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