New York state recovers a record $851 million in improper Medicaid payments

Preliminary calculations indicate New York state inspectors recovered more than $851 million in taxpayer money that was improperly spent in the Medicaid program in 2013, the “largest single year of recoveries” in state history.

That’s according to a statement New York Governor Andrew Cuomo released today.

New York’s Office of the Medicaid Inspector General (OMIG) recovered the funding from Medicaid providers who inappropriately billed Medicaid and individuals who received services to which they were not entitled, Cuomo’s office said.

It brings the three-year total under Cuomo to more than $1.73 billion recovered, representing a 34 percent increase over the previous three years.

OMIG’s recoveries are the “highest on record” for any state Medicaid program integrity unit, Cuomo’s office said.

The $851 million recovered from Medicaid abuses in 2013 is the highest total in the state’s history, Cuomo said in the news release.

“Our focus on cleaning up the Medicaid program is showing record-breaking results, and OMIG’s efforts serve as a role model for other states to follow. Eliminating this kind of waste is vital to transforming New York’s healthcare system, and this year’s tremendous amount of recoveries shows that we are well on our way to building a healthier and fairer New York,” Cuomo said.

OMIG has worked to eliminate fraud through aggressive responses to allegations of fraud in social adult-day care, excluding unscrupulous providers, and focusing on ineligible individuals.

Among the improvements in fraud and abuse prevention established under the Cuomo administration are the creation of pre-claim reviews, which are specialized reviews of home health claims and inventory reports; improved practices for reviewing pharmacy operations; and strong data sharing and coordination with federal, state, and local partners, according to the governor’s office.