Once notorious for widespread and brazen Medicaid fraud schemes, New York is making history these days by recovering more ill-gotten Medicaid dollars than ever before.
In 2013, the Empire State recouped $851 million in fraudulent and erroneous Medicaid payments, the largest amount since the state Office of the Medicaid Inspector General was created in 2006.
"Our focus on cleaning up the Medicaid program is showing record-breaking results, and OMIG's efforts serve as a role model for other states to follow," said New York Governor Andrew Cuomo, who launched an ambitious reorganization of the state Medicaid program with the goal of curbing the rate of growth and linking it to the consumer price index.
Under Cuomo's tenure during the past three years, the OMIG has recovered more than $1.7 billion, out of the more than $50 billion in federal and state dollars spent annually.
Some of the largest recoveries last year came from a statewide review of home health claims, which uncovered some $496 million in inappropriate billing for federal and state payments, with $211 million deemed to be New York's share and subsequently recouped for the state's coffers.
Home health care fraud and overbilling has been one area of prioritization. Another has been ineligible beneficiaries. Last year, the OMIG uncovered a group of wealthy Brooklynites -- "members of an exclusive gated beachfront community" -- who fabricated information on Medicaid applications to bypass eligibility limits. The state ultimately won six prosecutions for welfare fraud, grand larceny and offering a false instrument for filing.
Much of the rest of the $851 million recovered were likely related to overbilling, whether deliberate or unintentional, large and small.
For instance, two Bronx nursing homes were ordered to repay a combined $1 million last September after audits uncovered improper charges and miscalculations. In the first half of last year, the OMIG's audit team uncovered dozens of instances of similar overpayments totalling more than $100 million and resulting in more than $60 million in recoveries.
The OMIG has not yet released its 2013 annual report, or detailed every source of the $851 million. It's also not clear how much of that will be paid out to Medicaid recovery audit contractors, who earn a 5.25 percent commission for all recoveries up to $125 million.