The state Office of the Medicaid Inspector General recovered more than $851 million for 2013, the largest single year of recoveries in the history of the office, Gov. Andrew Cuomo announced today. The three-year total of money the state got back from Medicaid providers who inappropriately billed Medicaid or individuals who received services they were not entitled to $1.73 billion. That was a 34 percent increase over the previous three years.
Cuomo said the recoveries are the highest on record for any state Medicaid program integrity unit.
“Our focus on cleaning up the Medicaid program is showing record-breaking results, and OMIG’s efforts serve as a role model for other states to follow,” Cuomo said in a statement. “Eliminating this kind of waste is vital to transforming New York’s healthcare system, and this year’s tremendous amount of recoveries shows that we are well on our way to building a healthier and fairer New York.”
The Office of the Medicaid Inspector General has worked to eliminate fraud in social adult day care and to exclude unscrupulous providers and ineligible individuals. The department has initiated pre-claim reviews, which are specialized reviews of home health claims and inventory reports, as well as improved practices for reviewing pharmacy operations and shared data with federal, state and local partners.
Actions for 2013 include:
— Auditing the Abbott House in Irvington to determine whether the facility was complying with Medicaid regulations for outpatient services, which are provided at clinic and day treatment programs and through home- and community-based federal waiver programs. Auditors found that key parts of patient records were missing, so they couldn’t confirm whether the treatment had been delivered or whether the patient had responded to it. Abbot House billed for more days of service than were documented and for services when there was not a required residential habilitation plan in place. Following the audit, the Office of the Medicaid Inspector General recovered more than $254,000 from Abbot House.
— Investigating a group of people in Brooklyn who were members of an exclusive gated beachfront community and had fabricated information on their Medicaid applications to bypass eligibility limits. One person vacationed in Las Vegas and drove a Porsche, Aston-Martin and a BMW. This led to six prosecutions by the Brooklyn District Attorney for welfare fraud, grand larceny and offering a false instrument for filing.
— Finding cases in which Medicare should have paid claims of people eligible for both Medicaid, a health-care program for the poor and disabled, and Medicare, a health-care program for the elderly, but did not. Health-care providers should bill Medicare first and then Medicaid for any portion Medicare doesn’t pay. The office recovered $211 million for inappropriate Medicaid billings.
New Yorkers can assist the office by reporting potentially suspicious behavior or incidents. They can call the fraud hotline at 877-87-FRAUD or visit www.omig.ny.gov. Tips can be completely anonymous, and the office investigates information from all calls.