NCJ Number
69682
Date Published
1978
Length
5 pages
Annotation
Achievements of New York's Bureau of Medicaid Fraud and Abuse from January through October 1978 are described, including restitutions, administrative actions, and prosecutions.
Abstract
The Bureau has generated over $41 million in restitutions for erroneous Medicaid payments. Statistics on restitutions are categorized according to hospital clients, free-standing clinics, and physician providers. Since its inception, the Bureau has taken administrative actions to disqualify 134 providers and suspend 27 others for unacceptable practices. All providers were given the opportunity for a prompt hearing, and results of these hearings are now circulated throughout the State. Further refinements of the sanctioning process are planned. Recently the Governor designated the Office of the Special Services (OSP) to act as the State's Medicaid fraud control unit under provisions of new Federal legislation which will fund 90 percent of these activities. Areas of responsibility and lines of referral between the OSP and the Bureau are discussed. Data on convictions and indictments are provided. Improvements in computer systems to deter providers from improper and excessive billing to Medicaid involved extending the systems to some upstate counties, consolidating New York City's files, and converting records to microfiche. The Bureau has expanded its audit program of physicians to detect duplicate payments and plans to initiate a comprehensive audit plan for clinics. In these programs, considerable emphasis is placed on defining quality of care issues that can be audited or defended in court. Abuses in methadone maintenance treatment programs have also been discovered. The final section of the report covers Bureau cooperation in three projects sponsored by the Department of Health, Education, and Welfare and consultation activities with the Medicaid Management Information System. For previous reports, see NCJ 69681 and 69683. ABI mjm