By ADAM SICHKO
The Business Review

Much of the impact of the federal health care overhaul enacted last month remains to be seen-but it's sure to spur more audits and fraud investigations.

The laws aim to expand coverage to 32 million more Americans, which would generate hundreds of millions of new claims every year, all subject to audits. The laws also stiffen penalties for committing health care fraud, providing more incentive for governments to conduct investigations.

Plus, any new regulations generate the need for an attorney to explain the ins and outs of the law.

Legal experts believe all of that will continue to provide key business to law firms for years.

Health care laws are so complicated, "you really need an attorney just to help you figure out what you can and cannot do," said Beverly Cohen, a health law professor at Albany Law School.

"The health care debate only raises the visibility of the fraud question," Cohen said. "You're trying to expand coverage ... and where is the money to do that going to come from?"

As need increases, so do medicaid rolls

Currently, more and more Americans are streaming onto the Medicaid rolls, largely as a result of hard times they're suffering during the recession. That, too, creates more opportunities for audits, and possibly, fraud investigations.

New York's Medicaid case load has hit a record high, necessitating at least $400 million of unexpected spending, Gov. David Paterson said earlier this year.

About 4.3 million New Yorkers were expected to be receiving Medicaid benefits by the end of last month-200,000 more people than what the state budget originally projected. The increase is 16 percent above the previous record, set in 2005.

The increasing reliance on Medicaid should subside around the time key provisions in President Obama's health care law take effect, supplying insurance to millions more Americans.

"Particularly after the health care vote, and as more people are joining the Medicaid rolls, more and more states will be focused on fighting fraud, waste and abuse," said Robert Hussar, first deputy at the state Office of the Medicaid Inspector General.

A key question lingers: Just how much fraud is there?

Last year, there were $98 billion of "improper payments" in the nation's health care sector, Obama said. They could have been payments made in the wrong amount, to the wrong person, or for the wrong reasons, he said.

More than half of those incorrect payments came from either Medicaid or Medicare.

$68 billion lost

The National Health Care Anti-Fraud Association estimates, conservatively, that 3 percent of all health care spending-or $68 billion-is lost in improper payments. Other health care experts put the percentage as high as 10 percent.

Even health care attorneys can't say for sure how prevalent fraud is in the national health care system.

The uncertainty, though, is likely to drive even more audits and investigations, leading to an even greater need for attorneys to help clients handle the probes.

"The one mystery about fraud," Cohen said, "is that nobody has an absolutely clear idea of how much of it is going on."