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Whistleblower case alleges NYC overbilled Medicare by tens of millions of dollars

By Phillips & Cohen LLP

In an unfolding whistleblower case, the federal government has accused New York City of overbilling Medicaid by ?at least tens of millions of dollars.? The complaint alleges excessive and improper placement of Medicaid patients in a 24-hour home care program, often against the recommendation of medical professionals.

Home care services provide Medicaid patients with in-home support, ranging from cleaning and organization to administering medical care. The government alleges that New York City has been placing patients in home care that do not require such services, as well as placing patients in home care that require more intensive, institutional care ? payment for which the City would have had to contribute.

Before 2006, the cost of home care was split among the federal government, state government and New York City. Since 2006, New York City is no longer billed for that service; the government alleges this change in billing as a potential motive for overuse of the service, although their information goes back a decade and the lawsuit does not specify a significant change after 2006.

The case was brought to the government by whistleblower Dr. Gabriel Feldman, who stands to earn 10-30% of any money recovered by the government.

Full post as published by False Claims Act - Qui Tam on January 19, 2011 (boomark / email).