New York Medicaid Audit Process Faces Backlash from Powerful Interests

March 20, 2012
By Ettinger Law Firm on March 20, 2012 8:31 AM |

Many seniors who need around-the-clock care turn to Medicaid to provide support in securing that care. Our New York Medicaid lawyers have helped thousands of families navigate the confusing and stressful process associated with this time in life. Besides the inherent complications surrounding Medicaid, many community members are often made uneasy about the future of the program because of a steady stream of news stories that always seem to suggest that the program is in dire financial straits.

The doom and gloom about the New York Medicaid program is often exaggerated. While finances are always tight, the state has been leading the nation in cracking down on fraud and waste in an effort ensure that as much money as possible is going exactly to those who need it--like area seniors. The state's Office of the Medicaid Inspector General was recognized as the best in the nation, recouping $1.5 billion of Medicaid overpayments in its first four years. That is money that can be reinvested into the program to avoid cuts and ensure new community members have the life-saving services that they need.

However, according in a New York Times article this weekend, there has been a bit of a backlash around the often aggressive tactics of the New York Medicaid inspection process by those in the healthcare industry. Those interest groups complained that the investigations into fraudulent Medicaid payments were overzealous and unfair. At one point a nursing home trade group sought a court injunction to stop the audits, but they were rebuffed. Bowing to those pressures, last year Governor Cuomo quietly dismissed the office's first (and only) inspector general and gave instructions to his replacement to collaborate on new protocols with the industry insiders.

For their part, the Governor's office explains that the auditing process remains as tight as ever with more than $1.1 billion set to be recouped this year alone--even more than in years past. Observers note that it is vital not to backslide into older practices. The state's Medicaid auditing program was harshly criticized in the past for failing to catch even obvious signs of fraud--like a New York nursing home owner who took $1.5 million in annual salary and profits even after being cited for neglecting residents.

It is important to follow the latest Medicaid news, but all local residents should not be deceived into thinking that the program is going anywhere. It remains a vital link for millions of New York seniors who need support to get by each day. As with all financial and health matters, it remains prudent to plan ahead for the potential need for this care. A New York elder law attorney can use tools like Medicaid Asset Protection Trusts to protect family assets and can also help ensure the Medicaid application is properly filled out if the need arises.

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