N.Y. Medicaid Fraud Unit Notes Record Financial Recoveries for 2004

New York Attorney General Eliot Spitzer this week announced a record level of recoveries for the state’s Medicaid Fraud Control Unit (MFCU).

In 2004, MFCU recovered more than $65 million for the Medicaid program through its fraud detection efforts. This was the highest level of recoveries in the unit’s 29-year history.

MFCU completed 187 criminal and civil cases in calendar year 2004 in which payment of more than $90 million in long-term settlements and judgments for the Medicaid program was ordered. Recoveries in the unit’s cases are often structured to be repaid over time to ensure that a Medicaid-funded facility does not cease providing services to Medicaid recipients or go bankrupt through the immediate collection of overpayments.

In other cases, MFCU secures judgments ordering restitution from defendants who have long-term obligations to repay their debt to Medicaid or who may be in jail or have fled the state.

“Every dollar of savings that we obtain through aggressive enforcement helps reduce the burden on taxpayers and helps provide better health care to individuals,” Spitzer said.

Spitzer noted that the restitution numbers tell only part of the story at MFCU. He said many cases lead to program reforms that eliminate abusive billing practices and result in substantial additional reductions in Medicaid expenditures over time.

For example, he noted a recent joint investigation with the state Department of Health of part-time medical clinics. The investigation resulted in billing changes and other reforms that have so far generated savings to the Medicaid program exceeding $65 million.

In the last six years (1999 through 2004) restitution obtained by MFCU totaled more than $204 million, an amount that is 400 percent more than what was recovered in the six years prior to 1999.

In a related matter, Spitzer renewed his call for passage of legislation that facilitates recovery of wrongfully obtained public funds. The proposed New York State False Claims Act authorizes filing of civil actions against those who defraud the state or local governments. Similar legislation exists on the federal level and in several states, where it has produced millions in additional recoveries to Medicaid and other government programs.

He also renewed his call for adoption of a health care fraud statute that would enhance the ability of his office to pursue fraud.