Rockland Fights Medicaid Fraud, Contributions from Counties

NEW CITY, NY — Rockland County has saved nearly $7 million in Medicaid expenses by rooting out fraud, County Executive Ed Day has announced. Day is opposed to New York State's 50-year-old policy mandating county contributions to the federal program. One in three Rockland County residents receives Medicaid benefits.

Medicaid costs make up 55 percent of our tax levy, the county executive said. "We owe it to the taxpayers to do all we can to make sure this program is being used appropriately."

The County Executive has also announced that he is continuing to work to stop the state from charging counties for Medicaid.

That issue recently flared up as Republican members of the New York congressional delegation voted to repeal the Affordable Care Act when an amendment was added expressly aimed at New York. Rep. John Faso (R-Kinderhook) and Rep. Chris Collins (R-Geneseo) attached the amendment to Speaker Paul Ryan’s American Health Care Act that would have banned federal reimbursement for state Medicaid funds for local governments outside of New York City, cutting Medicaid for those local entities by $2.3 billion. The move was met with fury from Gov. Andrew Cuomo in Albany and fear from hospitals and nursing homes across the state.

Faso said he believed New York's Medicaid program should more closely resemble those in Texas and Florida. Florida is the fifth lowest state in terms of Medicaid payments per enrollee, while New York ranks second highest, according to a 2016 special report from 24/7 Wall Street.

According to the National Association of Counties, 26 states have counties contribute to Medicaid: "Of these, 18 mandate counties to contribute to the non-federal share of Medicaid costs and/or administrative, program, physical health and behavioral health costs. Mandated county contributions are the highest in New York, by far; counties in New York send nearly $7 billion per year – or $140 million per week – to the state for Medicaid costs."

"We have to pay these astronomical costs, but we have no say in how the program is run," Day said.

Day said he lobbied the County Executives of America, a non-partisan advocacy group of which he is a board member, to pass a resolution calling for New York to change its policy of requiring counties to pay for Medicaid. The organization passed a resolution calling on the state to change its policy. The resolution had bipartisan support, with the county executives of Orange County and Albany County co-sponsoring the resolution.

"We will continue to fight to get this expensive mandate off our backs," Day said.

How big a program is it? In Orange County, the heart of Faso's district, one in five people were Medicaid recipients in 2013, according to NY state. In 2016, one in three Rockland county residents received Medicaid benefits — 107,000 people — according to county data.

Rockland County spent $66 million on Medicaid in 2016, roughly 55 percent of its tax levy.

During Day's three years in office, the county has focused on Medicaid fraud on two fronts.

"We are appropriately aggressive," the county executive said.

The Rockland 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 has saved $3.5 million, the county executive said.

The county has also used a highly successful and cost efficient system of front end detection strategy to save $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," Day said.

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.

Rockland County works with other agencies to track down suspected fraud, including the New York State Office of the Medicaid Inspector General. When fraud is found, the county refers cases to the Rockland County District Attorney's Office.