N.Y. State Recovers $551M In Improper Medicaid Payments

Gov. David A. Paterson and New York State's Medicaid Inspector General (MIG) James G. Sheehan announced last Friday, Dec. 12 that New York State has recovered more than double the requirements for recovery of improperly paid Medicaid funds.

Under the Federal-State Health Reform Partnership (F-SHRP)—a federal program that sets requirements for Medicaid fraud and abuse recoveries—the federal government set and New York agreed to an ambitious recovery target of $215 million for federal fiscal year 2008.

New York State recovered $551 million—more than doubling the Medicaid fund recovery targets set by F-SHRP. This number combines reported collections identified through the fraud and abuse efforts of a number of New York State agencies.

"[This] announcement demonstrates that New York State is leading the way in monitoring and identifying Medicaid fraud, waste and abuse—all while maintaining the integrity of the program for those who truly need services," said Paterson.

"To understand the significance of this success, consider this: the total that all 50 states recovered in 2007 was $305 million," added Medicaid Inspector General Sheehan. "New York is leading the way in fighting not only against Medicaid fraud but waste and abuse of the system as well."

New York State's Medicaid fraud, waste and abuse recoveries have increased significantly over the last two years while federal recoveries are dropping. The latest figures from the United States Department of Justice indicate that the Bush Administration recouped $1.1 billion in federal fiscal year 2008, compared with $1.5 billion in 2007 and $2.2 billion in 2006.

The Office of the Medicaid Inspector General (OMIG) identifies Medicaid overpayments and subsequent recoveries through audits, investigations and program reviews of Medicaid providers. The state receives recovery payments in various forms including lump-sum payments, installment payments and through the withholding of future Medicaid payments to the provider.

The office works in partnership with the Department of Health, the New York State Office of the Attorney General Medicaid Fraud Control Unit, the Office of Temporary Disability Assistance, the Office of Mental Health, the Office of Alcoholism and Substance Abuse Services, and the Office of Mental Retardation and Developmental Disabilities.

OMIG was officially established as an independent office within the New York State Department of Health in the fall of 2006.