News about potential fraud and waste within the New York Medicaid system keeps on coming. It seems as if every week there is a new allegations of practices which unnecessarily cost the state money in unnecessary Medicaid payments. With Governor Cuomo’s continued focus on rooting out problems with the system, we can likely expect even more information to come out regarding these issues in the next few months.
In fact, just last week the Capitol Confidential published a story discussing how the New York Comptroller, Tom DiNapoli, recently released two new audits which suggest widespread waste in the system.
One of those audits suggests that the NY Department of Health paid out more money for certain procedures than is allowed under current Medicaid rules. The administrative rules for Medicaid set specific maximum rates for certain procedures. Care providers—from nursing homes to hospitals–know those set rates. Those facilities do not necessarily get to set their own price.
Yet, per the details of the audit, around $11.4 million of public money was lost in recent years as a result of overpayments–giving out more than the set rate for no known reason. For example, one bill to Medicaid was a $250 charge for a psychotherapy session, even though the set rate was supposed to be only $102. The Department of Health paid out the full $250 amount. When these types of errors occur thousands of times over the course of the year, the total waste amount adds up quickly. The audit suggest that over 8,700 different providers received more than they were owed. A few of those providers were paid more than $40,000 extra.
Identifying the problem was a huge step forward, as some of the money may be recovered. So far a little over 25% of the overpayments have already been returned. Though the prospects for getting the rest of it back remain unclear.
Perhaps more seriously, state officials are trying to figure out what needs to be done to ensure similar problems do not occur in the future. The Comptroller noted, “Year after year my auditors identify the same types of Medicaid errors due to weak controls. As a result, New York taxpayers pay millions more than they should. DOH needs to greatly improve its supervision of the program to protect taxpayer dollars.”
Please feel free to contact our team of attorneys for help with questions about the New York Medicaid system–from qualifying for participation, filling out an application, protecting assets from future needs, and everything in between.