NCJ Number
73069
Date Published
1980
Length
58 pages
Annotation
This 1979 annual report of the New York State Medicaid Fraud Control Unit discusses investigations of the State's ambulatory care programs, residential health care, and hospitals.
Abstract
Between 1969 and 1975 nursing home operators submitted inflated claims for Medicaid reimbursement costing the taxpayers $50 million. Of this amount, the Office of Fraud Control is in the process of recovering $22 million; measures to collect the remaining $28 million are being initiated in cooperation with the Office of Health Systems Management. Ambulatory care investigations reveal improper billing of Medicaid by optometrists, dentists, pharmacists, and doctors. Hospital investigations resulted in 48 indictments for alleged thefts from Medicaid, Blue Cross, and other insurance carriers totaling approximately $240,000. Four indictments of adult home operators are cited. After investigating 300 complaints of patient abuse, researchers found that the majority of abuses were the result of the lack of proper education and training for aides and orderlies who were responsible for direct care of patients. Court decisions that furthered the cause of fraud investigation in New York State are cited. Special projects of the Fraud Control Unit in communications, legislation, and a complaint telephone system are detailed. Appendixes contain case statistics, historical background, and a 1979 personnel list.