Erie County investigation uncovers $127,000 in Medicaid fraud - The Buffalo News

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Erie County investigation uncovers $127,000 in Medicaid fraud

Erie County has turned up $127,000 in fraudulent Medicaid claims that were paid out to a handful of Medicaid recipients, as well as an additional $320,000 in potential overpayments that were made to local Medicaid providers.

County Executive Mark C. Poloncarz on Thursday said the investigations were conducted by the county’s Office of Inspector General, an entity that the county executive initiated in September 2012.

“That’s $500,000, nearly, in total savings that this office has come up with in the last 1½ years, which surely pays for the office’s cost many times over for a number of years,” Poloncarz said at a news conference in the Rath County Office Building.

The county’s Office of Inspector General is part of a pilot program funded entirely by the state and headed by Michael Szukala, who previously served as deputy comptroller of audit under Poloncarz, when Poloncarz was county comptroller.

Szukala, who joined Poloncarz for Thursday’s news conference, said the audits were precipitated by anonymous tips to the county, as well as some random audits suggested by the state Medicaid office.

“We also do our own analysis in the office,” Szukala said. “My team has access to the New York State Medicaid Data Warehouse. We’re the only county employees that have complete access to it.”

The state’s data warehouse allows the office to monitor real-time Medicaid transactions for trends and anomalies. Poloncarz said confidentiality agreements with the state and federal governments barred county officials from revealing the names of those accused of fraudulently obtaining Medicaid benefits. However, he described them as individuals who were found to be ineligible for Medicaid benefits after it was determined that they had access to substantial assets that they attempted to hide.

“Just in the last couple of months alone, we have identified and sanctioned over $127,000 in fraudulent payments or claims for just a couple of individuals alone,” Poloncarz said.

Medicaid is Erie County’s single largest program expense, at a total cost of more than $1 billion annually, paid collectively by the county, state and federal governments. The county’s share of the cost comes to about $200 million annually.

In 2013, Medicaid provided medical services to about 225,000 people in Erie County or roughly one-quarter of the county population. “Such a big program certainly has a very large potential for abuse,” Poloncarz said.

“We wanted to go out and take a look at the loopholes to try to find fraudulent and dishonest actions that were being done by individuals in this community, not just recipients but also providers who were bilking the system,” he added.


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