New York City will pay $70 million to the federal government for overbilling Medicaid for home care services that patients may not have actually needed.  The city admitted that it re-authorized home care services for patients without first obtaining assessments from doctors, nurses, and social workers, and that it failed to obtain independent medical reviews when the level of care needed was disputed.

Despite the city’s stipulations that were submitted along with the settlement, Corporation Counsel Michael Cardozo characterized the city’s actions as merely “technical record-keeping deficiencies.” The whistleblower who brought the case to the attention of the federal government, a medical doctor employed by the city contractor who reviews applications for the Personal Care Services Program, tells a different story.  He alleged that patients were regularly given costly 24-hour home care services–services that could cost $75,000 to $150,000 a year for a single patient–when other levels of care or alternative social services would have been more appropriate.  The whistleblower will receive approximately 21 percent of the settlement.

Read the entire article, “City to Pay $70 Million in Medicaid Suit”