A record $851 million, a 34 percent increase, was recovered from Medicaid providers due to abuse, fraud, and waste in 2013, Gov. Andrew Cuomo announced today.
The Office of the Medicaid Inspector General works to eliminate fraud by responding to allegations, doing specialized reviews of home health claims and inventory reports. More than $1.73 billion has been recovered over three years because of inappropriately billed Medicaid and individuals who received services to which they are not entitled, Gannett’s Ashley Hupfl reports.
“With more than $851 million recovered from Medicaid abuses in 2013 alone – the most in the State’s history – New York is truly leading the nation in fighting fraud and protecting taxpayer dollars,” Cuomo said in a statement. “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. 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.”
Last year, the OMIG found members of an exclusive gated beachfront community Brooklyn were fraudulently enrolled in the Medicaid program and had fabricated information to bypass eligibility limits.
The OMIG recovered $211 million alone from inappropriate Medicaid billings. When a consumer with both Medicaid and Medicare is billed, Medicaid should pay the portion that Medicare does not, but the OMIG found Medicaid did not pay their portion of the bill.
The OMIG audited the Abbott House in Irvington, Westchester County, and found information was missing from consumer records, so they could not confirm whether a consumer had responded to treatment or if they treatment had been even delivered. Also, the Abbott House billed consumers for more services than they received. More than $254,000 was recovered from this provider.
“Fighting Medicaid fraud is the cornerstone of our efforts, and anyone who steals from Medicaid should know that we will find them. OMIG is proud of this record result,” James Cox, Medicaid inspector general, said in a statement. “This is an extraordinary accomplishment, and an historical achievement. Through dedication and perseverance, our staff is not only met but exceeded all expectations in recoveries for this year.”
To report suspected abuse, fraud, or waste, contact OMIG’s fraud hotline at 1-877-87-FRAUD or visit www.omig.ny.gov