$127,000 in Fraud Detected in Recent Months; More than $320,000 of Potential Overpayments Eligible for Recovery also Identified

ERIE COUNTY, NY— Erie County Executive Mark C. Poloncarz and Erie County Medicaid Inspector General Michael Szukala announced that recent ongoing investigations conducted by the Erie County Medicaid Inspector General have resulted in the identification and sanction of $127,000 in Medicaid-related fraud. Medicaid, a means-tested program that finances the delivery of primary and acute medical services to more than 68 million people nationwide, represents Erie County’s single largest program expense with a total cost to the county, state and federal governments of more than $1 billion.

Due to the Health Insurance Portability and Accountability Act (“HIPAA”), and the Health Informational Technology for Economic and Clinical Health Act (“HITECH”), the details of what the Medicaid Inspector general uncovered cannot be publicly released, but the vast majority of the tip-related fraud is directly related to persons concealing assets so as to appear to qualify for Medicaid-funded nursing home care.

“I commend Inspector General Szukala and his team for working tirelessly on behalf of Erie County taxpayers in their pursuit of fraud and abuse in the Medicaid system. The public should understand that my administration is very serious about addressing waste, fraud and abuse in the Medicaid system, a message I began talking about as County Comptroller,” said Erie County Executive Mark C. Poloncarz. “Medicaid fraud in any amount is a very real theft from all of us, and the identification and sanction of fraudulent claims helps to protect legitimate Medicaid recipients while weeding out false claims. Efforts like these will aid in controlling costs and should serve as a lesson and a deterrent to other abusers.”

“I take all complaints and tips of alleged Medicaid fraud received by my office very seriously,” said Erie County Medicaid Inspector General Michael Szukala.  “Individuals who have called with tips can take comfort in the knowledge that their allegations were researched, and we pursued sanctions against those that were found to be true.”   

Information received on the Medicaid Inspector General’s tip line has resulted in fraud investigations ranging in amounts from a few hundred dollars to tens of thousands of dollars; all tips received are investigated to the fullest extent by Mr. Szukala’s team for further action. Claims found to be fraudulent can be sanctioned for the amount illegally obtained, which means that these clients will have to pay future Medicaid bills up to the amount of the fraud out of their own pocket.

Since its inception in September of 2012, the Erie County Office of the Medicaid Inspector General has completed nine audits reviewing more than $51 million in Medicaid provider activity.  Medicaid providers include pharmacies, durable medical goods providers and transportation providers.  Four additional audits reviewing more than $12.59 million of activity are ongoing.  As of January 15, 2014, more than $320,000 worth of payments made to Medicaid providers that are potentially eligible for recovery have been identified through the audit process and these findings have been turned over to the New York State Office of Medicaid Inspector General for action.  This audit activity is separate from the $127,000 of tip related activity discussed above.

In 2013, Medicaid covered over 225,000 persons in Erie County at a cost of over $1.4 billion.

To report suspected cases of Medicaid fraud in Erie County, call (716) 858-4639.