New York State is one of 32 that have their qui tam statute. Like other statutes at the state and federal level, the New York State False Claims Act (NYFCA) empowers whistleblowers to file lawsuits against companies and individuals who submit fraudulent claims to the state. The whistleblowers then receive 15-30% of the state’s recovery. The state enacted this statute in 2007. It then amended it in 2018, so the state’s Attorney General would annually report of amounts recovered.
MFCU does much of this work
The state’s Medicaid Fraud Control Unit (MFCU) is the largest unit in the Attorney General’s Criminal Division. Its’ purpose is to recover taxpayer money paid to fraudsters through their illegal billing. The MFCU targets large-scale Medicaid “mills” that create businesses to bill Medicaid programs fraudulently. Their illegal activities often involve:
- Overbilling
- Double billing
- Use of substandard drugs
- Use of substandard medical equipment
- Kickbacks
- Selling prescription drugs or access to them
Along with recovering taxpayer funds, the goal is also to protect the state’s disabled and elderly from abuse and neglect at health care facilities and nursing homes.
It is a team effort
The whistleblowers play a crucial role in rooting out fraudulent billing. Then the MFCU can move in with its prosecutors, investigators and auditors. Their cost is covered by substantial funds they recover each year. The federal government also contributes matching funds at the 3:1 ratio. In the past, limited funding meant limited resources and limited results, but that has now changed. The MFCU has recovered more than $1 billion overall and $216 million between 2018-2020.
They do excellent work and provide fair compensation to whistleblowers, so it is still crucial to report large-scale Medicaid fraud. These cases can be highly complicated, so whistleblowers often benefit from attorneys with experience handling these types of cases.
