Wednesday, December 26, 2007

Experts estimate at least 3 percent of the nation's annual health care costs are lost to outright fraud

Health care fraud declines
State Medicaid program saves $1 billion in Spitzer's first year
By VALERIE BAUMAN, Associated Press
First published: Wednesday, December 26, 2007

Why can't all the states begin to implement these anti-fraud initiatives?
ALBANY -- A year ago, candidates for governor and attorney general promised voters they would crack down on Medicaid fraud to bring back millions of taxpayer dollars that have been wasted by unscrupulous doctors and scam artists.
So how have the winners, Gov. Eliot Spitzer and Attorney General Andrew Cuomo, done so far?

Pretty well, records show.

Changes the Health Department implemented under Spitzer's administration were largely responsible for a reported $1 billion savings this year in the health care program for the poor. That's about 1 percent of the total state funds budget. Both better administration and enforcement are cited in a program that some estimate loses billions to fraud and waste yearly.

A Health Department anti-fraud initiative, which used data mining to save $132 million, contributed to the $1 billion savings. The agencies responsible for Medicaid also have been reorganized and integrated to better monitor waste.

Cuomo's office has widely publicized investigations into home health aides with bogus certifications.

The investigations have saved the state about $110 million -- nearly double the $59 million recovered in 2006 when Spitzer was attorney general, officials said. That pales next to 2005, when Spitzer's attorney general office recovered $274 million in Medicaid fraud. About $63 million was recovered in 2004.

In 2007, the state comptroller's office identified more than $47 million in "potential" overpayments or inappropriate claims. It's unclear how much of that will be recovered by the state; officials said it's common to collect, but it can take years.

But don't expect all that recovered money to cut your taxes. It went toward other spending, mostly in health care, and toward reducing the state's budget deficit, expected to be at least $4.3 billion in the fiscal year starting April 1.

Experts estimate at least 3 percent of the nation's annual health care costs are lost to outright fraud. In New York's Medicaid program, that loss would represent $1.3 billion, according to officials in the state comptroller's office.

The fraud recovery target for the state's budget, which includes "cost avoidance" and funds that were recovered, was $430 million for 2007 and 2008 -- an increase over the $300 million in 2006-07. The agency has since increased that target to $505 million.

Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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