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April 13, 2005

Senate Majority unveils plans to 'overhaul' Medicaid fraud detection

The Senate Republican Majority has unveiled plans that would overhaul the state’s Medicaid fraud detection with the goal of reducing corruption and waste and returning money to taxpayers, according to a release from Senate Majority Leader Joseph Bruno’s office.

“Senate legislation restructures the detection, investigation and prosecution of Medicaid fraud in New York by strengthening and streamlining the roles of the Health Department and Attorney General, and creates a new Medicaid Inspector General to help uncover fraud, waste and abuse,” the release said.

The release cited statistics from the U.S. General Accounting Office that estimated between 10 and 30 percent of Medicaid expenses are “diverted” through fraud. “New York's anti-fraud efforts have recouped only a fraction of that amount, and have lagged those of other states,” the release added.

“In Federal Fiscal Years from 2001 to 2003, New York's Medicaid Fraud Control Unit, which prosecutes fraud and recovers illicit gains, posted 72 cents in recoveries for every dollar spent by state and local governments on fraud recovery, according to a review of filings with the Inspector general of the federal Department of Health and Human Services,” the release said.

“By contrast, Texas recouped five times its anti-fraud spending; New Jersey regained six times its investment.”

The proposal would include the creation of a “state-of-the art” computer fraud detection system and provide funding and personnel to help local district attorneys investigate and prosecute fraud cases not handled by the Attorney General.

The release said the plan would mean additional savings to taxpayers since detected fraud would return the money to local governments who paid the bill initially.

"Our objective is to get $4 billion minimally ... without impacting the quality of care," Senator Bruno told the Associated Press. "It just gets the thieves and crooks out of the system."