Medicaid, the State and City program providing medical care for those without the means to properly obtain it, is supported in large part by IREA’s work at verifying eligibility and investigating fraud and abuse.  The vast proportion of Medicaid cases assigned to IREA are recommended for closure.  IREA investigates client fraud and abuse along with investigating and auditing providers to ensure Medicaid providers do not abuse the system.

• Data Matches:
  IREA’s investigators extensively utilize data matches to identify fraud and abuse
  
  
  • Clients with unreported income and residency outside of New York City, making them ineligible for the benefits they receive;
    
    
  • Clients and Medicaid providers involved in Medicaid prescription drug fraud activities; and
    
    
  • Clients who receive dual Medicaid benefits in both New York City and another state or county.
    
    
• Investigations by Borough:
  
  • 2011, we had 21,000 with specific borough data
  • 4,900 investigations were in the Bronx,
  • 6,100 in Brooklyn,
  • 4,000 in Manhattan,
  • 4,700 in Queens, and
  • 800 on Staten Island
    

Medicaid Program Integrity Resources:

• U.S. Centers for Medicare & Medicaid Services Medicaid Program Integrity Manual, Chapter 16 Useful Websites & Social Media (in PDF)
  
• Reports to Congress on Medicaid and CHIP, available quarterly:
  
• Payment Accuracy for Medicaid Program
  
• Presentations