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Post date: August 6 2007

Attorney General Cuomo Announces Recovery Of Approximately $7 Million From Managed Care Providers

ALBANY, NY (August 6, 2007) – Attorney General Andrew M. Cuomo today announced approximately $7 million in duplicate claim payments have been recovered from two managed care organizations (MCOs) as part of a series of joint audits and investigations.

These recoveries are the first in a series of continuing inquiries concerning duplicate claims made and payments received by more than 30 MCOs throughout New York State. These organizations have state contracts to provide or arrange for health services to Medicaid and Family Health Plus (FHP) patients. Duplicate claims were made after more than one Client Identification Number (CIN) for the same Medicaid or FHP recipient had been erroneously assigned.

“The billing for duplicate claims is costing New York’s taxpayers millions of dollars,” said Attorney General Cuomo. “Managed care organizations must be more vigilant identifying duplicate charges so that taxpayer funds received in error are returned in a timely manner.”

Between July 1, 2000 and November 30, 2006, Healthfirst PHSP, Inc. and its affiliate Managed Health, Inc., submitted duplicate coverage claims for nearly 6,000 individuals who had more than one CIN assigned to them. Healthfirst received duplicate monthly payments, averaging $126 per-month and maxing out at $626 per-month, in addition to supplemental monthly payments averaging $2,957 and going as high as $4,995. Healthfirst has reimbursed the approximately $6 million overpaid by the State.

St. Barnabas Community Health Plan, also known as Partners In Health, agreed to reimburse $902,000 in overpayments for duplicate CINs going back to 2000. Significantly, this agreement was obtained even though the company ceased operating in late 2006.

Since 1996, Medicaid payments to MCOs rose from approximately $1 billion to over $7 billion in 2006, as they are playing an expanded role in providing healthcare to uninsured New Yorkers. These providers are contractually entitled to only one monthly payment for each person enrolled in Medicaid or FHP. The MCOs are responsible for alerting their local Department of Social Services when multiple payments are received so that the ineligible accounts can promptly be removed from the program and reimbursement can be made. The Attorney General’s Office worked closely with the Medicaid Inspector General in these recent recoveries, and both are coordinating with state and local agencies to prevent the assignment of more than one CIN to the same person.

Medicaid Inspector General James Sheehan said, “Recouping duplicate Medicaid payments identified through audits is an important achievement. But preventing them from happening in the first place is even more important. The Spitzer Administration early on identified the need for a systems fix for this problem. The Office of the Medicaid Inspector General is working closely with the Attorney General, the State Department of Health and the New York City Human Resources Administration on approaches that will help prevent duplicate enrollee payments in the future.”

The investigation was led by Special Assistant Attorney General Bonnie Stein of the Attorney General’s Medicaid Fraud Control Unit’s New York City Regional Office and Special Assistant Attorney General Sherrie Brown of the Civil Enforcement Unit. Special Deputy Attorney General Heidi Wendel heads the Medicaid Fraud Control Unit. Supervising Special Auditor Investigator Helen Long, Principal Special Auditors Emmanuel Archer and Jerome Hosinking and Senior Special Auditor Investigator Monica Silber conducted the audit with Senior Special Investigator Thomas Burke assisting in the investigation. Representing the Office of the Medicaid Inspector General were Principal Medical Facilities Auditor Patrick W. Dufresne and Management Specialist 2 Paul Konecnik. Also assisting in the investigation and audit was the Human Resources Administration and the Office of the State Comptroller. In 2004, the Comptroller’s Office issued a report entitled Multiple Medicaid Payments for Managed Care Recipients.