The Empire State Strikes Back at Medicaid Fraud: $216M Recovered Under New York’s False Claims Act Over Three-Year Period
- January 05, 2022 by Pietragallo Admin
- Medicaid, State False Claims Acts
Takeaway: From 2018 to 2020, the New York False Claims Act yielded an impressive $216,936,354 in recoveries and returned $130,161,812 to New York State’s Medicaid Program.
New York is one of 32 states with its own qui tam statute.[1] Enacted in 2007, the New York State False Claims Act (NYFCA) lets whistleblowers (called “relators”) sue individuals and businesses that submit false or fraudulent claims for payment to the State.[2] The NYFCA awards successful whistleblowers with a share of the State’s recovery.[3]
In 2018, New York amended its whistleblower statute to require annual reporting by the State Attorney General to the State Legislature.[4] Each report includes the amount of monies recovered by the State’s Medicaid Fraud Control Unit (MFCU) under the NYFCA in the preceding calendar year. The reports also reveal how much more money the State recovered by having a false claims act that satisfies Section 1909 of the Social Security Act.[5]
Based on three years of reporting, the NYFCA has yielded large recoveries for the Empire State.
| NYFCA Recoveries Reported by the New York State Attorney General N.Y. State Fin. Law § 190-b |
| Calendar Year | Total Recovered by the New York Medicaid Fraud Control Unit |
Total Returned to New York State’s Medicaid Program (60%) |
Additional Monies Returned under Section 1990 of the Social Security Act |
|---|---|---|---|
| 2018 | $ 40,504,700.87 | $ 24,302,820.52 | $ 4,169,926.13 |
| 2019 | $ 114,076,564.58 | $ 68,445,938.75 | $ 11,407,656.45 |
| 2020 | $ 62,355,088.63 | $ 37,413,053.18 | $ 6,235,508.86 |
| Totals | $ 216,936,354.08 | $ 130,161,812.45 | $ 21,813,091.44 |
From 2018 to 2020, New York State recovered an impressive $216,936,354.08 under the NYFCA. From these recoveries, $130,161,812.45 was returned to the State’s Medicaid Program. Since the NYFCA complies with Section 1909 of the Social Security Act, $21,813,091.44 went to New York’s Medicaid program instead of the federal government.[6]
The Attorney General Reports under N.Y. State Fin. Law § 190-b can be found here.
[1] See https://www.falseclaimsact.com/states-municipalities-fcas/.
[2] N.Y. State Fin. Law §§ 187–194.
[3] Between 15% and 25% of the proceeds if the government intervenes, and 25% to 30% if the government does not intervene. N.Y. State Fin. Law § 190.
[4] N.Y. State Fin. Law § 190-b (Added L.2018, c. 57, pt. J, § 2, eff. Sept. 30, 2018.)
[5] States with qui tam laws that meet the requirements of Section 1909(b) of the Social Security Act, 42 U.S.C. 1396h, receive an extra 10 percent of all Medicaid dollars recovered.
[6] See Letter from Office of Inspector General to the New York State Attorney General (Jan 25, 2019), https://oig.hhs.gov/documents/false-claims-act/266/NewYork.pdf.