NCJ Number
68146
Date Published
1979
Length
4 pages
Annotation
THE BILL HR-3 HAS SOUGHT TO IMPROVE, AND IN SOME CASES HAS SUCCESSFULLY IMPROVED, STATE AND FEDERAL GOVERNMENTS' CAPACITY TO DETECT, PROSECUTE, PUNISH, AND DISCOURAGE FRAUD AND ABUSE BY MEDICARE AND MEDICAID PROVIDERS.
Abstract
WHILE THE LEGISLATION OF HR-3 CONTAINS FUNDING INCENTIVES FOR INVESTIGATING UNITS, MANY STATES HAVE SEEN LITTLE, IF ANY, PROGRESS TOWARD DISLODGING THE MILLIONS OF DOLLARS WORTH OF FRAUDULENT SCHEMES USED BY VENDORS AND HEALTH CARE PROVIDERS, SUCH AS INFLATED BILLINGS, PHONY BILLINGS, OR ITEMS ON BILLS, AND FRONT MONEY. NEW YORK STATE'S OFFICE OF THE SPECIAL PROSECUTOR HAS BEEN WORKING WITH THE PROBLEM FOR 4 YEARS, AND HAS CONCENTRATED HEAVILY ON NURSING HOME FRAUDS. THEIR INVESTIGATIONS OF FRAUD WERE FACED CONTINUALLY WITH MOTIONS TO QUASH THEIR SUBPOENAS AND EFFORTS TO HIDE BOOKS AND RECORDS FROM THE INVESTIGATORS THROUGH SUCH METHODS AS DECLARING THE RECORDS LOST OR DESTROYED BY FIRE, FLOOD, OR THIEVERY. MANY OF THE ACCUSED DELAYED PROSECUTION EFFORTS THROUGH ELABORATE ATTEMPTS TO APPEAL THEIR CASES. THUS THE NEW YORK STATE OFFICE DEVELOPED A CIVIL RECOVERY COMPONENT ESPECIALLY AS THE OFFICE FELT THAT IT IS AS IMPORTANT TO EXACT RESTITUTION FROM CONVICTED OPERATORS AND TO PURSUE RECOVERY OF STATE AND FEDERAL MONEY WHICH HAS BEEN OVERPAID TO OPERATORS. THE CIVIL RECOVERY UNIT HAS ALREADY BROUGHT LAWSUITS WHICH HAVE HELPED RECOVER NEARLY $7 MILLION. YET AUDIT REPORTS, REPRESENTING AN INDEPTH REVIEW OF ALL PRIVATE PROPRIETARY NURSING HOMES IN NEW YORK STATE, POINT TO MORE THAN $63 MILLION IN OVERPAYMENTS. ON THE CRIMINAL SIDE, NEW YORK HAS INDICTED 147 INDIVIDUALS. NEVERTHELESS, HEALTH CARE PROBLEMS WILL NOT BE SOLVED SOLELY THROUGH DETECTING AND ERASING FRAUD, THERE IS NEED FOR SOME KIND OF NATIONAL HEALTH INSURANCE TO ENSURE THAT EVERY ONE (INCLUDING THE INSTITUTIONALIZED POOR, THE ELDERLY, AND OTHERS) RECEIVES ADEQUATE AND PROPER HEALTH CARE. (MHP)