Attorney General Recovers $1.7 Million From 77 Hospitals Across The State For Medicaid Overbillings

Attorney General Spitzer today announced that 77 hospitals across the state have agreed to repay more than $1.7 million for overbilling taxpayers. An investigation by the Attorney General's Medicaid Fraud Control Unit (MFCU) revealed that the hospitals improperly billed the Medicaid system for treating patients who had been transferred to them from hospices between 1994 and June of this year. Terminally ill Medicaid patients who enter hospices can, at times, require hospital inpatient care as well. Spitzer explained that such general inpatient care is covered by the payment rate hospices receive from the State Medicaid program. As a result, when a hospice patient is admitted to a hospital, the correct procedure is for the hospice to continue to bill Medicaid and pay the hospital itself for the patient's care. There should never be any patients who are the subjects of simultaneous claims by hospitals and hospices. "Apparently, this was just another case of hospitals establishing protocols to ensure that they were never underpaid, while at the same time failing to take necessary steps to prevent overpayments," said Spitzer. "The recovery of these sorely needed tax dollars from scores of hospitals across the state will help ensure that the needs of Medicaid patients are properly met."

Deputy Attorney General Jos' Maldonado, Director of Spitzer's MFCU, noted that the duplicate billing issue was discovered last September during an investigation of a hospice by the MFCU's Long Island Regional Office. Using the unit's data warehouse computer system, which contains years of adjudicated Medicaid claims, the review was expanded both in geographic scope and by time frame. "We then matched billings for the same patient on the same day and added the total amounts paid to the hospitals," he said. "What would have taken weeks to audit in the past was accomplished in a matter of minutes."

Spitzer added, "Once the problem was brought to the attention of the hospitals, they readily agreed to reimburse the State. They also asked for guidance to put safeguards in place to ensure that the problem would never occur again."

The statewide audit-investigation resulting in the repayment was principally conducted by Special Assistant Attorney General Michael P. Sofarelli, Deputy Director of MFCU's Special Projects Unit, and members of his staff, including Principal Special Auditor Granville Senior, and Associate Special Auditors Ali H. Sencer and Deowattie Khelawan. Additional assistance was provided by Chief Auditor Ronald Tysowski, Supervising Associate Auditor Christopher Simeti, and Associate Special Auditor Joann Satchwill, of MFCU's Long Island Regional Office.

All cases are handled under the direct supervision of Deputy Attorney General Jos? Maldonado.