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NEW YORK---New York City has become an active partner with the State of New York in the State's pilot Medicaid Fraud, Waste and Abuse Demonstration Project, designed to empower localities, primarily counties, to join with the State to increase vigilance over the Medicaid program.
"Medicaid is projected to cost the City nearly $5 billion in 2007, and this innovative program allows us to play a key role in rooting out fraud and waste committed by certain unscrupulous Medicaid providers, said New York City Mayor Michael Bloomberg. We expect that the City's efforts could eventually generate millions of dollars in fraud recoveries and will contribute to restoring the integrity of the Medicaid program."
The City's Human Resources Administration (HRA) already has extensive experience detecting client-related Medicaid fraud and has combined annual recoveries and cost avoidance attributable to investigations of prescription drug fraud of approximately $2.5 to $3 million. HRA will move quickly to establish an office of Medicaid Provider Fraud Investigation that will work with New York State Office of the Medicaid Inspector General (OMIG) to audit and investigate New York City Medicaid providers. The City is eligible to receive up to 25% of any net savings as a result of the audits and investigations it conducts. The City will be credited for the costs of running this new program.
"The Demonstration Project allows New York State to synchronize efforts with participating counties to chart a new course to combat Medicaid fraud, waste and abuse," said Acting Medicaid Inspector General David R. Ross, "and local governments such as New York City have much to add to our collective efforts throughout the State. New York City's participation in the Demonstration Project significantly alters and augments the scope of the project and promises to return significant taxpayer savings and efficiencies."
The Office of the Medicaid Inspector General was established in July 2005 by Executive Order and became law this year. In May 2006, Gov. George Pataki, in conjunction with the Medicaid Inspector General's office, reported $1.4 billion in savings and recoveries for the State during the two previous state fiscal years. Early this year the State announced it had recovered $566 million in Medicaid payments stemming from the identification of available health insurance for services provided to Medicaid clients. In addition, New York State prevented Medicaid spending totaling $842 million over the past two years by identifying available health insurance coverage for Medicaid clients before Medicaid payments were made.
The County Fraud and Abuse Demonstration Project was enabled through Chapter 58 of the Laws of 2005. In the same legislation, the financial contribution of counties to the Medicaid program was capped to a set yearly increase. The Demonstration Project creates a structural incentive for counties to continue to contribute to the efficiencies of the program. As the agent of the OMIG, participating counties are able to pursue provider fraud, waste and abuse via audits and/or investigations.
Prior to New York City's participation, 12 local districts (out of 58) participated in the demonstration project. These counties are now empowered to investigate and audit providers under the OMIG's supervision. In addition to New York City, participating counties include: Albany, Broome, Chautauqua, Dutchess, Monroe, Erie, Nassau, Orange, Rensselaer, Rockland, Suffolk, and Westchester.
Savings resulting from the Demonstration Project will help enable New York State to meet the goals established by the October 2006 agreement with the federal Health and Human Services Administration, the Federal State Health Reform Partnership (F-SHRP), which provided New York with up to $300 million annually to invest in rightsizing and restructuring reforms. Failure to meet the fraud and abuse recovery targets will result in penalties for the State and failure to reach other milestones will result in termination of the waiver.
Suspicions of possible Medicaid fraud, waste, and abuse can be reported online at www.omig.state.ny.us or to the New York State OMIG Fraud Hotline 1-877-87FRAUD. 12-29-06
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© 2006 North
Country Gazette
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