ASK THE DA: How is law enforcement dealing with Medicaid fraud?

March 25, 2013 By Kings County District Attorney Charles J. Hynes Kings County District Attorney's Office

AP081209017797.jpg

Share this:

As a new retiree, I was particularly interested in a recent news story where you announced that indictment of a doctor who was charged with stealing hundreds of thousands of dollars from Medicaid and Medicare for services he did not render. Can you tell me what your office is doing to combat such criminal abuses of our healthcare system?

Medicaid is a government-subsidized benefit for those who cannot afford medical care. Medicaid fraud can be committed by either the provider who provides the medical services, or by the individual who receives the benefit, and intentionally misrepresents facts affecting their eligibility to receive Medicaid.

My office prosecutes Medicaid fraud cases in Brooklyn that are referred to us by the Human Resource Administration or reported by people such as you. Twelve years ago I created a Public Assistance Crimes Unit (PAC) to address Cash Assistance, Medicaid, Food Stamp and other related frauds which divert funds from the disadvantaged who are in need of these services. This group of dedicated, highly skilled attorneys also prosecute individuals engaged in Medicaid related black market prescription medication trafficking.

Several weeks ago I expanded this highly successful bureau with the help of city and federal resources in order to vigorously pursue these crimes which present a threat to the public health. Both Commissioner Doar of the New York City Human Resources Administration and U.S. Senator Charles Schumer have collaborated with me along with Loretta Lynch, United States attorney for the Eastern District; Kathleen Sebelius, the United States secretary of health and human services; and Bridget Brennan, the New York special narcotics prosecutor.

Together we announced our plan to share information and combine our resources to combat fraud committed by doctors, pharmacies, clinics, and all other Medicaid and Medicare providers who are exploiting the programs necessary for the health and well-being of our community. It was during this announcement that I discussed the case you referred to in your question.

The following are examples of how individuals and medical providers commit Medicaid fraud:
● Billing for services not rendered
● Billing for medically unnecessary services
● Billing Medicaid for more expensive procedures than those that are actually performed
● Double-billing (billing both Medicaid and a private insurance company or the recipient directly, or multiple providers billing Medicaid for the same recipient and procedure)
● Hidden financial arrangements between providers involving some material benefit, in return for another provider prescribing or using their products or services, which frequently results in unnecessary treatment)
● Inflating costs in order to obtain a higher reimbursement rate
● Misrepresenting your income, residence, marital status and hiding assets

It is important that we all do our part to help stop Medicaid fraud. If you are not sure about whether a suspicious activity may be fraudulent, call my Citizen Action Center, which will direct your inquiry to the appropriate Bureau in my office and will keep your report confidential. My Citizen Action Center can be reached at (718) 250-2340.