New York has one of the most aggressive Medicaid Fraud Control Units (MFCU), with a staff of more than 315 people across the state. They work closely with the Medicaid Inspector General in the NYS Health Department to detect and prevent Medicaid fraud.
The most common forms of Medicaid fraud in New York last year included:
- billing for services not provided
- billing for unnecessary services by falsifying symptoms and diagnoses
- billing for multiple office visits when the services could have been rendered in a single visit
- double billing Medicaid and private insurers
- paying and receiving kickbacks in return for referrals of Medicaid patients
- billing for services provided by unlicensed healthcare workers
- off-label marketing and false reporting of prices by pharmaceutical companies
The largest Medicaid fraud recoveries came from pharmaceutical companies. Abbott Labs, Boehringer-Ingelheim, Dava Pharmaceuticals, GlaxoSmithKline, K-V Pharmaceutical, McKesson, Merck, and other pharmaceutical companies paid more than $250 million to settle allegations that they submitted false price reports to Medicaid and/or promoted their products for uses not approved by the federal Food and Drug Administration (off-label marketing).
Other significant recoveries involved pharmacists, hospitals, and dental clinics.
Pharmacy Fraud: Four pharmacists and a pharmacy owner agreed to pay $9.9 million in restitution after pleading guilty to billing Medicaid for drugs that they never dispensed to their patients.
Stark Law Violations: Cayuga Medical Center paid $3.1 million to settle a whistleblower or qui tam lawsuit alleging that the hospital billed Medicaid and Medicare for patients referred by physicians who had financial relationships with the hospital. The Stark Act prohibits a physician from referring patients to a hospital if the physician has a financial relationship with the hospital, unless an exception applies. The whistleblower in this case, a physician at the hospital, received 18% of the settlement (approximately $560,000) as his whistleblower reward.
Dental Fraud: Kaleida Health repaid $1.6 million to Medicaid after an internal audit revealed that it had billed Medicaid for patients who received teeth cleanings more often than once in six months, which violated Medicaid reimbursement rules. The audit also revealed that the dental clinic had billed Medicaid for multiple visits to complete exams, x-rays, and cleanings. Medicaid regulations require dental clinics to perform and bill these tasks in one office visit.
If you are under investigation or have been charged with Medicaid fraud, then you should consult with an experienced Medicaid fraud attorney immediately, before you speak with government investigators. Anything you say to the investigators can and will be used against you. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email.
You should also consult with an experienced Medicaid and Medicare fraud lawyer if you know that your employer is submitting false claims to the government. You may be entitled to a substantial whistleblower reward and legal protections if you help the government recover money paid on false and fraudulent claims. Call our office today to schedule a free and confidential consultation.
John Howley, Esq.
The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.