Medicaid Fraud Efforts Start to Pay Off

by Assemblyman Will Barclay

Medicaid fraud detection efforts are starting to pay off.  It was recently reported that Onondaga County has recouped $1.8 million just in the last seven months after launching Medicaid fraud detection efforts.  In some cases, county workers detected provider fraud; investigators paired billing statements with care ordered by doctors.  When the records didn’t match, the district attorney was called in to prosecute.  In other instances, Medicaid recipients claimed they have no income but this was found to be untrue.

Residents are starting to see the results of laws that were passed several years ago.  During Governor Pataki’s administration, the Office of the Medicaid Inspector General was created.  I happily voted in support of Pataki’s executive order.  The bill made it possible for New York to target and penalize people who contribute to the nearly $4.5 billion’s worth of fraud, waste and abuse.  Our total budget is $122 billion, so this is a significant amount of money the state could use.  The total Medicaid budget is $47 billion and fraud is estimated to be 10 percent of the cost of the Medicaid budget.

The Office of the Medicaid Inspector General works to prevent, detect and investigate medical assistance program fraud and abuse among seven separate agencies, including: the Department of Health; the Office of Mental Health; the Office of Mental Retardation and Developmental Disabilities; the Office of Alcoholism and Substance Abuse Services; the Office of Temporary Disability Assistance; the Office of Children and Family Services; and the Department of Education.

I’m pleased that Onondaga County has had such reported success with their detection unit.  I hope that savings will translate into property tax breaks for residents.  The state Office of the Medicaid Inspector General has set a goal for itself to collect $384 million over the next two years but, according to projections, the department will surpass that goal.

I think the state can go further in combating fraud, waste and abuse.  Since Medicaid is largely managed at the local level, it’s counties who are integral in helping to stop the fraud.  To that end, I am the sponsor of legislation that would help counties pay for combating Medicaid fraud, waste, and abuse through the use of data mining software.  The software helps detect inaccuracies in the Medicaid system automatically.  This would also free up resources at the state level as well.

If you have any questions or comments or if you would like to be added to my mailing list or receive my newsletter, please contact my office by mail at 200 North Second Street, Fulton, New York 13069, by e-mail at [email protected] or by calling (315) 598-5185.

1 Comment

  1. Data mining for welfare fraud is a great idea and should have started years ago. The next step is to use data mining to catch tax cheats!

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