Combating Medicaid Fraud

When you pay your county property taxes, more than half of the tax levy – 55 percent – goes toward paying for one item: Medicaid.
Here in Rockland County, our share of Medicaid costs us $66 million every year.
Two factors are at work here: New York State charges counties more than three times all other counties in the nation combined to pay for what is essentially a state program.
The other factor is the sheer number of people in Rockland County who participate in this program. Our latest figures show that 107,000 Rockland residents qualify for Medicaid – roughly one of every three people in the county.
With those kind of costs eating up our budget, we have no choice but to be what I call appropriately aggressive in rooting out fraud.
We owe it to the taxpayers to do all we can to make sure this program is being used appropriately.
During my three years as County Executive, we have beefed up our efforts to detect both applicants and recipients who don’t actually qualify for this entitlement.
Those efforts are paying off: we have saved nearly $7 million of your money in Medicaid expenses by rooting out fraud.
Here’s how we did it.
Our Department of Social Service’s Special Investigations unit has identified numerous cases of people receiving benefits when they were did not meet income eligibility guidelines.
That effort alone has saved $3.5 million.
We have also used a highly successful and cost efficient system of front end detection strategy that has saved us $3.4 million in costs.
The goal of the front end detection strategy is to identify potential fraud or misuse at the time of application, before tax dollars are spent on benefits.
Our investigators look for indicators that have been approved by the state as red flags, including expenses that exceed reported income, applicants who have worked off the books or people who are self-employed but don’t have records to substantiate reported information.
Front end detection is key because it enables the county to avoid paying expensive benefits to an ineligible applicant instead of trying to recover funds later. Those recovered funds go largely to the state and federal governments.
When we do find potential fraud, we work with other agencies, including the New York State Office of the Medicaid Inspector General.
When fraud is found,  we refer cases to the Rockland County District Attorney’s Office for possible criminal charges.
Just last month, District Attorney Thomas Zugibe brought fraud charges against five Haverstraw residents who allegedly engaged in fraud to obtain $95,000 in benefits.
That’s real money and a chunk of it is coming out of your pocket.
We will continue our efforts to root out fraud.

At the same time, I am continuing my fight to get this expensive Medicaid cost off the backs of counties.
We have to pay these astronomical costs, but we have no say in how the program is run.
If the state of New York is running Medicaid, let the State of New York pay the bill.
I have also lobbied the County Executives of America, an influential non-partisan advocacy group of which I am a board member, to pass a resolution calling for New York to change its policy of requiring counties to pay for Medicaid.
The organization took up the cause and passed a resolution calling on the state to change its policy. The resolution had bipartisan support, with the countyexecutives of Orange County and Albany County co-sponsoring the resolution with me.
Counties should not be stuck with this expense. But while we are, you have my word that we will be appropriately aggressive about making sure only residents who truly qualify get this service that all of us are funding.

About the Author
Ed Day, the current Rockland County Executive, has resided in Rockland for over 30 years and raised his family here. His varied non-political background includes executive professional experience in law enforcement and the private sector; civic experience including being past president of the Little Tor Neighborhood Association and 20 years of coaching young people; and extensive school and youth advocacy that includes being a PTA Life Award winner.

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