Suozzi Appoints Ex-Prosecutor to
Lead Medicaid Investigations

Mineola, NY – Nassau County Executive Thomas R. Suozzi today appointed a former prosecutor as Director of Medicaid Investigations to lead a team of investigators, researchers and analysts who are pursing cases of Medicaid waste and fraud within the county.

Suozzi tapped Nicole Watkins, 42, a former assistant district attorney in the Manhattan District Attorney’s office, to the new position. As a prosecutor in the DA’s Special Prosecutions and Trial Bureaus, Watkins investigated and prosecuted complex financial crimes. She also built hundreds of domestic violence and child abuse cases, developed trial strategies, presented cases before grand juries and conducted trials. As a prosecutor, Watkins built bridges with outside organizations, working closely with law enforcement agencies and community groups.

“The appointment of Medicaid czar is a key part of the fight, and I’m very pleased to have an experienced, aggressive prosecutor like Nicole Watkins take on the challenge,” Suozzi said.

“I am looking forward to joining Nassau’s team,” Watkins said. “The county’s taxpayers deserve a strong advocate to ferret out anyone who may be abusing taxpayer money in this very important program.”

In addition to this new appointment, Suozzi announced an effort to work with home health care agencies in the county to ensure that their billing procedures accurately reflect the services they are providing to Medicaid recipients. A county investigation found that 16 home health care agencies in Nassau County could not fully substantiate more than $700,000 they billed to Medicaid during a six-month period, Suozzi said.

Investigators are examining the financial records of 37 home health care agencies that have contracts with the County. All 16 of the agencies that have been investigated so far submitted claims for payment the county believes should be better documented, investigators found. The unsubstantiated claims to Medicaid total $700,865.

The discrepancies in the agencies’ records were identified through the Automated Time and Leave system, which the county launched in 2003. Home health care agencies that do business with the county must require workers to call into the system when they start a shift, and again at the end of the shift. But investigators found that time records at each of the 16 agencies were inconsistent. Some home health aides checked in at the beginning of the shift, but didn’t check out at the end. Some checked out, but neglected to check in. And others didn’t report in at all.

Investigators found wide variations in the procedures used by agencies to confirm their aides’ hours of work when the automated system wasn’t used. This lead the county to conclude that this is an area of the Medicaid billing system that needs to be tightened up.

“We’ve been successful in putting the Medicaid issue front and center, and we’ve fought for and achieved results both in Albany and here in Nassau County,” Suozzi said. “This investigation shows the Automated Time and Leave System we put in place is working, alerting us to potential problems. But more needs to be done. Each and every one of the agencies we’ve looked at so far submitted thousands of dollars in claims they can’t substantiate. Each one. And that’s just in six months. Every dollar wasted in Medicaid hurts this program, which remains a vital safety net for so many of the county’s residents who cannot afford private health insurance.”

The appointment of Director of Medicaid Investigations is the first element in Suozzi’s four-point plan to rein in out-of-control Medicaid costs. The plan also calls for:

• establishing clear lines of communication between various County and State agencies and making the system more efficient;  
• enhancing the County’s technology to automatically red-flag potential fraud;
• getting the message out to the public and encouraging whistle-blowers to come forward.

The cases have been turned over to the State Department of Health, said Peter Clement, Acting Commissioner of the Nassau County Department of Health and Human Services. If a state review finds wrong-doing, the agencies could face fines, sanctions and criminal or civil charges.

The Suozzi administration looks forward to working with home health care agencies that contract with the county to make the Medicaid system more efficient. Many of the agencies involved provide critical services to the neediest of the county’s residents.

“We are happy that the members of the home care industry want to work with us on this vital initiative,” Suozzi said.

County investigators are currently examining the records of the remaining 21 home health care agencies that have contracts with Nassau County.

New York State spends two and a half more per Medicaid beneficiary than the national average. Since taking office in 2001, Suozzi has made reforming the bloated Medicaid system a priority. He launched the “Fix Albany” campaign two years ago to convince state lawmakers to take action, and was part of a bi-partisan group of New York county executives that successfully fought Albany for a cap on local governments’ share of the burden.

The Suozzi administration has also gotten local results. The county and the New York State Attorney General last month sued a Rockville Centre home care agency, Nurses on Hand Registry, Inc., and its owner for allegedly falsifying documents. County investigators found the company had falsely billed $200,000 to Medicaid for 10,000 hours of care.