New York overbilled Medicaid by 'tens of millions,' suit alleges

The federal government filed a lawsuit against New York City Tuesday for allegedly overcharging the program tens of millions of dollars for unwarranted services, especially 24-hour care, the Associated Press reports.

The suit comes as New York Gov. Andrew Cuomo considers deep Medicaid cuts for the state and rising demand for Medicaid plus shrunken coffers put the squeeze on states around the country.

The allegations "unfortunately reflect a systemic failure to responsibly administer the Medicaid program," U.S. Attorney Preet Bharara said in a statement.

The lawsuit mentions that 17,500 people have received 24-hour personal care services from the city since 2000. That's at an annual cost ranging from $75,000 to $150,000 per person. But the care wasn't always warranted by the patient's needs. In one case, the feds cited, a medical doctor who decided that a 65-year-old woman did not need round-the-clock services, but was overruled by a city administrator who authorized the services, the AP reports.

"It goes without saying that ultimate medical decisions about patient care should be made by doctors and nurses, not government bureaucrats," Bharara said, "and they should be based first and foremost on the best interests of the patient."

The lawsuit also suggests that the city approved 24-hour home care for people who needed more intensive services--like nursing home care--because the latter would have cost the city, while the round-the-clock care did not, the New York Times reports. Home care, which involves aides helping to clean houses, dress, bathe and shop, is one of the fastest growing services Medicaid covers.

Connie Ress, a spokesperson for the city's Human Resources Administration, which administers the Medicaid program in the city, said the agency is reviewing the complaint.

To learn more:
- read the Associated Press story
- here's the New York Times story

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