STAFF REPORTNorth Country This Week

State Senator Dan Stec is going to introduce legislation intended to reduce alleged Medicaid fraud through eligibility verification and other safeguards. 

Gov. Kathy Hochul’s proposed 2027 budget includes $38.2 billion for New York’s Medicaid program, including $1.2 billion this year in federal funding generated through an assessment on Managed Care Organizations.

Hochul faces some scrutiny over the state’s healthcare program, which serves about 7 million people in the state. 

Earlier this month, the Trump administration launched a probe to investigate reports of fraud in the program and demanded that state officials provide details about their handling of fraud, waste and abuse within 30 days or risk deferred payments.

Conservative lawmakers have made repeated efforts to reduce spending within the program and investigate alleged fraud.  Sen. Stec’s bill is  cosponsored by Sen. Mark Walczyk and a companion version of the law is being supported in the Assembly by Scott Gray. 

In January, Hochul said she would continue to support the state’s Medicaid system, saying,

“access to affordable, high-quality health care is essential to New York families,” Governor Hochul said. “While Washington cuts and destabilizes care, New York will continue investing in patients, providers, and protections to ensure health remains accessible across the state.”

It’s unclear if Stec’s bill will face opposition in the majority Democratic state legislature. 

If enacted, Senate bill S.9219 “would provide needed accountability and oversight to the state’s Medicaid system,” according to a press release from Stec’s office. 

The legislation reportedly strengthens Medicaid payment accountability by requiring routine eligibility verification, mandating audits in alleged high-risk areas, establishing structured payment safeguards with notice and response periods, and authorizing limited verification tools to confirm service delivery, while preserving eligibility standards and due process protections.

According to the Senator’s statement, recent reports have highlighted “significant fraud” in the Medicaid system. A state Comptroller report examining the years 2017-2024 unearthed a potential $2.6 billion in improper payments to people no longer living in New York State, 

 Stec sees his legislation as crucial to ensuring Medicaid funds are delivered to people who need and are legally eligible to receive them.

            “New York State is hemorrhaging billions of dollars each year in fraudulent and improper Medicaid claims. This is absolutely unacceptable. My legislation would require routine eligibility verification and audits, ensuring the accountability and oversight sorely lacking - and urgently needed - for our Medicaid system,” Stec said.

            A video of  Stec highlighting his Medicaid fraud legislation can be found here: https://youtu.be/2VI5mXiXzQk