As Medicaid Balloons, Watchdog Force Shrinks

New York Times ^ | July 19, 2005 | Michael Luo and Clifford J. Levy

[cyborg]

New York's Medicaid program pays more than a million claims a day, feeding a $44.5 billion river of checks to radiologists and ambulance drivers, brain surgeons and orderlies, medical centers and corner pharmacies. Many who get those checks pocket more money than they deserve, and millions of taxpayer dollars are believed to be lost every day to theft and waste. Skip to next paragraph Andrea Mohin/The New York Times

Falling Behind: Boxes of cases in the attorney general's Medicaid Fraud Control Unit, where the size of the staff has failed to keep up with the program's growth. PROGRAM DISORDER High Costs, Little Scrutiny

This article is the second in a series examining the security, effectiveness and cost of New York's Medicaid program, the largest of its kind in the nation and the state's biggest expense. Related New York Medicaid Fraud May Reach Into Billions (July 18, 2005)

Yet the state, charged with protecting those dollars, has done little to stop them from draining away.

A yearlong New York Times investigation found only a thin, overburdened security force standing between this enormous program and the unending attempts to steal from it. Even as spending by New York Medicaid has more than tripled since the late 1980's, the number of fraud investigators who guard its cash register has fallen by half, and several of their leaders have quit or retired in disillusionment.

Of the 400 million claims that Medicaid paid last year, Health Department regulators uncovered just 37 cases of suspected fraud, far fewer than their counterparts in any other large state, even though New York's Medicaid budget is by far the largest in the nation. Many experts say that it is likely that at least 10 percent and probably more of New York Medicaid dollars are stolen or wasted.

[cyborg]

Check out the physical therapists too. The amount of fraud is unbelieveable!

[cyborg]

bugmenot or try pidmeoff and password pidmeoff1234

[Vision Thing]

Ah yes. Nothing like hording all those taxpayer dollars into a government coffer, which becomes the easy target of thieves. This article shows how much easier it is to steal from one gigantic government fund than it is to steal from the individual bank accounts of 250+ million Americans.

[cyborg]

exactly

[neverdem]

FReepmail me if you want on or off my New York ping list.

Belated Charge Ignites Furor Over AIDS Drug Trial

It's much more about the politics of the usual left wing suspects, especially in New York, the internet, and foster children, than it is about real medicine.

[Cincinatus' Wife]

......In an interview last night, Grasmick said the problems don't all stem from the district's financial crisis. She pointed to more than $4 million in federal funds that the city received last year but did not use, and problems documenting Medicaid bills for students receiving school health and transportation services.........

Md. urges takeover of city's schools

[Shady]

The Governor, the Attorney General, the Comptroller and every member of the New York State Legislature should be impeached for this robbery of the taxpayers. But they won't be. No one will "suffer" except for the "Barnumites*" who live here.
(* suckers)

[The Mayor]

1 in 5 are on medicaid in NYState..

we pay over 10,000 per person, national avg is half.
Welcome to NY, pay toll ahead.

[mewzilla]

Spitzer's been AWOL on this. Good one, Eliot. Yup, great gov material you'd make. SNORT.

[NYFriend]

And, Spitzer's the AG, with a dedicated Medicaid Fraud unit which supposedly spends more that it recovers.

[mewzilla]

And, Spitzer's the AG, with a dedicated Medicaid Fraud unit which supposedly spends more that it recovers.

That's gonna make a great campaign commercial :)

[eleni121]

Boss Tweed and his Democratic gang has expanded his dominance to include the whole state...every other person working in NYS is getting funded by the public trough.

An analogy: It's like the assemblyman in the Bronx 80% of whose continuents are somehow in the penal system, and so has no choice but to vote against stronger laws against crime.

[neverdem]

Part II, courtesy of cyborg, on the the wonders of Medicaid in NY State.

Ex-shrimper at the forefront of 'personalized medicine'

Company scientists have recently published 1.6 million genetic differences sussed from the DNA of 71 Americans of European, African or Chinese ancestry.

Most of them are single nucleotide polymorphisms

I Googled DNA for Dummies?, and I found 4 very useful links, especially the NCBI and Nature Genetics links, for anyone interested in following this stuff.

A Gene for Romance? So It Seems (Ask the Vole)

Health and Nutrition: Dark Chocolate Isn't a Health Food, but . . . The last next to last paragraph has a diet link which allows free access to Times' archived health articles.

[PGalt]

Thanks for the ping and your links. Thanks for your work cyborg.

[cyborg]

It's a travesty. I was in the hospital today and they couldn't sign people up fast enough.

[NYFriend]

From www.senatordeanskelos.com

SWEENEY AND SKELOS CALL FOR AUDIT OF NEW YORK STATE’S USE OF FEDERAL MEDICAID FRAUD PREVENTION FUNDS


New York State Receives Over $93 Million To Fight Fraud But Gets Few Results


Tuesday, July 19, 2005


United States Congressman John E. Sweeney (R-Clifton Park) and New York State Senate Deputy Majority Leader Dean G. Skelos (R-Rockville Centre) today issued a formal request to the United States Department of Health and Human Services (“HHS”) to audit New York State’s use of over $93 million Medicaid fraud prevention funds received from the federal government. In its recent series on Medicaid fraud, the New York Times uncovered numerous instances of unchecked Medicaid fraud costing taxpayers millions of dollars. Congressman Sweeney and Senator Skelos have called for this audit to help determine why this type of pervasive Medicaid fraud was not detected by state prosecutors and investigators.

“New York State taxpayers absorb a heavy burden at all levels to ensure that those who can not afford proper care receive it. The appalling lack of oversight into how and where those tax dollars are being spent is unconscionable,” said Rep. Sweeney. “The federal audit we are calling for will help restore accountability into a worthwhile program that has been tragically abused. The taxpayers, as well as Medicaid recipients, deserve a full accounting and I am committed to providing one.”

"Medicaid fraud steals from everyone in New York State. It drives up property taxes, state taxes and federal income taxes and deprives the neediest New Yorkers of the quality health care they deserve,” said Senator Skelos. “We have the nation’s largest Medicaid program and receive the most money to fight fraud, but we’ve fallen far behind other states in recovering taxpayer money stolen from our Medicaid system. This audit is a necessary first step to determine where the system is broken and how to fix it.”

In 2005, New York State’s Medicaid program is projected to cost $44.5 billion—or 33% more than the nation’s second largest Medicaid system (California). Between the New York State Department of Health’s (“DOH”) Office of Medicaid Audit and Fraud Prevention and the Attorney General’s Medicaid Fraud Control Unit (“MFCU”), the state spends more than $130 million to combat Medicaid fraud, with nearly 800 employees. Of those 800 employees, the $93 million federal share funded 246 employees at the DOH and 208 positions in the Attorney General’s office.

In its investigative series, New York Times’ reporters cited numerous cases of overt fraud that went undetected by state investigators in the Attorney General’s office and the Department of Health. For example, the Times referenced a Brooklyn dentist who stole $5.4 million from the Medicaid system in 2003, including billing for 991 procedures in a single day that September, “or more than 100 an hour in a typical workday.”

While neither the Attorney General’s office or DOH ever investigated these claims, “[t]he Times found [the dentist’s] extraordinary billings using a laptop computer and commonly available software after spending a few hours studying New York Medicaid billings. And [this] was only one of scores of medical providers who turned up in the search[.]” Further, the Times noted that only 37 cases of suspected fraud were uncovered out of 400 million Medicaid claims processed last year.

Conservatively, the federal Government Accountability Office (“GAO”) estimates that fraud accounts for 10% of all Medicaid spending. That said, other industry and governmental studies suggest that fraud could consume up to 25%-30% of certain segments of New York State’s Medicaid budget. Based upon these projections, fraud, waste and abuse within New York State’s Medicaid program will cost New York State taxpayers at least $4.5 billion during the current state fiscal year. Notwithstanding a $30.8 million settlement negotiated by the National Association of Medicaid Fraud Control Units, New York State’s MFCU recovered approximately $32 million in 2004—or less than one-tenth of one percent of the state’s Medicaid budget.

From 2001 to 2003, New York State’s MFCU recovered $.72 for every dollar that it received in federal Medicaid fraud prevention funding. At the same time, California (189 employees), Florida (127 employees) and Texas (43 employees) recovered 200%, 300% and 500%, respectively, of their federal funding level. The audit requested by Congressman Sweeney and Senator Skelos specifically includes a detailed analysis of investigations initiated and claims filed by the state MFCU’s seven regional offices located in Buffalo, Rochester, Syracuse, Albany, Pearl River, New York City and Long Island.

In April, the New York State Senate passed Senator Skelos’ legislation (S.3685-B) establishing an independent Office of Medicaid Inspector General. Through this plan, an independent Office of Medicaid Inspector General would be created to aggressively investigate cases of Medicaid fraud and provide evidence to the Attorney General and local district attorneys for prosecution. By reorganizing and streamlining the state’s current anti-fraud efforts, the legislation clearly separates the three, distinct components of combating Medicaid fraud—data collection, investigation and prosecution—between the Department of Health, the Medicaid Inspector General and the Attorney General, respectively. Governed by an independent board of directors, the Office of Medicaid Inspector General would be responsible for maintaining a state-of-the-art computer system to detect Medicaid fraud and providing staffing and other resources to local prosecutors.

Despite bipartisan support for this legislation in the Senate and the Senate’s inclusion of funding in the 2005-06 state budget for preliminary costs, the Assembly refused to introduce the bill. Also, the Attorney General refused the Senate’s offer to include millions of dollars in the state budget to update its computerized Medicaid fraud detection system.