New York’s Medicaid Director, Amir Bassiri, defended the state’s healthcare oversight before Congress, with federal lawmakers scrutinizing billions in taxpayer funds lost to fraud. The hearing linked multiple alleged controversies surrounding Medicaid beyond just the $11.2 billion CDPAP system. Bassiri argued that New York lowered management fees from $200 per member down to $68.50 per month by selecting PPL as the single statewide fiscal intermediary for CDPAP. Just days before Bassiri testified, PPL agreed to a settlement proposed by the Legal Aid Society and the law firm Katz Banks Kumin to resolve the federal class-action lawsuit Calderon v. Public Partnerships LLC concerning payroll for home health aides under CDPAP.<\/p>\n
ALBANY, N.Y. (NEXSTAR) \u2014 New York\u2019s Medicaid Director, Amir Bassiri, defended the state\u2019s healthcare oversight before Congress on Thursday<\/a>, with federal lawmakers scrutinizing billions in taxpayer funds lost to fraud<\/a>. The testimony unfolded two days after the state\u2019s home care payroll contractor PPL\u2014the private company that administers the Consumer Directed Personal Assistance Program\u2014agreed to a $162 million settlement over unpaid worker wages<\/a>.<\/p>\n \t U.S. Congressmembers Brett Guthrie of Kentucky and John Joyce of Pennsylvania called Thursday\u2019s hearing to examine systemic Medicaid fraud risks nationwide. Before the House Energy and Commerce Subcommittee on Oversight and Investigations, Bassiri detailed New York\u2019s efforts to protect taxpayer money in the Medicaid program.<\/p>\n CDPAP is a Medicaid-funded program that lets older New Yorkers and those who are disabled hire caregivers of their choice, like friends, neighbors, or family. The streamlined, single-contractor model was supposed to curb runaway costs. But claims of fraud in the home care industry prompted the committee to investigate New York\u2019s oversight.<\/p>\n \t The hearing linked multiple alleged controversies surrounding Medicaid beyond just the $11.2 billion CDPAP system. For example, Republican Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz has repeatedly roasted New York about lax oversight<\/a> that promotes hundreds of millions of dollars in fraud. In the video above, U.S. Congressmember Yvette Clarke of New York\u2014the ranking Democrat on the subcommittee\u2014questioned Bassiri about the legitimacy of Oz\u2019s claims of fraud and the math that got him there.<\/p>\n \u201cThere are 450,000 New Yorkers that receive some form of personal care services, including consumer-directed and licensed home care,\u201d Bassiri said. \u201cIt is not the 4 million that was referenced [by Dr. Oz]. It\u2019s a little under 5%.\u201d<\/p>\n \t Bassiri argued that New York lowered management fees from $200 per member down to $68.50 per month by selecting PPL as the single statewide fiscal intermediary<\/a> for CDPAP. Fiscal intermediaries were the companies handling pay and paperwork for caregivers, which the executive branch consistently called middlemen.<\/p>\n He also testified that New York is putting certain new Medicaid health businesses on a high-risk watchlist to watch them more closely. Bassiri said the state is temporarily freezing new business applications in some areas to investigate and catch scammers.<\/p>\n \t Just days before Bassiri testified, PPL agreed to a settlement proposed by the Legal Aid Society and the law firm Katz Banks Kumin on June 23 to resolve the federal class-action lawsuit Calderon v. Public Partnerships LLC<\/a> concerning payroll for home health aides under CDPAP.<\/p>\n According to court filings and Legal Aid, the Georgia company\u2019s broken apps, phone systems, and portal left thousands of caregivers unpaid for weeks. That agreement established $162 million to be paid to about 200,000 personal assistants downstate who worked without pay\u2014or were underpaid or paid late\u2014once PPL took over.<\/p>\n \t In a press release, Lolli Edinger from the New York Caring Majority\u2014an advocacy group of people with disabilities, seniors, and home care workers\u2014celebrated the payout while pushing state lawmakers to cut ties with PPL. \u201cA settlement doesn\u2019t repair the damage PPL has done to the CDPAP program, to the workers who went without pay, or to the New Yorkers who have lost their aides and essential care,\u201d Edinger said. \u201cThis is what happens when working people refuse to be silenced.\u201d<\/p>\n For the personal medical aides in the lawsuit, the settlement offers direct cash payouts: a $40.5 million general damages fund, $25 million to refund money improperly withheld from paychecks for health insurance, and $92 million for accrued paid time off. Workers who were allegedly promised but denied sign-on bonuses will receive a flat $50 each for their specific claims, while the rest of the general damages would be prorated based on hours worked.<\/p>\n \t A company spokesperson insisted that PPL \u201ccontinues to deny all allegations of wrongdoing and the resolution contains no admission of liability.\u201d They said their focus remains on caregivers, not expensive litigation.<\/p>\n The court is holding a hearing on July 1 to approve or deny that settlement agreement.<\/p>\n Bill Hammond\u2014Senior Fellow at independent Albany-based think tank the Empire Center for Public Policy\u2014also testified in Washington this week. On Wednesday, he explained to the Joint Economic Committee that the CDPAP budget spiked from below $1 billion in 2016 to $11.2 billion by 2024 because the state expanded the program, letting more relatives get paid for providing care.<\/p>\n \t Hammond said that New York employs 33 home health aides per 1,000 residents, which is 163% above the national norm. \u201cCDPAP plays an invaluable role in the lives of many disabled New Yorkers, but it has also fallen prey to widespread waste, abuse and fraud,\u201d Hammond testified. <\/p>\n He also pointed out that, while the over-65 population grew by 17%, state spending on personal care surged by 178%. Hammond made the case that the ballooning Medicaid spending isn\u2019t driven by the aging population alone<\/a>.<\/p>\n \t The scrutiny on New York extends to the highest levels of the federal government. In a March letter to Democratic Governor Kathy Hochul, Dr. Oz presented concerns about skyrocketing costs and suspicious clusters of healthcare businesses in New York\u2019s Medicaid system, specifically CDPAP. He pushed the state to detail strategies for screening providers and addressing vulnerabilities in areas like personal care and adult day care.<\/p>\n For some more context about federal Medicaid fraud investigations, on June 16, the Department of Justice filed a lawsuit accusing Bassiri, New York State Health Commissioner Dr. James McDonald, and PPL<\/a> of rigging the CDPAP contract bidding process and covering up overbilling. It\u2019s just one of the several lawsuits fielded by the state government about the transition<\/a> from multiple fiscal intermediaries to one.<\/p>\n \t Despite the federal lawsuit and the class action settlement, Bassiri maintained during his testimony that New York actively combats waste, fraud, and abuse. He testified that the state uses a centralized, online portal for screening and does more than the federal government requires to investigate businesses with a history of fraud<\/a>.<\/p>\n In a statement, a spokesperson from the New York State Department of Health echoed Bassiri\u2019s testimony while he was giving it on Thursday morning. They said the new centralized structure not only saved taxpayers over $1 billion in its first year, but also enables analytics that block fraudulent billing.<\/p>\n
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