Spitzer's Medicaid Inspector

Eliot Spitzer just nominated James G. Sheehan to serve as New York State Medicaid Inspector General.

Medicaid is the state’s most expensive program, and Spitzer’s effort to reduce the cost of the program led to a bruising budget fight with health care groups who engaged in a highly nasty exchange of negative ads against him.

From the governor’s statement on Sheehan:

“As a career prosecutor specializing in complex health care enforcement and recovery matters, Mr. Sheehan has experience rooting out fraud that dramatically drives up costs and severely threatens the efficiency and delivery of health care services.”

More on Sheehan after the jump.

– Azi Paybarah

GOVERNOR ELIOT SPITZER AND LIEUTENANT GOVERNOR DAVID PATERSON
NOMINATE NEW YORK STATE MEDICAID INSPECTOR GENERAL

Governor Eliot Spitzer and Lieutenant Governor David Paterson today
announced the nomination of James G. Sheehan to serve as New York State
Medicaid Inspector General.

As Medicaid Inspector General, Mr. Sheehan will oversee the fraud and abuse
enforcement activities of New York’s $50 billion Medicaid program. The New
York State Office of the Medicaid Inspector General audits and investigates
Medicaid providers, recovers revenues through its enforcement system, and
develops and operates automated health care data detection systems.

“As a career prosecutor specializing in complex health care enforcement and
recovery matters, Mr. Sheehan has experience rooting out fraud that
dramatically drives up costs and severely threatens the efficiency and
delivery of health care services,” said Governor Spitzer. “New York State’s
health care spending is the highest in the nation and our system requires
dramatic reform.
Mr. Sheehan will bring his experience and energy to that effort.”

Mr. Sheehan currently serves as an Associate U.S. Attorney for Civil
Programs in the Eastern District of Pennsylvania. He has served as an
Assistant U.S. Attorney since 1980, and a supervisory Assistant U.S.
Attorney since 1983.

While serving in the U.S. Department of Justice’s Philadelphia office, Mr.
Sheehan personally handled over 500 health care fraud matters, as well as
managed all civil litigation for the federal Eastern District of
Pennsylvania. He has personally led, managed and developed health fraud
and kickback cases from pharmacy benefit firms, pharmaceutical
manufacturers, medical suppliers, hospitals, nursing homes, and physicians.

From 1999 to 2006, Mr. Sheehan led the government investigation against
Medco Health Solutions, which resulted in the recovery of over $155
million, as well as substantial business changes to protect patients and
pharmacists. From 1993 to 1997, he was lead counsel in United States v.
SmithKline Beecham Clinical Labs, which resulted in a $332 million recovery
for the United States.

Mr. Sheehan has supervised joint health care investigation teams that
included the FBI, Federal Inspector Generals from many agencies, and
private investigators, which resulted in more than $600 million in awards.
He has also developed a model Qui Tam Program to identify and pursue fraud
cases.

Mr. Sheehan received his B.A. from Swarthmore College and his J.D. from
Harvard Law School.

Mr. Sheehan comes to New York State through the Intergovernmental Personnel
Act program. This program provides the opportunity for career federal,
state and local employees to work at another level of government. The
program maintains salary and benefits for participating staff, with any
difference paid through the originating agency.

As Medicaid Inspector General, Mr. Sheehan’s annual salary will be
$136,000, with the $9,300 difference between that amount and Mr. Sheehan’s
current salary to be paid by the U.S. Department of Justice.
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