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January 28, 2013

Maragos: County Is Effectively Monitoring Medicaid Eligibility

County Medicaid Expenditures at $1.8 Billion Annually

Mineola, NY - Nassau County Comptroller George Maragos released his review of the Nassau County Department of Social Services (DSS) Medicaid Unit’s effectiveness in managing Medicaid costs and preventing abuse. In 2011, the Medicaid Program spent approximately $1.8 billion while handling approximately 94,000 cases. The Medicaid Unit was found to be effective in managing the Medicaid Program with relatively few instances of weaknesses.

“We were pleased to find the Medicaid Unit operating efficiently, and protecting taxpayer money,” Comptroller Maragos said. “The Medicaid Unit and the Mangano Administration should be commended for handling a large and growing caseload with reduced staff and with little error while providing benefits to eligible residents.”

During the review auditors found only 13 cases, totaling $29,315, involving clients who moved out of state and who continued to erroneously have their Managed Care premiums paid. This represented about 0.014% of the total annual case volume managed by the Medicaid Unit. The Department reviewed these cases and was able to recover almost $9,000 to date. It also tightened policies to better safeguard taxpayer dollars.

Additionally, the auditors found that out of 23,183 new Medicaid cases processed in 2010, 10.7% or 2,482 required more than 45 days and 2.5% or 582 cases took more than 90 days to determine eligibility due to extenuating circumstances. On average, cases were disposed within 24 days.  New York State law requires that disability cases be processed within 90 days and all others within 45 days. The Medicaid Unit has already implemented a proprietary tracking system to better track application type and due date.

The Medicaid Unit was also found to be effectively verifying applicant income and eligibility. In 2010 and in 2011 the Unit referred about 2,100 questionable applicants for formal investigation. The following are some examples of fraud which was uncovered:

  • A 51-year-old Great Neck man falsely reported that he was a part-time security guard for a retail store and falsified records to indicate that his family paid $750 in monthly rent, in order to illegally qualify for $40,722 in Medicaid benefits.  A DSS investigation revealed that the man actually owned a successful clothing store in Manhattan and owned a home in Great Neck purchased in 2006 for $856,000;
  • A 52-year-old Merrick man illegally obtained $42,322 in Medicaid and Food Stamps benefits after concealing income he received from several businesses that he owned. Despite reporting that he was either unemployed or working as a day laborer at various times, a DSS investigation revealed that the man and his family owned four businesses, a $613,000 home in Merrick, a 2010 Cadillac and a 2011 Chevy Camaro;
  • A 52-year-old Plainview woman and her husband failed to report their true income, resulting in $33,618 in illegally obtained Medicaid benefits; and
  • A 56-year-old East Meadow man failed to disclose his true income and falsely stated that he was working part-time at a pizzeria in order to illegally qualify for $15,844 in Medicaid and Food Stamps benefits.  A DSS investigation revealed that the pizzeria that the man reportedly worked for does not exist and that he is employed as an “Executive Chef” at an upscale restaurant.

All of these cases were referred to the Nassau County District Attorney’s Office for criminal fraud prosecution, and full restitution. 

The total Medicaid cost per year in Nassau County amounts to approximately $1.8 billion.  The County’s portion of this federal, state, and local program costs Nassau County taxpayers approximately $226 million or about 12.5% of the total expense.

PDF File Limited Review of the Nassau County Department of Social Services Medicaid Administration Unit