New York City Settles Allegations of False Medicaid Claims

The case of Ohlmeyer ex rel. United States of America v. City of New York, a whistleblower action brought by the federal government against the city of New York has been settled. The 2012 complaint accused the city’s education department of submitting false claims to Medicaid for counseling services to special education students, and as of January 2014, New York City has agreed to pay $1.37 million in an official settlement.

The complaint, charged that New York City’s Department of Education (DOE) knowingly billed Medicaid for psychological counseling services for individual special education students who did not receive two monthly counseling session, the minimum number required for payment, between 2001 to 2004.

In an effort to break down the allegations, officials explained: Medicaid pays the DOE a flat fee of $223 for each student to whom the DOE provides at least two psychological counseling sessions in a calendar month. Half of that money comes from the federal government. The DOE is not entitled to any payment if an individual student receives fewer than two counseling sessions in a month.

In one of the allegations, the federal government asserts that the DOE requested 15 months of payments from Medicaid for psychological counseling to a student during the 2001-02 and 2002-03 school years, yet the student (according to the DOE’s service records) received fewer than 2 counseling sessions in 12 of the 15months.

Of the settlement amount, 15 percent, or $206,250, will be paid to Dana Ohlmeyer, a DOE social worker,who initiated the case under the whistleblower provisions of the FCA (False Claims Act). The city will also pay FCA attorney’s fees of $40,000.

The city contends that it did nothing wrong and the discrepancies had to do with misplaced documents. However, the case shines a light on the enforceability of Medicaid fraud and its severe consequences. If you or a loved one have been accused or charged with Medicaid fraud, contact an experienced attorney. An skilled medicaid attorney will afford you the representation you deserve and ensure your legal rights are protected. 

Author: Tanya Hobson-Williams

Appointed to the bench by the Board of Trustees in 2008, and elected in 2009, Tanya Hobson-Williams was the first African-American Female Justice in the Incorporated Village of Hempstead. Tanya Hobson–Williams obtained her B.A. in Government and Politics from St. John's University and her law degree from Benjamin N. Cardozo School of Law. Tanya Hobson-Williams has an active elder law practice assisting senior citizens in obtaining Medicaid for Home Care and Nursing Home Care. She routinely lectures at senior citizen centers, assisted living facilities, law schools and counsels families on a variety of topics of concerns to families caring for the elderly. View all posts by Tanya Hobson-Williams