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