Exclusive | House panel accuses NY of flouting law by ignoring fraud risk to Medicaid providers

WASHINGTON — A House committee has accused New York of flouting federal law by failing to identify “risk levels” of Medicaid service providers that could be defrauding the taxpayer-funded program, according to a new report.The House Energy and Commerce Committee has been probing New York and nine other states for potential fraud in the distribution of Medicaid or Medicare funding and concluded in a Tuesday report that the Empire State was “not complying with federal law by designating provider risk levels” for some of its state-level programs.“New York’s counsel later disclosed to the Committee that it does not designate categorical risk levels of all Medicaid-only providers,” the 87-page report from the Republican-led panel found.“Only recently did New York begin the process of elevating the three provider types that it does designate by risk level to the high risk category,” the report also noted.“It is deeply concerning that the nation’s second largest Medicaid program, which spent nearly $98.2 billion in FY 2024 and $12,528 per enrollee per year in FY 2023, is not complying with federal regulations.”The Energy and Commerce Committee claimed that the Empire State, in response to the House investigation, ended up pausing enrollment for a six-month period in some programs such as home health care agencies, adult day cares and applied behavioral analysis, among others.It’s unclear exactly how much taxpayer funding may have been diverted for fraudulent purposes, though Centers for Medicare and Medicaid Services Administrator Dr.

Mehmet Oz has been probing New York’s system.Medicaid spending currently makes up the largest category of state budgets, with 30.7% set aside on average in funding for the programs, the House report added.“Every dollar stolen from Medicare and Medicaid is a dollar taken from the seniors, children, pregnant women, and Americans with disabilities these programs were created to serve,” Committee Chairman Brett ...