New York is about to get the Oz treatment.
Medicaid czar Dr. Mehmet Oz is turning up the heat on Gov. Kathy Hochul, launching an investigation into the state’s massive $124 billion Medicaid program — which he has claimed is rife with waste, fraud and abuse, The Post has learned.
In a letter sent to Hochul Tuesday, Oz, who heads the US Centers for Medicare and Medicaid Services, posed 50 questions scrutinizing what she and her team are doing to control costs and identify and prevent fraud.
“I am formally requesting detailed information regarding program integrity and provider screening and enrollment oversight within New York’s Medicaid program. This request is necessary to ensure public confidence and protect beneficiaries in your state’s Medicaid program,” said Oz.
Medicaid is the public health insurance program for those in need, with costs split among the federal, state and local governments.
“The data is clear. New York far outspends other states on its Medicaid program on a statewide and per beneficiary basis,” Oz said in the letter, also sent to state Health Commissioner Dr. James McDonald, state Medicaid Director Amir Bassiri and acting Medicaid Inspector General Frank Walsh Jr.
New York’s average spending on each Medicaid beneficiary is $12,528 — 36% higher than the national average, he said.
“New York’s average Medicaid spending per resident was the highest in the country — nearly 80% higher than the national average,” he said.
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“These elevated costs reflect a combination of more New Yorkers enrolled in Medicaid relative to the state’s population, potential fraud, expansive benefit structures, and excessive provider payment levels within New York’s program compared with most other states,” Oz added.
More than 6.8 million New Yorkers — 34% of the state’s population — are currently covered by Medicaid
Oz said one of the leading drivers of Medicaid’s explosive growth is the increase in the number of workers serving elderly New Yorkers in home care, adult day care and personal care programs.
He also pointed to criminal fraud uncovered by the Justice Department — including two Brooklyn scammers who pleaded guilty to defrauding a whopping $68 million from the state’s Medicaid home care program by paying health care kickbacks for services they didn’t provide at three Big Apple businesses.
In another case, 10 defendants were arrested in a home health aide fraud scheme, where Medicaid was billed for home health services that were never provided.
The Post also recently uncovered how the state allegedly lost millions of taxpayer money to scammers through the Consumer Directed Personal Assistance Program and how it spends up to $400 million a year on Social Adult Day Care centers, which mostly duplicate the offerings of senior centers.
“These cases expose ongoing program integrity vulnerabilities within the New York State Medicaid program and home and community-based service delivery system that warrant structural program-integrity measures given the scale of such services,” Oz said.
Additionally, the letter stated that CMS found a 121% increase in spending on non-medical transportation services in the last three months of data surveyed.
He also expressed concern that some of the same providers billed Medicaid for adult day care and transportation services, a practice that could invite “coordinated fraud” via recruitment schemes, phantom rides, inflated mileage claims and for transportation to adult day care sessions “that never occurred.”
Oz also said spending on mental health/psychotherapy services appeared to be high.
He has launched similar probes in California and Minnesota.
