Two Firms Accused of Using Political Ties to Bilk Medicaid

Written By Unknown on Minggu, 11 Agustus 2013 | 13.57

The letters, signed by Representative Darrell Issa of California, the Republican chairman of the committee on oversight and government reform, demanded that both companies produce several years of documents and e-mails on the matter by Aug. 20. The demand is part of a broadening inquiry into whether New York's Medicaid inspector general gave preferential treatment in its audits to organizations with political influence.

Richard Azzopardi, a spokesman for Gov. Andrew M. Cuomo, called the inquiry "Washington partisan politics at its worst, using government resources to make political attacks."

In the case of the pharmacy, Marra's in Cohoes, N.Y., a 2009 audit alleged that Medicaid, having been overbilled, overpaid it by $2.9 million; a year later, the office of the Medicaid inspector general, known as O.M.I.G., offered to settle for $1,467,804.

The committee on oversight said, in a letter to John T. McDonald III, the current president of the pharmacy: "Two days after that final audit was issued, Barbara J. McDonald, your mother and president of Marra's Pharmacy, wrote Governor Cuomo in an attempt to have him intervene in your dispute with O.M.I.G."

"After your mother's letter to Gov. Cuomo," the letter continued, "O.M.I.G. further reduced the findings of Medicaid overpayments." The agency eventually settled for $268,000.

Mr. McDonald, formerly the mayor of Cohoes and now a Democratic state assemblyman, said Friday he was happy to cooperate and provide the voluminous file showing why his family had fought the audit, eventually suing the state, and why the amount had been reduced. "We'll be even happier when they review it and realize there was nothing wrong," he said.

Far from receiving favoritism, he said, his small pharmacy was almost destroyed by an unforgiving government bureaucracy and is now being swept into a politicized inquiry. Medicaid requires prescriptions to be kept for six years so the government can verify that its payments are justified, but his mother mistakenly believed they could be destroyed after five, and did so. The audit sample showed 30 prescriptions missing. Auditors estimated the pharmacy had been improperly reimbursed by Medicaid by at least $1.4 million, an extrapolation technique used by James Sheehan, then the Medicaid inspector, that providers protested.

"My mother is 78," Mr. McDonald said. "She's devoted her life to the pharmacy."

A second letter from the committee went to John Navarra, owner of Town Total Nutrition Inc. in Manhattan, which had been overpaid through Medicaid by more than $10 million, according to a 2007 preliminary audit. After it was disputed, the inspector general repeatedly reduced the recovery demand, eventually settling for $521,291, less than 5 percent of the initial finding.

The letter said that several whistle-blowers had indicated the reduction "possibly resulted from your powerful political influence." It said Mr. Sheehan had told the committee that Mr. Rendell, now with a Philadelphia-based law firm, had "called him in an apparent attempt to obtain favorable treatment for Town Total." Messages left for Mr. Rendell through his law firm were not returned Friday night.

Mr. Navarro is on the New York State Board of Pharmacy and is chairman of the Medicaid Pharmacy Advisory Committee.

"Town Total is cooperating with an ongoing congressional investigation," Gabe Nugent, a lawyer for the company, said in an e-mail on Friday. "Town Total's audit was addressed through the normal administrative process, and the resolution of the audit was based on the merits."

The oversight committee has also been investigating why a long-running audit of Visiting Nurse Service of New York, one of the state's largest home health care providers, has yet to be released. It has accused the Cuomo administration of muzzling employees involved in the multimillion-dollar audit.

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