New York Makes Historic $851 Million in Medicaid Recoveries

New York State Governor Andrew Cuomo proudly announced the state’s Office of the Medicaid Inspector General (OMIG) made unprecedented recoveries of $851 million from Medicaid providers in 2013. During a three year period the OMIG has recovered $1.73 billion from providers who did not bill Medicaid properly for services rendered. The OMIG also charged several individuals with fraud for obtaining Medicaid benefits they were not eligible to receive. Governor Cuomo stated that eliminating this kind of waste is vital to transforming New York’s healthcare system.

Providers

The OMIG highlighted some of the cases they exposed in their investigation. The OMIG focused on home health agencies (HHA) who inappropriately billed Medicaid for dual eligible beneficiaries. HHAs are required to first bill Medicare and then seek the remaining balance from Medicaid. The agency recovered approximately $211 million from their audit of HHAs. The OMIG also investigated Abbott House to check for compliance with Medicaid regulations regarding its provision of outpatient services. Abbott House’s patient records were audited and the OMIG determined Abbott House: (1) records did not comply with the documentation requirements needed to support reimbursement claims; (2) billed for more days of service than were documented; and (3) provided services when there was no required residential habilitation plan. Abbott House had to repay $254,000 to the state Medicaid program.

Individuals

The OMIG also disbanded a group of individuals who had fraudulently enrolled in the Medicaid program. Many had lied about their incomes so that they could qualify for Medicaid benefits, when in fact some them lived in gated beach-front properties and drove luxury automobiles. Unfortunately stories like these are not limited to just Americans. In December 2013 Russian diplomats in New York were charged with Medicaid fraud. The federal government charged 50 Russian nationals in a massive Medicaid scam that totaled $1.5 million. The government alleged the Russians lied about their incomes to obtain Medicaid benefits while they lived lavishly in New York spending thousands of dollars on cruises, watches and shoes and jewelry at Tiffany, Prada and Bloomingdale’s.