New York’s Medicaid program, a health care program that covers more than a third of all New Yorkers, is under the federal microscope after the leader of the Center for Medicaid Services sent a letter to Gov. Kathy Hochul alleging widespread fraud.
In the letter, Dr. Mehmet Oz said he is “formally requesting detailed information regarding program integrity and provider screening and enrollment oversight within New York’s Medicaid program. This request is necessary to ensure public confidence and protect beneficiaries in your state’s Medicaid program.”
Dr. Oz has sent similar letters to California and Minnesota.
CMS Zeroes in on Personal Care, Home Care, Medical Transportation and Related Services
The letter from CMS says that “[r]ecent public reporting, federal prosecutions, and CMS analyses raise serious concerns about New York’s oversight of personal care, home health, adult day care programming, non-emergency medical transportation (NEMT), and behavioral health services. This evidence, combined with New York’s elevated per capita Medicaid spending and workforce utilization patterns that significantly exceed national norms, underscore the need for immediate investigation, corrective action, and enhanced transparency.”
Oz said in the letter that New York’s Medicaid program costs over $90 billion a year — the second highest in the nation – and the state spends an average of $12,528 on each of the state’s 6.8 million beneficiaries, which is 36 percent higher than the national average. He also pointed out that spending per resident was 80 percent higher than the national average.
He further specifically called out the state’s spending on personal care and home care services, saying spending in these areas seemed unusually high and requested answers to more than 50 questions about Medicaid spending.
It is those services that are expected to be the target of a Department of Justice lawsuit that will be filed in the coming weeks, according to a recent New York Post report. The Post reports the Department of Justice is targeting the state’s Department of Health over alleged bid-rigging when the state awarded Public Partnerships LLC the contract to run payroll for the Consumer Directed Personal Assistance Program, a popular Medicaid home care program. CDPAP allows Medicaid members eligible for home care services to choose and hire their own personal caregiver. CDPAP provides services to elderly, chronically ill or physically disabled individuals who have a medical need for help with daily activities or who require skilled nursing services. The CDPAP services provided by a personal assistant can include any of the services normally provided by a personal care aide (home attendant), home health aide or nurse.
What Does this Mean for New York Medicaid Providers?
Medicaid providers in New York can expect increased scrutiny, potential audits and heightened compliance requirements regarding program integrity, documentation, and eligibility verification.
Gov. Hochul said her administration has been proactive on Medicaid fraud and will continue to be aggressive.
“When there is fraud, I will help them fight it,” the governor told City & State. “I already have.”
Al Cardillo, president and CEO of the Home Care Association of New York State, said in a statement shared with McKnight’s Home Care Daily Pulse, that the letter paints all home providers with a broad brush.
“Respectfully, the content of the Administrator’s letter risks an across-the-board mischaracterization, particularly by conflating all home care with the CDPAP system that the state has created,” he said. “If anything, HCBS agencies are shouldering extensive losses to meet their patients’ and communities’ skilled health care needs because federal and state systems do not adequately recognize or support the breadth of their roles in the health system.
“Therefore, we encourage all of the actors in this effort to be careful to first do no harm and to protect and defend the integrity of the legions of bona fide and committed agencies that care for our loved ones in their homes every day.”
How Harris Beach Murtha Can Help
Harris Beach Murtha’s Government Compliance and Investigations Practice Group and Health Care Industry Team will continue following these and related issues and report out significant developments. If you are a Medicaid provider and need assistance with this or related matters, please reach out to attorney Marina Plotkin at (212) 313-5409 and mplotkin@harrisbeachmurtha.com; attorney Roy W. Breitenbach at (516) 880-8378 and rbreitenbach@harrisbeachmurtha.com; attorney Terrance P. Flynn at (716) 200-5120 and tflynn@harrisbeachmurtha.com; attorney Glenn M. Jones at (516) 880-8494 and gjones@harrisbeachmurtha.com; or the Harris Beach Murtha attorney with whom you most frequently work.
This alert is not a substitute for advice of counsel on specific legal issues.
Harris Beach Murtha’s lawyers and consultants practice from offices throughout Connecticut in Bantam, Hartford, New Haven and Stamford; New York State in Albany, Binghamton, Buffalo, Ithaca, New York City, Niagara Falls, Rochester, Saratoga Springs, Syracuse, Long Island and White Plains; as well as in Boston, Massachusetts, and Newark, New Jersey.