| Picture this: you're a health care provider. Your | | | | Among New York Medicaid Providers involved |
| business largely depends on Medicaid billing. In fact, | | | | with New York Medicaid Fraud are medical and |
| Medicaid pays your bills. Your business is booming | | | | dental offices, "ambulette" transportation |
| and then one day you get a letter or a call from | | | | companies, hospitals, nursing homes, pharmacies, |
| The Office of Medicaid Management or an | | | | school districts officials, and even retailers. |
| Attorney General's Office. They tell you they | | | | New York Medicaid Fraud cases may be |
| investigate certain claims made by your office. | | | | investigated by the Office of Medicaid |
| They ask you for your billing records and your | | | | Management, the Office of the Attorney General, |
| mood suddenly is not the same it was 5 minutes | | | | the local law enforcement, or even federal |
| ago. Assuming the investigators have reasons not | | | | investigators. |
| be impressed with your Medicaid billing practices, | | | | Because the problem has gotten out of hands |
| you will need a lot of hope and maybe some | | | | lately, Attorney General Cuomo and the local |
| serious help because serious trouble is probably on | | | | district attorneys are really cracking down on New |
| the way. | | | | York Medicaid Fraud. According to the April 30, |
| New York's Medicaid program has been funded | | | | 2008 Attorney General Office's report, New York |
| more than 40 years ago and what it presently is | | | | had recover $112,5 millions in Medicaid fraud |
| may be defined as a cash cow or a "honey jar" | | | | recoveries in 2007. |
| that attracts all kinds of money-loving bees. New | | | | The latest in the string of New York Medicaid |
| York Medicaid enrolls millions of people and spends | | | | Fraud indictments is the prosecution of B&H |
| over $40 billion a year for everything from | | | | Health Care Services, Inc., (Nursing Personnel |
| medical care to transportation to adult daycare to | | | | Home Care), a Licensed Home Care Service |
| paying for shoes, diapers, etc. Because may | | | | Agency and half a dozen of its shareholders and |
| Medicaid programs were so easy to exploit, New | | | | managers who managed to bill over $30 million in |
| York Medicaid fraud became quite rampant and | | | | Medicaid fees. Providers accused of New York |
| uncontrollable. It became an industry in itself and | | | | Medicaid Fraud face various fraud-related charges |
| fortunes were made on Medicaid Fraud. | | | | as well as civil suites claiming damages. In the |
| There are several ways in which Medicaid Fraud | | | | case of B&H Health Care Services, for example, |
| can occur. The most popular method of Medicaid | | | | the indictment contains charges of Grand Larceny |
| fraud with which defense attorneys routinely deal | | | | in the First Degree (a Class B felony that carries a |
| is billing for services that were not provided. In | | | | mandatory minimum sentence of 1 year and a |
| fact, some providers manage to bill millions of | | | | maximum sentence of 25 years' imprisonment) |
| dollars in fees for services they have never | | | | and charges of Offering a False Instrument for |
| performed. The next forerunner is double billing | | | | Filing in the First Degree (a Class E felony that |
| (billing Medicaid after private insurance and/or the | | | | carries a maximum sentence of 4 years' |
| recipient have already paid for services). | | | | imprisonment.) |
| Unnecessary procedures and appointments billed | | | | The civil suite filed by the state demands treble |
| to Medicaid are popular, too. Many providers find | | | | damages of $90 million. If it is a federal |
| themselves in hot water because they have | | | | investigation, charges and potential consequences, |
| unlicensed personnel perform services that may | | | | both criminal and financial, could be even more |
| only be provided by licensed persons as per | | | | severe. So, let's go back to the beginning. You get |
| Medicaid regulations and bill Medicaid as if the | | | | that letter or a phone call. Your next steps are |
| professional do the work. Health care providers | | | | limited to telling the investigators to disappear |
| routinely overcharge Medicaid by inflating time | | | | from your life, telling them all they want to hear, |
| they actually spend on providing their services. On | | | | or telling them that your lawyer will contact them |
| occasions, providers engage in fees sharing with | | | | for you. Let me end with a banality: if you are |
| other provider. This means referring patients to | | | | accused or investigated for Medicaid Fraud, it is |
| other offices that bill Medicaid and share the | | | | not the time to do it yourself. |
| reimbursement paid by the Medicaid program. | | | | |