NCJ Number
63226
Date Published
1978
Length
96 pages
Annotation
HIGHLIGHTS OF ACTIVITIES OF THE DEPUTY ATTORNEY GENERAL'S OFFICE FOCUSING ON INVESTIGATION OF PROVIDER FRAUD IN NURSING HOMES, HOSPITALS, AND AMBULATORY CARE SERVICES ARE DISCUSSED; 1978 ACHIEVEMENTS ARE STRESSED.
Abstract
TO DATE, THE NEW YORK OFFICE HAS INDICTED 184 INDIVIDUALS FOR MEDICAID FRAUD AND RELATED CRIMES. OUT OF 122 COMPLETED CASES, THERE ARE OVER 103 CONVICTIONS, 10 ACQUITTALS, AND 9 DISMISSALS. OVER $6 MILLION HAVE BEEN RECOVERED THROUGH CRIMINAL PROSECUTION, AND $64 MILLION MORE IN MEDICAID OVERSTATEMENTS HAVE BEEN IDENTIFIED. NEW YORK'S PROFIT-MAKING NURSING HOME OPERATORS SUBMITTED OVER $63 MILLION WORTH OF INFLATED CLAIMS FOR MEDICAID REIMBURSEMENT 1969 AND 1975 WHICH COST THE TAXPAYERS $42.6 MILLION. A MAJOR REASON FOR SUCCESS IN NURSING HOME INVESTIGATIONS HAS BEEN THE OFFICE'S USE OF THE 'TEAM CONCEPT' OF INVESTIGATION INVOLVING ATTORNEYS, AUDITORS, AND INVESTIGATORS WORKING TOGETHER IN ONE AGENCY. A THREE-PRONGED SYSTEM TO DEFRAUD MEDICAID WAS IDENTIFIED INVOLVING PERSONAL LUXURY FRAUD, KICKBACKS, AND PYRAMIDING. INVESTIGATIONS OF A NUMBER OF HOSPITALS HAVE COMMENCED, AND THE AUDIT PHASE OF MANY HAS BEEN SUBSTANTIALLY COMPLETED. IN ADDITION, THE DIVISION HAS EXAMINED THE BOOKS AND RECORDS OF DOZENS OF VENDORS. IN MARCH 1978, THE FIRST HOSPITAL INDICTMENT WAS ANNOUNCED WHICH INVOLVED SMITHTOWN GENERAL HOSPITAL. ADDITIONAL ACTIVITIES HAVE FOCUSED ON AMBULATORY CARE FRAUD AND PATIENT ABUSE. THE PATIENT ABUSE REPORTING STATUTE, IMPLEMENTED IN APRIL 1978, HAS FACILITATED THESE INVESTIGATIONS. THE SPECIAL INQUIRIES SECTION OF THE OFFICE INVESTIGATES ALLEGATIONS INVOLVING GOVERNMENT OFFICIALS, LABOR OFFICIALS, AND BANK EXECUTIVES AS THEY RELATE TO HEALTH CARE INDUSTRIES. THESE CASES ARE AMONG THE MOST DIFFICULT TO PROVE. IN 1978, THE OFFICE BEGAN THE AUDIT OF A NUMBER OF ADULT HOMES; 22 HAVE BEEN COMPLETED TO DATE. THE OFFICE IS NOW SHIFTING PRIORITIES FROM NURSING HOMES TO THE MORE PRESSING AREAS OF HOSPITALS AND AMBULATORY CARE PROVIDERS SUCH AS DOCTORS AND PHARMACISTS AND TO INDUSTRY WIDE INVESTIGATIONS. FOOTNOTES AND APPENDIXES ARE PROVIDED IN THE REPORT. (LWM)