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NEW YORK STEPS UP MEDICAID FRAUD PROSECUTION EFFORTS.

In response to a series of recent articles appearing in the New York Times, Governor Pataki recently created an independent Inspector General's office to investigate and assist in the prosecution of Medicaid fraud cases. Additionally, the Governor ordered a broad overhaul of the various state agencies that both administer the program and scrutinize potentially fraudulent claims. The new Inspector General is expected to take over some investigatory authority from the State Department of Health, which now administers the overall $44.5 billion anti-fraud program. The Times reported that in 2004, the State Department of Health referred just thirty-seven cases of suspected fraud to the state Attorney General's office for possible prosecution, far fewer than similar agencies in other large states. According to federal statistics, the recovery of monies from fraud and abuse inquiries by the N.Y.S. Department of Health has fallen by seventy percent in the last four years. Since the changes were authorized by executive order, they do not require the approval of the state legislature and will be implemented immediately. In the wake of the Times series and the Governor's reaction, physicians across the state should anticipate a dramatic increase in investigations, enforcement and prosecution on the part of the new Inspector General for Medicaid Fraud, the N.Y.S. Department of Health and the Office of the Attorney General. If you are contacted by any governmental agency investigating allegations of health care fraud, feel free to contact Kern Augustine for assistance.

NEW MEDICAL REPORTING ERROR LEGISLATION SIGNED INTO LAW

Late last month President Bush signed into law legislation aimed at improving patient safety by instituting a system for medical error reporting. Passage of the measure was swift, with the Senate unanimously approving the bill on July 21, 2005 and the House following suit by an overwhelming majority some six days later. The "Patient Safety and Quality Improvement Act", as the measure is known, is intended to encourage voluntary error reporting by protecting such information from disclosure in civil, criminal or administrative proceedings before federal and state courts or administrative agencies. Accordingly, it is intended that the information will be protected from disclosure to state disciplinary authorities such as the New York State Department of Health, Office of Professional Medical Conduct.

FEDERAL FUNDS AVAILABLE FOR EMERGENCY ROOM SERVICES TO UNDOCUMENTED ALIENS.

Under new Medicare law, some physicians may be eligible for federal funds for otherwise un-reimbursed emergency care provided to undocumented aliens and certain other non-U.S. citizens. The payment window opens when the hospital's EMTALA obligation begins and closes when the patient is stabilized. Payment is not provided for physician follow-up care for patients no longer receiving hospital services. Detailed information can be found at www.cms.hhs.gov/providers/section 1011.

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