Laura
06-17-2011, 10:01 PM
State's top Medicaid-fraud cop asked to resign
New York's hard-charging Medicaid Inspector General Jim Sheehan >ticked off many hospitals and nursing homes in aggressively recouping more than $1 billion in improper Medicaid payments. Governor reportedly now wants him to quit.
By Gale Scott, Crain's June 17, 2011 11:02 p.m.
NY's hard-charging Medicaid Inspector General Jim Sheehan has been told to resign within 30 days. Mr. Sheehan got the news Tuesday. The official announcement is expected to be made by the office of Gov. Andrew Cuomo.
As the "top cop" for NY's sprawling $52.8 billion Medicaid program, the most expensive in the nation, Mr. Sheehan has recouped more than $1 billion in improper payments and fines since he took the job in 2007. He is the first to hod the post, created to round up hundreds of millions of misspent Medicaid dollars annually. Mr. Sheehan's tactics in doing that enraged many in the hospital and nursing home arena, sparking legislative hearings in 2010 by now-former LI state Sen. Craig Johnson.
Those Mr. Sheehan crossed have been quick to say they will not be sorry to see him go. Their main criticism is that, unlike health insurance companies, he treats all payment errors as fraud or abuse. Insurers who find such errors typically have only 60 days to recover their money and do not impose penalties during that time.
"If I were appointing his successor I'd look for someone who was not a punitive nit-picker, someone who would do the job without the 'gotcha' attitude,'' said Neil Heyman, president of the Southern NY Assoc, a nursing home group.
The news that Mr. Sheehan is leaving has also raised questions about the fate of the Office of Medicaid Inspector General (OMIG) itself, one with a staff of hundreds of investigators. The move could signal that the Cuomo administration is going to divert those resources to other agencies.
Health care providers said they are hopeful the ouster is a repudiation of Mr. Sheehan's aggressive prosecutorial stance in the job. One Albany insider speculated that if that is the case, the logical choice would be a person from the provider side, someone who knows how to run a large health system or a managed care company.
But a second source, a lobbyist for mental health organizations disagreed: "Sheehan was about money and Cuomo's about money. Cuomo won't want to give up all the revenue OMIG has brought in."
At the time the office was created, NY had entered a complex financial agreement with the federal government in which New York got $3.1B to use to cover some costs of closing and consolidating its hospitals. In return, the state pledged to meet specific annual dollar targets in Medicaid savings. That task fell significantly on the OMIG.
Under Mr. Sheehan, who earned a national reputation for fighting health fraud as an associate U.S. attorney in Philadelphia, recouping $332M in one high-profile pharmacy case, his Medicaid inspector office launched a blitz of audits, doing 1,500 between '08 and '10, a period in which federal auditors did only 200. The money soon starting pouring in.
But at Mr. Johnson's state senate hearings, witnesses told of what one called "gangster style tactics" in which auditors would urge facilities to pay up rather than fight charges.
Mr. Sheehan's position has been that there is nothing wrong with treating any accounting error as "Medicaid abuse" or with using extrapolation to estimate how much that error should cost the facility that made it.
For instance, in testimony at the hearing, a nursing home lobbyist said he had seen $700 mistakes turn into $500,000 bills from the Office of the Medicaid Inspector General.
More recently, Mr. Sheehan has devoted more time to educating providers on how to avoid such costly mistakes, holding regular Webinars and frequently lecturing both in New York and nationally. In fact, on Wednesday Mr. Sheehan traveled to Newark, N.J., to give a talk on Medicaid compliance.
Friends said they were not concerned about his employment prospects. "I'll bet he has a new job before the speech is over," said one.
New York's hard-charging Medicaid Inspector General Jim Sheehan >ticked off many hospitals and nursing homes in aggressively recouping more than $1 billion in improper Medicaid payments. Governor reportedly now wants him to quit.
By Gale Scott, Crain's June 17, 2011 11:02 p.m.
NY's hard-charging Medicaid Inspector General Jim Sheehan has been told to resign within 30 days. Mr. Sheehan got the news Tuesday. The official announcement is expected to be made by the office of Gov. Andrew Cuomo.
As the "top cop" for NY's sprawling $52.8 billion Medicaid program, the most expensive in the nation, Mr. Sheehan has recouped more than $1 billion in improper payments and fines since he took the job in 2007. He is the first to hod the post, created to round up hundreds of millions of misspent Medicaid dollars annually. Mr. Sheehan's tactics in doing that enraged many in the hospital and nursing home arena, sparking legislative hearings in 2010 by now-former LI state Sen. Craig Johnson.
Those Mr. Sheehan crossed have been quick to say they will not be sorry to see him go. Their main criticism is that, unlike health insurance companies, he treats all payment errors as fraud or abuse. Insurers who find such errors typically have only 60 days to recover their money and do not impose penalties during that time.
"If I were appointing his successor I'd look for someone who was not a punitive nit-picker, someone who would do the job without the 'gotcha' attitude,'' said Neil Heyman, president of the Southern NY Assoc, a nursing home group.
The news that Mr. Sheehan is leaving has also raised questions about the fate of the Office of Medicaid Inspector General (OMIG) itself, one with a staff of hundreds of investigators. The move could signal that the Cuomo administration is going to divert those resources to other agencies.
Health care providers said they are hopeful the ouster is a repudiation of Mr. Sheehan's aggressive prosecutorial stance in the job. One Albany insider speculated that if that is the case, the logical choice would be a person from the provider side, someone who knows how to run a large health system or a managed care company.
But a second source, a lobbyist for mental health organizations disagreed: "Sheehan was about money and Cuomo's about money. Cuomo won't want to give up all the revenue OMIG has brought in."
At the time the office was created, NY had entered a complex financial agreement with the federal government in which New York got $3.1B to use to cover some costs of closing and consolidating its hospitals. In return, the state pledged to meet specific annual dollar targets in Medicaid savings. That task fell significantly on the OMIG.
Under Mr. Sheehan, who earned a national reputation for fighting health fraud as an associate U.S. attorney in Philadelphia, recouping $332M in one high-profile pharmacy case, his Medicaid inspector office launched a blitz of audits, doing 1,500 between '08 and '10, a period in which federal auditors did only 200. The money soon starting pouring in.
But at Mr. Johnson's state senate hearings, witnesses told of what one called "gangster style tactics" in which auditors would urge facilities to pay up rather than fight charges.
Mr. Sheehan's position has been that there is nothing wrong with treating any accounting error as "Medicaid abuse" or with using extrapolation to estimate how much that error should cost the facility that made it.
For instance, in testimony at the hearing, a nursing home lobbyist said he had seen $700 mistakes turn into $500,000 bills from the Office of the Medicaid Inspector General.
More recently, Mr. Sheehan has devoted more time to educating providers on how to avoid such costly mistakes, holding regular Webinars and frequently lecturing both in New York and nationally. In fact, on Wednesday Mr. Sheehan traveled to Newark, N.J., to give a talk on Medicaid compliance.
Friends said they were not concerned about his employment prospects. "I'll bet he has a new job before the speech is over," said one.