7/11/12: Bee News Guest Editorial - County pursues new fight against Medicaid fraud, abuse

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July 11, 2012 

While Medicaid represents the single largest cost to Erie County, more than $211.7 million this year alone — the local share of more than $1 billion annually — prior administrations failed to take significant action to help reduce this burden on local taxpayers.

As your comptroller, I issued a report examining Erie County’s Medicaid anti-fraud processes. I was surprised to find that while the county actively worked to prevent waste, fraud and abuse of Medicaid by recipients — both preventing those unqualified for benefits from receiving them and those qualified for benefits from using them inappropriately — we did absolutely nothing when it came to potential abusive Medicaid providers.

Unfortunately, instead of heeding my advice to take advantage of the resources available to the county for the aggressive investigation of Medicaid providers, my predecessor chose to just blame Albany in a war of words. As a candidate for Erie County executive, I promised to take action, and I am proud to announce the creation of the Erie County Medicaid Anti-Fraud Task Force, which will have the sole purpose of rooting out the provider-level waste, fraud and abuse that exists within Medicaid.

Since taking office, I have been working closely with the New York State Department of Health and the Office of the Medicaid Inspector General to make Erie County the “flagship” of the state’s revamped demonstration project process, which creates a coordinated structure to investigate and audit the Medicaid program.

Initially, the task force will comprise a three-person unit, the Erie County Medicaid inspector general, a senior investigator and a support staffer, who will utilize the latest data-mining and investigatory tools to review Medicaid-related payments made to providers. In addition to serving as a strong deterrent against local providers’ taking advantage of the system, in instances when we identify waste, fraud or abuse, we now will have the ability to recover improper or illegal payments made to these providers.

For example, last year, Monroe County received more than $500,000 in reimbursements for its role in the recovery of nearly $4 million in Medicaid claim overpayments made to providers. Best of all, as part of this partnership, the startup and administration of this new task force will be fully funded by New York State and will not require any county share.

Once we receive final approval by theCounty Legislature at the end of this week and the task force is up and running, we will immediately begin this coordinated effort to stamp out Medicaid waste, fraud and abuse. It is our responsibility to ensure every tax dollar is accounted for and spent properly. We will work in concert with the state to prosecute the offenders and recover those dollars.