On April 22, 2009,  New York Medicaid Inspector General James Sheehan testified before the U.S. Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Medicare and Medicaid about waste and fraud.

New York was the most successful state in the nation in Medicaid program integrity in the past year, measured by fraud and abuse recoveries reported to the Centers for Medicare and Medicaid Services (CMS). Still, there are opportunities for significant improvement, especially when it comes to fraud prevention, Sheehan says in the statement.

Sheehan says that for fraud prevention to become reality, there must be a proactive, rather than reactive system-one with oversight, investigative and prosecutive efforts.

One example of how today’s system falls short: the government’s investigations of improper payments, when they involve large organizations and the potential for intentional conduct, tend to fizzle after years of investigation. Eventually, these might result in criminal declination or an indictment, with limited effect on the provider, payment of large amounts of money in a civil settlement, and a corporate integrity agreement to address future conduct. The statement goes on to say: “By the time the settlement occurs, the individuals who were in charge at the time have moved on, and the business models have changed …. [And] the stock goes up.”

The text of his testimony is posted on the OMIG Web site.

http://www.omig.state.ny.us/data/images/stories/press_releases/js_dc_testimony.pdf .

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.