Whistleblower Sparks Federal Suit Against NYC

In January 2011, the U.S. Attorney’s office in Manhattan filed a lawsuit against the City of New York, accusing the city’s Human Resources Administration of overbilling Medicaid millions of dollars by abusing the federally funded 24-hour home care program.  The suit followed a complaint filed by a whistleblower.  The suit alleges that, in response to a 2006 modification in Medicaid policy relieving the city of financial responsibility for the 24-hour home care program, the city began improperly and unnecessarily approving the use of the program for inappropriate patients.  Prior to 2006, the City of New York shared the cost of the 24-hour home care program (then called Personal Care Services) with the federal and state governments.  Beginning January 1, 2006, Medicaid removed NYC from the contributing equation, leaving the financial burden of the program to fall solely on federal and state funding.

Though the complaint did not specify whether enrollment in the program spiked after 2006, it did allege that improper and/or fraudulent enrollment in the program had steadily occurred between the years of 2000 and 2010; the time period on which their investigation focused.  Improper enrollment, the government said, was demonstrated in the countless cases where patients either did not need the services of in-home 24-hour care, or needed more intensive services that could not be provided by in-home care.  The U.S. Attorney’s office said that the city had improperly authorized coverage for a “substantial percentage”, often disregarding various stipulations and qualifications mandated by the Medicaid program for approving patients for 24-hour home care.  The lawsuit failed to provide an amount that the City of New York had allegedly overbilled throughout the ten year span, however, the government asked the court to award treble damages.

For more information see:  http://www.nytimes.com/2011/01/12/nyregion/12medicaid.html?_r=2&partner=rss&emc=rss