Monday, July 18, 2005

NY Medicaid program under fire...

...and for good reason--fraud. Not fraud by the client/recipient, but fraud by unethical providers. And it sucks.

We have 4.2 million people--children and adults--who are income eligible, receiving Medicaid right now. But there are thousands more who are income eligible and on wait lists, with no medical. And, standard services are now being cut to save money. New York's program is the most costly in the nation, at $44.5 billion annually, while covering only 20% of the population. California, on the other hand, covers 55% of the population, for less than NY spends.


Why? Because of people like this (from the NY Times):

-- Dentists like Dr. Dolly Rosen, who within 12 months somehow built the state's biggest Medicaid dental practice out of a Brooklyn storefront, where she claimed to have performed as many as 991 procedures a day in 2003.

--School officials around the state have enrolled tens of thousands of low-income students in speech therapy without the required evaluation, garnering more than $1 billion in questionable Medicaid payments for their districts. One Buffalo school official sent 4,434 students into speech therapy in a single day without talking to them or reviewing their records, according to federal investigators.

--Nursing home operators have received substantial salaries and profits from Medicaid payments, while keeping staffing levels below the national average. One operator took in $1.5 million in salary and profit in the same year he was fined for neglecting the home's residents.

--Medicaid has even drawn several criminal rings that duped the program into paying for an expensive muscle-building drug intended for AIDS patients that was then diverted to bodybuilders, at a cost of tens of millions. A single doctor in Brooklyn prescribed $11.5 million worth of the drug, the vast majority of it after the state said it had tightened rules for covering the drug. The Times concludes by stating: New York's Medicaid program, once a beacon of the Great Society era, has become so huge, so complex and so lightly policed that it is easily exploited. Though the program is a vital resource for 4.2 million poor people who rely on it for their health care, a yearlong investigation by The Times found that the program has been misspending billions of dollars annually because of fraud, waste and profiteering. A computer analysis of several million records obtained under the state Freedom of Information Law revealed numerous indications of fraud and abuse that the state had never looked into.


I simply seethe with anger when greedy, unsconcionable people steal from government programs, leaving the poor who actually need the program sitting in the cold. Yes, I take things like this very personally. I've dealt with extremely serious illnesses in the past--things like viral encephalitis and pleurisy--because I couldn't get medical care. Something that could have been treated by a quick doc appt and meds if caught early became life-threatening illnesses because I was on a Medicaid wait list. When I get really, truly angry, I want to hurt someone -- bad. Lock me in a room with some of these thieves, and just see if I don't wreak a little vengeance on behalf of all those who were desperately ill and couldn't get medical treatment. GGGGGGGGRRRRRRRRRRRRRRR!!!!!!!!!!!!!!!

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