8:41 AM, Oct 28, 2014 • By DANIEL HALPER
The federal government is taking New York City to court. "Manhattan U.S. Attorney Files Healthcare Fraud Lawsuit Against Computer Sciences Corp. And The City Of New York For Orchestrating A Multimillion-Dollar Medicaid Billing Fraud Scheme," reads a headline from the Justice Department's press release.
"Suit Alleges Computer Sciences Corp. and New York City Systematically Submitted Tens of Thousands of Claims to Medicaid Without Exhausting Private Insurance Coverage and Also Switched Diagnosis Codes in Tens of Thousands of Medicaid Claims to Get Those Claims Paid."
Preet Bharara, the United States Attorney for the Southern District of New York, announced today that the United States has filed a civil healthcare fraud lawsuit in Manhattan federal court against COMPUTER SCIENCES CORP. (“CSC”) and the CITY OF NEW YORK (the “CITY”). The Government’s Complaint seeks treble damages and civil penalties under the False Claims Act against CSC and the CITY for orchestrating billing fraud schemes that used computer programs to automatically alter billing data. Two of the schemes involved CSC and the CITY using computer programs to circumvent the requirement that Medicaid should be billed after private insurance coverage had been exhausted, and a third scheme involved the use of a defaulting program to systematically falsify diagnosis codes submitted to Medicaid. According to the Complaint, these fraud schemes caused the submission of tens of thousands of false claims to Medicaid and allowed the CITY, through CSC, improperly to obtain millions of dollars of Medicaid reimbursements.
Manhattan U.S. Attorney Preet Bharara said: “As alleged, CSC and the City created computer programs that systematically, and fraudulently, altered billing data in order to get paid by Medicaid as quickly as possible and as much as possible. Billing frauds like those alleged undermine the integrity of public healthcare programs like Medicaid. All public healthcare program participants, whether they are healthcare providers, localities like the City, or contractors like CSC, should understand that they must comply with the applicable billing rules.”
The following allegations are based on the Complaint filed today in Manhattan federal court:
In New York State, early intervention program (“EIP”) services are available to children under the age of three who demonstrated developmental delay or have been diagnosed with medical conditions likely to cause delay. For children in New York City receiving EIP services, the CITY was responsible for processing and paying claims submitted by service providers, then seeking coverage from private insurers or Medicaid or billing New York State for its 49% share of the costs not covered by private insurance or Medicaid.
To minimize its share of the costs of the EIP services, the CITY set annual targets for Medicaid payments and made it a priority to obtain Medicaid payments as soon as possible and for as much as possible. The CITY contracted with CSC to process service provider claims and then seek coverage from private insurers, Medicaid, or the State. To ensure that CSC would focus on obtaining Medicaid payments, the CITY offered CSC financial incentives for exceeding certain targets for Medicaid payments and imposed penalties when CSC failed to meet the CITY’s goals for Medicaid payments. To meet those targets, CSC and the CITY implemented billing fraud schemes using computer programs that automatically altered billing data.
Two of these schemes were designed to circumvent Medicaid’s secondary payor requirement, which required the CITY and CSC to exhaust private insurance coverage before billing Medicaid. In the first scheme, rather than obtaining correct private insurance policy IDs for children who had missing or incomplete policy IDs, CSC developed a program to identify missing insurance policy IDs and then applied a default policy number of 999-999-999, which CSC and the CITY knew would result in denials by private insurers. This scheme enabled CSC and the CITY to submit tens of thousands of false claims to Medicaid without exhausting private insurance coverage and to obtain millions of dollars from Medicaid improperly.
7:45 AM, Sep 4, 2014 • By AVIK ROY
Given that I’ve probably published more articles critical of Obamacare than anyone alive, I’m often asked to speak to conservative audiences about our new health law.
11:02 AM, May 13, 2014 • By JERYL BIER
On Sunday, the White House blog declared that Obamacare made this Mother's Day "particularly special." On Monday, the Obamacare website Healthcare.gov got into the act, suggesting that "Health insurance with Medicaid is the perfect Mother’s Day gift":
What LBJ wroughtMay 19, 2014, Vol. 19, No. 34 • By NICHOLAS EBERSTADT
May 22, 2014, marks the 50th anniversary of President Lyndon Baines Johnson’s “Great Society” address, delivered at the spring commencement for the University of Michigan. That speech remains the most ambitious call to date by any president (our current commander in chief included) to use the awesome powers of the American state to effect a far-reaching transformation of the society that state was established to serve. It also stands as the high-water mark for Washington’s confidence in the broad meliorative properties of government social policy, scientifically applied.
8:11 AM, Apr 1, 2014 • By JERYL BIER
The office of the inspector general (OIG) for the Department of Health and Human Services (HHS) has uncovered seventy-nine "high-risk security vulnerabilities" in the information processing systems of ten state Medicaid agencies that "raise concerns about the integrity of the systems used to process Medicaid claims." While the ten states are not identified by name, the OIG said that the investigation "suggests that other State Medicaid information systems may be similarl
7:32 AM, Oct 18, 2013 • By JERYL BIER
In light of the beating the Obama administration is taking over the ignominious launch of the Obamacare insurance marketplaces, it makes sense that the White House would be looking for good news to share. The White House Twitter account attempted to provide a boost on Thursday with the following:
8:44 AM, Aug 29, 2013 • By JERYL BIER
The state of Alabama received bonus payments from Medicaid for 2009 and 2010 that were a stunning 13 times higher than the state was eligible for. So says the inspector general (IG) for Health and Human Services in a report released on Wednesday.
10:24 AM, Mar 15, 2013 • By DANIEL HALPER
In a report on its website, the credit rating firm Moody's pushes for Medicaid expansion. The firm warns that states who do not expand Medicaid will face "political and budgetary pressure."
11:45 AM, Feb 27, 2013 • By JEFFREY H. ANDERSON
Yesterday, Chris Christie became the eighth Republican governor to capitulate on Obamacare’s massive Medicaid expansion, declaring his desire to implement it in his state. Yet while Christie wasn’t the first GOP governor to fold, he was presumably the first to offer the novel defense that his decision somehow won’t cost federal taxpayers any money.
1:01 PM, Jan 22, 2013 • By MICHAEL WARREN
Wisconsin congressman Paul Ryan knocked President Barack Obama for "shadowbox[ing] a straw man" in his inaugural address. Speaking Tuesday morning on the Laura Ingraham Radio Show to guest host Raymond Arroyo, Ryan responded to Obama's statement that Medicare, Medicaid, and Social Security "do not make us a nation of takers, they free us to take the risks that make this country great."
Ryan called Obama's insinuation that he and other reform-minded Republicans consider recipients of these benefits "takers" a "switcheroo."
5:35 PM, Jan 16, 2013 • By GEOFFREY NORMAN
The head of the AARP has stated clearly where his organization stands on the matter of cutting entitlements. As Kate Ackley reports in Roll Call:
12:14 PM, Nov 16, 2012 • By JEFFREY H. ANDERSON
First off, it’s not a “fiscal cliff.” What we’re slated to hit as of New Year’s Day, as the Wall Street Journal notes, is a tax cliff. Our fiscal cliff, which drops off into a far deeper canyon, is what looms because of our $16,000,000,000,000 debt and the runaway entitlement spending that fuels it — Medicare, Medicaid, (and now) Obamacare. In truth, the debt deal passed in the summer of 2011 — which the press now says we must scrap if we are to avoid the “fiscal cliff” — was designed to postpone our going over the (actual) fiscal cliff.