Patricia Monks stands for a photo Thursday, May 15, 2015, at the Times Union in Colonie, N.Y. She was fired from her job as an auditor of the state’s Medicaid program after she raised questions about improprieties in how the work was being done
The auditors worked in a non-descript, three-story brick building near a warehouse district in Menands, a couple miles north of the stateCapitol.
Their surroundings were ordinary, including hand-me-down state government furnishings. But their job was a crucial one: auditing the eligibility rates for recipients of New York’s $22 billion-a-year Medicaid program.
For New York, the potential of paying tens of millions of dollars in penalties was at stake if their error rates exceeded a threshold set by the federal government. The audits were mandated by Congress, in part, to rein in the fraud and mistakes that have permeated the nation’s massive health care system for people with low incomes.
Now, several current and former state employees, who were part of two federal lawsuits that alleged the state’s Medicaid program is awash in fraud, are speaking out about their efforts to report the abuse. In one case, a group of auditors whose job it was to detect fraud said stateHealth Department managers unethically directed and altered their work results.
“People stopped us from doing it,” said Patricia Monks, then a longtime state worker who questioned the interference. “I was fired after eight months because I ‘didn’t have the right attitude.’ ”
At the time, Monks, 68, worked in the Menands office for the Center for Development of Human Services, which was headquartered at SUNY Buffalo State and served as an arm of the quasi-public SUNY Research Foundation. The Research Foundation had won a contract with the state Health Department to do the work
In April 2008, with less than a year on the job, Monks and a supervisor in her office, Patrick Campion, complained to supervisors that state Health Department officials were interfering with their work and taking steps to manipulate the audit results. Monks said Diane Farrell, a DOH manager tasked with monitoring the work, was a fixture in the Menands office and met weekly in a conference room with a CDHS supervisor, Ann Marie Hutchinson.
“I saw her and Ann Marie in the conference room on several occasions. They had case files open,” Monks said in an interview last week, marking her first public comments on the case. “I had discussions with Ann, specifically, about how unethical that was. … The other thing they did was they destroyed records. Any of the cases I called in error, they destroyed, and did their own audit.”
Less than a month after Campion and Monks reported their concerns, they were both fired, in April 2008, according to court records.
Monks brought her concerns to the U.S. Attorney’s office in Albany, where she met with a former assistant U.S. Attorney, Sara Lord, who opened a criminal investigation that would languish for years as the case bounced to different attorneys in the office. Initially, several Health Department managers were told they were targets in the criminal probe, but no one was ever charged and the state would ultimately be absolved of wrongdoing.
Two years after she was fired, Monks and four other former Research Foundation employees in the audit unit, including Campion, filed a federal complaint, known as a qui tam, under the False Claims Act accusing their supervisors and state Health Department managers of undermining their work and manipulating the Medicaid error rates.
“Frankly, the entire Medicaid program is a sham in New York,” Monks said. “People are getting Medicaid and maybe shouldn’t be. … Ninety percent of the cases I had I couldn’t tell if they were eligible or not. We weren’t allowed to contact anyone. We weren’t allowed to write letters to anyone.”
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