This case illustrates how, even at the State level, fraud continues to occur because government officials do NOT implement sound enough business controls to prevent fraud.
In this case, New York State Medicaid auditors found 417 dead people and 912 prison inmates still receiving Medicaid payments even though neither group is supposed to get them.
Officials said 296 of the death cases have been closed and $1.7million recovered from providers, like nursing homes.
Thus, it seems that nursing homes can continue to bill for medicaid for dead patients, and prisons apparently have no downside in failing to report new prison inmates to the Medicaid system so they can be dropped from the rolls.
In my 18 years of government and corporate audit experience, the biggest problem was always that some bureaucrat was not following procedure or using professional level control procedures to prevent such improper payments. In this case, the nursery homes should be fined twice the overpayments, and the prisons should be billed for the overpayments since neither group followed procedures to minimize the fraudulent payments.
Tough love is needed in government.
Favorite Quote from the article at the link below:
Okay, maybe you're dead or in prison, but it's not all bad news: You may still be collecting Medicaid.
This Medicaid problem compares to the situation in three recent audits at the Lake County School District, which paid for a mentor program improperly, and overpaid a contractor, and allowed someone to manually override payroll systems to overpay staff after they were demoted. Each of those findings exceeded $500,000 but I don't believe any recoveries have yet been announced. Lake County officials and staff need to start acting on collection actions like it was their own money, and not "free" money from the taxpayers.
vj
Dead still collecting benefits from Medicaid
Friday, October 3rd 2008, 9:46 PM
ALBANY - Okay, maybe you're dead or in prison, but it's not all bad news: You may still be collecting Medicaid.
Auditors found a whopping 417 dead people still on the rolls, the state Office of Medicaid Inspector General said Friday in its annual report on Medicaid fraud, waste and abuse.
Another 912 prison inmates were still collecting - although they're supposed to be cut off.
Officials said 296 of the death cases have been closed and $1.7million recovered from providers, like nursing homes.
In most cases, someone died and Medicaid kept paying the bills because no death certificate was sent in, Medicaid spokeswoman Wanda Fischer said.
Often billing clerks automatically kept submitting bills for nursing home or home care, she said.
Other times, there was criminal intent, though Fischer couldn't say how much.
"If there's a criminal problem, we hand it over to the attorney general's office because we can't prosecute people," Fischer said.
Overall, 121 Medicaid fraud cases last year were referred to the attorney general's office and another 364 to other agencies, including local district attorneys offices, the report said.
Auditors also found 101 cases in which the Medicaid program paid for drug prescriptions for dead people, the report said. Officials expect to recover up to $134,000 from pharmacists.
As for the prisoners improperly collecting Medicaid, officials said sometimes a person on the outside could have been illegally using an inmate's card.
Other times, Medicaid is unaware a person is incarcerated and Medicaid and the prison health system both wind up paying for an inmate's treatment, she said.
The inspector general's office said the audits will save some $6.7million.