New York Reports Record-Breaking Medicaid Fraud Recoveries In 2013

by Akin Gump Strauss Hauer & Feld LLP

In an official press release issued on February 3, New York State Governor Andrew M. Cuomo stated that 2013 was “the largest single year of recoveries of taxpayer dollars in the history of the Office of the Medicaid Inspector General (OMIG).” New York recovered “more than $851 million dollars” in 2013, bringing its total Medicaid fraud recoveries to more than $1.73 billion since Governor Cuomo took office in 2010.

The Governor touted New York’s recoveries as “the highest on record for any state Medicaid program integrity unit.” His office credited the New York OMIG’s efforts “to eliminate fraud through aggressive responses to allegations of fraud in social adult day care, excluding unscrupulous providers, and focusing on ineligible individuals.” The Governor’s office also credited “improvements in fraud and abuse prevention established under the Cuomo administration” including “the creation of pre-claim reviews – specialized reviews of home health claims and inventory reports – improved practices for reviewing pharmacy operations, and strong data sharing and coordination with federal, state, and local partners.”

There were several notable actions in 2013 that resulted in Medicaid fraud recoveries, including:

  • The New York OMIG investigated Brooklyn residents who fraudulently enrolled in the Medicaid program by fabricating their financial information on their Medicaid applications. (In one such case, the resident vacationed in Las Vegas and drove a Porsche, Aston-Martin, and BMW.)  
  • The New York OMIG recovered $211 million in inappropriate Medicaid billings when it reconciled Medicare and Medicaid payments to home health care providers for dual-eligible Medicaid consumers. When Medicaid consumers are eligible for both Medicare and Medicaid, home health care providers should first bill Medicare, and then bill Medicaid for whatever portion of the bill Medicare does not pay. The New York OMIG discovered $496 million in inappropriate Medicaid billings.  
  • The New York OMIG audited Abbott House, an outpatient service provider, and discovered that it failed to comply with Medicaid regulations. The audit revealed that information was missing from Medicaid consumer records needed to support reimbursement for service, including records needed to confirm whether a consumer had responded to treatment, or whether the treatment had been delivered in the first place. The New York OMIG recovered more than $254,000 from Abbott House.    

Governor Cuomo characterized New York as “truly leading the nation in fighting fraud and protecting taxpayer dollars.” Although Governor Cuomo focused on New York’s Medicaid fraud recoveries, as we have previously discussed, New York amended its False Claims Act (New York State Finance Law § 187, et seq.), in 2010 to authorize actions for tax fraud and may reap big recoveries from pending tax fraud actions such as the New York Attorney General’s action against Sprint (see here and here), which recently survived Sprint’s motion to dismiss.

The Governor’s press release is available here.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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