OIG: State Medicaid Fraud Unit lacks training, staff

The New York Medicaid Fraud Control Unit has been busy; it filed criminal charges against more than 400 defendants, obtained more than 400 convictions and was awarded more than $750 million in recoveries between fiscal years 2008 and 2010, the Office of Inspector General's Office of Evaluation and Inspections (OEI) said in a report released Friday. But despite the activity, the OEI found the unit was deficient in training, staffing and protocol.

In particular, the Medicaid Fraud Control Unit lacked policies to reflect its operations, in addition to several inadequate internal controls necessary to prevent error or fraud. The OEI also noted that the unit failed to create annual training plans and opportunities for its auditors, investigators and attorneys, according to a summary.

And while referrals to the unit increased by 22 percent during the three-year period, the number of cases opened and closed dropped by 25 percent and 20 percent, respectively, according to the report.

The unit attributed the shrinking caseload to reduced staff and funding.

"There are cases we probably should do but can't because we don't have the manpower; we have to refer them back," one manager said of staff and state budget restrictions.

Since the on-site review, the state Medicaid Fraud Control Unit hired additional staff members, implemented robust recruitment efforts and is overhauling the way it maintains policy statements, the report noted.

Earlier this year, the unit found that two Sound Shore Health System hospitals overbilled Medicaid for physician-administered drugs and made more than $1 million in profit. To settle the allegations, Sound Shore Medical Center of Westchester agreed to repay $2.2 million, while Mount Vernon Hospital already has paid $85,497.50.

 To learn more:
- read the OIG summary and report (.pdf)