Sunday, May 1, 2011
Medicaid fraud rampant in Rego Park
Medicaid is a health care program reserved, primarily, for the poor. Benefits are based on federal poverty guidelines. To be eligible in New York State, a single person must earn less than $17,000 a year.
With that in mind, you might expect the most impoverished neighborhoods would be the ones that generate the most Medicaid bills.
It turns out, the state’s highest Medicaid billing total can be found within a relatively affluent community: Rego Park, Queens.
With the help of the New York Office of the Medicaid Inspector General, NBC New York examined Medicaid data from all of the state’s nearly 15,000 zip codes.
The analysis found Rego Park -- a neighborhood with a median income above $50,000 -- generated more than $1.5 billion in Medicaid reimbursements in 2010. Because the health care program is aimed at helping poor people, the findings had even regulators scratching their heads.
By running data queries, Little discovered one of the state’s largest Medicaid managed care contractors uses a Rego Park address to process bills -- a clear reason for the high billing volume.
That doesn’t mean investigators won’t continue to have their eyes on the Queens neighborhood.
In his data query, Little also discovered pharmacy reimbursements make up the second largest share of Medicaid bills in Rego Park. That is significant because Rego Park pharmacists have been snared for fraud in the past. Most recently, federal prosecutors busted Rego Park’s ASA Pharmacy for taking part in a $2.5 million kickback scheme.
Currently there are thirteen Rego Park medical service providers who have been banned from participating in Medicaid.