Out of Control Policy Blog

This is No Time to Go Soft on Medicaid Fraud

New York has decided to soften their audits or medicaid fraud, make them less adversarial. Which is striking considering how much fraud their audit program has uncovered and and how much it has saved taxpayers--$1.5 billion in the first 4 years.

James Introne, Mr. Cuomo’s deputy secretary for health said “An audit need not be an adversarial enterprise. To the extent that an audit turns into an adversarial affair, it may not be conducted properly. An audit is successful when people agree.”

That may be true of audits attempting to identify opportunities, like recovery audits. But it is NOT true of fraud audits.  Everyone is innocent until proven guilty, but audits for fraud have to assume the perpetrators are trying to cover their tracks. So such audits have to be tough.  NY is essentially saying they'd be willing to led some fraudsters get away with it and give up some of that $1.5 billion recovered if it would make everyone more comfortable, less "adversarial." This when NY is has raised taxes and still has a $2 billion budget deficit.

Adrian Moore is Vice President, Policy


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