New York City Agrees to Pay $70 Million to Settle Medicaid Fraud Allegations

On October 31, 2011, the US Attorney’s Office for the Southern District of New York announced its latest victory in the fight against healthcare fraud.  Although healthcare fraud often involves healthcare providers and large companies, state entities can commit fraud too.  In this False Claims Act lawsuit, the Government accused New York City of committing Medicaid fraud for ten years.  The complaint alleged that New York City wrongly managed the Medicaid personal care services program (PCS) by allowing the authorization and re-authorization of personal care services for Medicaid recipients without completing the mandatory assessment and approval process.  Additionally, the complaint alleged that between 2000 and 2010, the Government paid millions of dollars to reimburse the city for these billed personal care services.

New York City has agreed to pay $70 million to settle these allegations and has actively admitted to wrongdoing in the settlement agreement.  Finally, the City has agreed to implement better practices in order to be sure to comply with New York State regulations regarding personal care services in the future.

Dr. Gabriel Ethan Feldman was the determined whistleblower in this qui tam case.  Feldman is a double-board certified physician and a fellow of the American College of Preventative Medicine with Master’s degrees in Business, Public Health, and Health Administration.  He continually tried to raise public awareness surrounding New York City’s abuse of PCS, and finally filed his case in 2009.  Feldman will be receiving $14.7 million as his reward for bringing the City’s fraud to the attention of the Government.

If you know about fraud or are considering blowing the whistle on Medicare fraud or Medicaid fraud being committed and want to speak with an attorney about your options, contact the qui tam attorneys at Tycko & Zavareei for a free initial consultation.  For more information, visit our website at www.fraudfighters.net.

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