-19 testing. When an insurer does not waive out-of-pocket costs of COVID-19 related visits, we encourage patients to contact their insurance carrier and ask that they explain their plan’s benefits related to COVID-19 services at an urgent care center.”