Attorney General Andrew M. Cuomo today announced that his Medicaid Control Fraud Unit (MFCU) recovered over $263 million in damages and restitution from cases of provider fraud across New York State in 2008.

According to MFCU’s 2008 Annual Report, which was submitted today to the U.S. Department of Health and Human Services, the Unit obtained nearly 150 convictions last year, the highest number in the last five years. The Unit also secured settlements and court orders requiring the payment of $263.5 million in civil damages and criminal restitution, surpassing the $113.8 million achieved in 2007 and $59.3 million in 2006.

“2008 marks a truly landmark year for New York’s Medicaid Fraud Control Unit,” said Attorney General Cuomo. “Through efficient use of our resources and a steadfast commitment to the patients of New York State, we were able to more than double the money recovered in cases of provider fraud and hold accountable individuals and companies that abuse or neglect their patients. In this economic climate, MFCU’s mission to protect both taxpayer dollars and patient wellbeing is absolutely essential.”

The report highlights the Unit’s activities and major cases during 2008, and includes data regarding the 143 convictions the Unit obtained. Some of the cases, settlements, convictions, and achievements described in the report include:

Operation Home Alone: The Attorney General’s investigation of corruption in the home health industry resulted last year in civil settlements with certified home health agencies totaling $27.7 million. In addition, the former owner and president of an agency was convicted of a felony for falsifying the agency’s cost reports. Operation Home Alone also produced numerous convictions of private-duty nurses who billed Medicaid for home health services they never provided and convictions of more than 45 defendants who took part in a network of home health aides who possessed bogus certifications, schools that sold certificates without providing adequate training, and licensed home health care service agencies that knowingly hired unqualified aides, resulting in millions of dollars in unlawful Medicaid billings.

New York Certified Aide Registry and Employment Search Act: At the request of Attorney General Cuomo, the state legislature passed and the governor signed into law the “New York Certified Aide Registry and Employment Search Act,” establishing a registry of home health and personal care aides. The act, which was signed into law on September 25, 2008, addresses the problem of unqualified aides working with invalid training certifications. It creates new protections for care-dependent New Yorkers by establishing, through the New York State Department of Health, a central, internet-based registry of aides that includes background information and sworn proof of proper training.

Pharmaceutical Settlements: NYMFCU participated along with other states and the federal government in settlements with pharmaceutical companies, including Bristol-Myers Squibb, Merck, and Cephalon, for off-label marketing, kickbacks, and other fraud.

Healthfirst Settlement: NYFMCU obtained $35 million in a settlement with Healthfirst, the largest Medicaid managed provider in New York State, as a result of the company’s violation of its managed care contracts and the indictment of a former executive of the company is pending in New York County.

Hidden Camera Investigation into Nursing Home Abuse: In October 2008, NYMFCU, which leads the nation in the use of covert surveillance in nursing homes to uncover and deter the criminal abuse and neglect of vulnerable nursing home residents, arrested and charged eight health care workers at the Medford Multicare Center for Living on Long Island with endangering patients and falsifying business records to conceal their neglect. Footage from a hidden camera concealed in one patient’s room captured six of these eight workers allegedly neglecting the patient.
MFCU is the largest unit within the Criminal Division of the Office of the New York State Attorney General. It is dedicated exclusively to the investigation and prosecution of Medicaid fraud and patient abuse and neglect, and served as the federal statutory model for the creation of the national Medicaid fraud control unit program.

Under the federal legislation that created the Medicaid fraud control unit program in 1978, the federal government funds 75 percent of Medicaid fraud control units’ budgets and states fund 25 percent. The U.S. Department of Health and Human Services administers the federal grant funds for the nation’s 50 Medicaid fraud control units. The NYMFCU’s own monetary recoveries fund New York State’s share of the unit’s budget with the remainder of the money returned to the New York State Department of Health’s Medicaid budget.