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