Fraud found in Medicaid in Erie County

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Erie County leaders say they’re finding fraud in the Medicaid system and are now trying to stop it and keep taxpayers’ money where it belongs.

Officials updated their review of the massive health insurance program for low income patients on Thursday. Nine audits in the last year-and-a-half have uncovered nearly a half million dollars the county has overpaid for health care, through Medicaid. That’s out of more than a billion dollars in annual Medicaid expenditures.

County executive Mark Poloncarz says about a fourth of the overpayments involved outright fraud and came from tips. The rest came from overbilling by health providers.

“We’ve identified and sanctioned over $127,000 in fraudulent payments or claims for just a couple of individuals alone. This means that these individuals will have to pay for all claims associated with their health care out of their own pocket,” Poloncarz said.

The other approximately $320,000 would not be considered fraud but would be considered payments that a provider made inappropriately.

County officials say the audits can be turned over to state officials for further investigation and possible criminal prosecution.

The majority of the fraud cases are linked to persons in nursing homes hiding their assets to put their health care on the taxpayers’ dime.

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