Published: 2010-03-02 20:06:02
Author: Barbra Golub | Atlantic Information Services | February 18, 2010
In fiscal year 2009, New York state exceeded the amount of recovered improper third-party liability payments federally mandated under the Federal-State Health Reform Partnership (F-SHRP). The state also shouldn’t have problems meeting recovery goals for FY 2010, which ends Sept. 30. However, according to New York state Medicaid Inspector General Jim Sheehan, the state may have difficulties meeting FY 2011 goals.
Under the F-SHRP — a federal program that sets requirements for Medicaid fraud and abuse recoveries — New York agreed to recover a certain amount of overpayments from Medicaid providers and suppliers every fiscal year through 2011. For example, the recovery target was $215 million for FY 2008. New York exceeded that target by $336 million, recovering $551 million in FY 2008. This was more than was recovered by all states combined in FY 2007 ($305 million). The recovery target was $322 million for FY 2009, and is $429 million for FY 2010 and $644 million for FY 2011. The state receives recovery payments in various forms, including lump-sum payments, installments and through the withholding of future Medicaid payments to providers.
In a presentation Sheehan made to the state Senate Committee on Investigations and Government Operations Jan. 7, he told the committee that the state has collected $323 million in FY 2009 recoveries.
In an interview with MCN, he says the state should be able to meet the FY 2010 goal, but he is not as certain about FY 2011 recoveries. It will be difficult to collect $644 million in third-party payments, he says, especially in light of the efforts New York is making to prevent overpayments in the first place. “If I’m right and we get to 2011 [and can’t make the recovery goal], we have to go back to CMS” and re-evaluate the target amount, he says. If CMS does not agree with adjusting the targeted amounts and the state fails to meet any of these established goals, it will lose up to $1.5 billion (up to $300 million per year) of federal funding for specific designated expenditures.