The Office of the Medicaid Inspector General has also stopped the payment of more than $30 million in Medicaid funds to CRS. The $16.5 million fine is the largest fine ever levied by either the OMIG or OASAS. The New York Times reported today that the clinic is a profit-making entity owned and operated by psychiatrist Dr. Yelena Mamedova-Braz, and Maya Gurevich.
"This joint investigation between OASAS and the OMIG enabled New York State to stop $30 million in Medicaid funds from being spent, and sends a clear and concise message to Medicaid providers that if you bilk the system, you will be punished accordingly," Pataki said in a release. "CRS was cheating the State's Medicaid program at the expense of patient care -- an abhorrent practice -- and a practice that will come to an end thanks to this enforcement action."
On-site inspections and interviews were conducted with current and former CRS staff. Triggering this targeted investigation was CRS's failure to comply with its OASAS-issued Operating Certificate by providing inappropriate and unnecessary patient services and evidence of potentially fraudulent and excessive Medicaid billing.
The investigation concluded that CRS has clearly provided excessive and unsuitable services to its patients over a period of years. CRS has by far the highest average number of per patient visits in the entire OASAS outpatient system (152 per year vs. the system-wide average of 34.4). Many of the individuals treated by CRS presented minimal alcohol and substance abuse patterns. Many so-called patients have seemingly not had abuse or dependence issues for years.
Despite this fact, CRS patients were assigned intensive treatment schedules and tended to stay in the clinic an average of over 20 months, while the average length of stay for the statewide OASAS system is roughly 3.7 months per patient.
As a result of this joint investigation, the Medicaid Inspector General's Office will be terminating the provider's contract with the Medicaid program and excluding it and all of its principals from future participation in Medicaid. During the course of this investigation, the OMIG has withheld 100 percent of Medicaid payments and suspended all claims from processing. Additionally, as a result of this joint investigation, OASAS intends to revoke the Operating Certificate of CRS.
State Office of Alcoholism and Substance Abuse Services (OASAS) Executive Deputy Commissioner Henry F. Zwack said, "With this enforcement action, we are slamming the door shut on the largest, most abusive Medicaid mill in the OASAS system. This program was averaging five times the amount of billable services than the average treatment provider, a prime example of why OASAS is revising its regulations. Clearly, programs that don't adapt, don't adopt and don't improve their accountability standards will simply not survive in this ever-changing field."
New York State Medicaid Inspector General Kimberly A. O'Connor said, "OASAS and the Office of the Medicaid Inspector General want those who abuse the Medicaid program to know that excess billings for unnecessary services will not be tolerated. Those who attempt to game the Medicaid system will be caught; taxpayer funds will be recovered; and perpetrators will be thrown out of the system and kept out."
