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Senator Scott and witnesses highlight decertification of New York fraud control unit and uneven state enforcement
Summary
Lawmakers discussed HHS decertification of New York’s Medicaid fraud control unit and wide variation in states’ fraud investigations and convictions, with witnesses urging stronger codified oversight of state fraud units.
Senator Scott asked witnesses about the HHS Office of Inspector General's recent decertification of New York’s Medicaid fraud control unit and contrasted New York’s low conviction counts with higher rates reported in some smaller states. Jonathan Ingram said New York had been "horrendous" in performance compared with some smaller states that secured many more indictments and convictions relative to size and argued for stronger, codified oversight requirements for state fraud control units.
Ingram and other witnesses recommended tighter oversight metrics and regular rescreening of providers; they cited examples where states failed to revalidate providers for years and urged measures to suspend payments to providers credibly accused of fraud. Senators asked for stronger enforcement mechanisms and for documentation supporting relative state performance claims.
