U.S. Says New York City Overbilled Medicaid

[alp227]

Source: The New York Times

The federal government has accused New York City of overbilling Medicaid by “at least tens of millions of dollars” by improperly approving 24-hour home care for thousands of patients.

In a lawsuit filed Tuesday, the United States attorney’s office in Manhattan also insinuated that the city had cheated the federal government after a 2006 change in Medicaid rules relieved the city of having to contribute to the cost of the round-the-clock care. In many cases, the government said, the city enrolled patients who did not need such services. And in some cases, the lawsuit alleged, the city approved in-home care for people who needed more intensive services, like nursing home care, but which would have required the city to contribute to the cost.

In one example, the government said a 75-year-old woman with dementia who tried to jump out her window several times a day and who punched her daughter was kept in the home care program when she should have been in an “appropriate facility,” like a psychiatric center.

The lawsuit, which followed a whistle-blower’s complaint, also said the city ignored rules requiring recommendations from doctors, nurses and social workers before patients could be enrolled in the home care program, or sometimes rejected doctors’ findings that the services were not needed. The lawsuit did not say exactly how much overbilling the federal government believed had occurred, but it asked the court to award it triple damages.

Read more: http://www.nytimes.com/2011/01/12/nyregion/12medicaid.html