Sweeney And Skelos Applaud Findings Of Medicaid Fraud Investigation For New York State


Highlights of the Report include:

Ø Diminished audit collection is a result of numerous factors including a shift in focus from enforcement to education in an attempt to root out fraud in the front-end of the program instead of recovering losses on the back-end. CMS clearly outlined concern with this approach as it resulted in a less effective program than previously. Collections from audits for both fee-for-service and rate-based providers were at a 4-year low in spite of an increase in actual number of audits.

Ø Insufficient program integrity staff was a negative result of an increase in the State Medicaid program by 55%, from $27.2 billion in 1998, to $42.3 billion in FY 2004 and a reduction in staff of 60% from 950 staff in 1998, to 584 in 2004. New York State has the largest Medicaid program in the nation. While recent additional staff members are welcomed, New York staffing will still be only at 70% of the 1998 level when the program size was nearly 1/3 smaller than in FY 04.

Ø An additional issue regarding lower than expected referrals to the Medicaid Fraud Control Units (MFCU's) was also noted as a concern. The highest level of referrals was a drastically low 77 for any given calendar year and was outlined as an area needing improvement on the part of DOH.