State Of New York Recoups More Than $800M In Medicaid Fraud In 2013

Continuing a national trend of increased aggressive enforcement to minimize abuse and waste and prosecute fraud in healthcare, New York’s Medicaid Inspector General announced this week that the state had recovered $851 million in improperly received Medicaid funds in 2013.

The total doubles the state’s previous top recovery of $468 million in 2012. The state has recouped $1.7 billion through anti-Medicaid fraud efforts in the past three years alone.

New York’s recovery came from multiple sources, including:

• Targeting individuals fraudulently enrolled in the Medicaid program. In one case in Brooklyn, members of a gated community made up information on their Medicaid applications to evade the income eligibility limits, according to the governor’s office. Six prosecutions by the Brooklyn District Attorney’s office followed.
• Clawing back home health payments. The state recovered more than $200 million in state payments for dual-eligible Medicare-Medicaid patients who received home-healthcare services that should have been billed to Medicare.
• Compliance checks. In one case, a facility in Irvington, New York had to refund $254,000 to the state for failing to document residents’ information properly in their records and for billing for services not supported by the records.

This increased compliance, audit, and enforcement methodology has shown great success and will continue through 2014 by Medicare and the individual states’ Medicaid systems. Healthcare providers in New York (and around the country) need to take stock of this increased enforcement and ensure compliance with the state and federal laws and regulations that govern their practice.