Rockland County, New York, Uncovers $13M In Questionable Medicaid Billings

Main Category: Medicare / Medicaid / SCHIP
Article Date: 10 Jan 2006 - 0:00 PDT

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Officials in Rockland County, N.Y., announced Thursday that they had uncovered as much as $13 million in improper Medicaid billings after an examination of one small part of the program, the New York Times reports. The discovery is the first since the state Department of Health gave permission for the first time to 12 counties to examine Medicaid bills filed by doctors, pharmacists, nursing homes, hospitals and others. New York's Medicaid program, the largest in the nation, is the only one that requires counties to pay a large share of costs. Until now, the state has prohibited counties from reviewing Medicaid claims, but concerns that the state was not doing enough to regulate the program prompted officials to grant permission for the counties' reviews. The counties granted permission to investigate Medicaid billings and hired IBM to conduct a statistical analysis of their Medicaid bills and look for irregularities. Potentially improper bills are to be investigated by the Department of Health, after which legal action can be taken by the attorney general's office to prove fraud and recover funding. However, Medicaid experts and county officials said the state does not have enough staff overseeing Medicaid, and officials might have difficulty handling a large number of referrals from the counties. In Rockland County, officials worked with IBM to review bills submitted by pharmacies and general practitioners during a 21-month period. Only 10% of providers who received the most money were investigated in each of those categories. Potentially improper bills accounted for 19% of the reimbursements to the providers. County officials called the findings a "watershed moment" because they mean that other counties across the state could find billions of dollars of questionable Medicaid bills, according to the Times. Rockland County executive C. Scott Vanderhoef said the announcement was just a first step and does not guarantee the recovery of money or punishment of those who defrauded the system (Perez-Pena, New York Times, 1/6).

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