Despite New York's record-breaking success in Medicaid fraud recovery, the state is working to make audits less of an "adversarial enterprise," according to a New York Times report.
Gov. Andrew Cuomo dismissed the state's first Medicaid inspector general, James G. Sheehan, last June. Mr. Sheehan helped recover $1.5 billion in Medicaid overpayments in four years, but had sparked criticism from the healthcare industry for "overzealous, nitpicking audits and unfair tactics," according to the report.
Following Mr. Sheehan's dismissal, New York lawmakers passed legislation to restrict the office's authority, cutting the government's time to reclaim overpayments to three years from six .
Mr. Sheehan's successor, James C. Cox, was tasked to collaborate with providers for audits. In the report, a spokesperson for Gov. Cuomo's administration said, "To the extent that an audit turns into an adversarial affair, it may not be conducted properly. An audit is successful when people agree."
The new style doesn't make sense to many in the regulatory industry, however. Some experts cited in the report say by definition, audits identifying fraud, overbilling or waste will be adversarial. Another expert cited in the report said, "Asking the regulator and the regulated party to sit down and come to some sort of consensus on how the regulation should be — to me, that makes no sense."
According to the report, audit figures released by New York state show Mr. Cox's identification of overpayments have "fallen steeply" since Sept. 30, the date when the state met the deadline for its $1.5 billion federal target.
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Gov. Andrew Cuomo dismissed the state's first Medicaid inspector general, James G. Sheehan, last June. Mr. Sheehan helped recover $1.5 billion in Medicaid overpayments in four years, but had sparked criticism from the healthcare industry for "overzealous, nitpicking audits and unfair tactics," according to the report.
Following Mr. Sheehan's dismissal, New York lawmakers passed legislation to restrict the office's authority, cutting the government's time to reclaim overpayments to three years from six .
Mr. Sheehan's successor, James C. Cox, was tasked to collaborate with providers for audits. In the report, a spokesperson for Gov. Cuomo's administration said, "To the extent that an audit turns into an adversarial affair, it may not be conducted properly. An audit is successful when people agree."
The new style doesn't make sense to many in the regulatory industry, however. Some experts cited in the report say by definition, audits identifying fraud, overbilling or waste will be adversarial. Another expert cited in the report said, "Asking the regulator and the regulated party to sit down and come to some sort of consensus on how the regulation should be — to me, that makes no sense."
According to the report, audit figures released by New York state show Mr. Cox's identification of overpayments have "fallen steeply" since Sept. 30, the date when the state met the deadline for its $1.5 billion federal target.
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