N.Y.'S MEDICAID MESS, CONT'D

N.Y.’S MEDICAID MESS, CONT’D

June 7, 2006 — Anyone who doubted reports last year that New Yorkers were losing billions annually to Medicaid fraud should take a look at a federal audit released Monday, which ripped Albany for doing so little to stop the bleeding.

As the clock winds down on Gov. Pataki’s tenure, reports like this will cast a giant shadow over his legacy.

“New York’s anti-fraud efforts over the last several years have not been proportionate to its vulnerability,” said the audit by the Centers for Medicare and Medicaid Services. “In the final analysis, the CMS review team believes that New York must do more to meet its program integrity obligations.”

Actually, Medicaid outlays grew so fast (from $27 billion in 1998 to roughly $45 billion this year), it might’ve been hard to hire investigators fast enough.

But here’s the sad truth: The state never even tried to keep up. Instead, it cut staff dedicated to “program integrity” from 950 to 584, a nearly 40 percent drop.

New York also emphasizes preventing fraud, the report said, at the expense of trying to catch the crooks. (Who can forget Dolly Rosen, the dentist accused of stealing more than $1 million through fraudulent claims? On a single day, she said she preformed 991 procedures, about 100 an hour.)

Meanwhile, Attorney General Eliot Spitzer has a statutory duty to probe cases – through his Medicaid Fraud Control Unit (the largest of its kind in the country). Yet, as we’ve noted before, he’s put his time and energy into sexier cases, going after deep-pocket Wall Street investment banks, mutual funds and insurance companies.

The result?

Only a fraction of the estimated $4 billion to $18 billion lost each year to Medicaid fraud and abuse is ever recovered.

Monday’s report does confirm Spitzer’s gripe that the state’s Department of Health refers a paltry number cases to him – just 77 in 2005. In a $45 billion program, you’d almost have to be willfully blind not to find more cases.

But Pataki’s folks have said that Spitzer can’t even keep up with the cases he gets. And anyway, there’s been nothing to stop him from pursuing cases on his own, just as he did with the Wall Street probes.

Since the exposé by The New York Times last year, Pataki has moved to bolster fraud-detection efforts. To which only four words spring to mind: “Too little, too late.” The Legislature, meanwhile, has been dumb as a doorpost when it comes to passing reforms.

Spitzer’s lack of concern as AG for curbing Medicaid abuse bodes ill for the chances that, should he become governor next year, he’d crack down on fraud. Taxpayers may just continue losing billions.

It’s enough to make you sick.

But if so, please don’t file a fraudulent Medicaid claim. New York has enough of that already.

Spitzer should be focusing on fraud in government instead of cases like H&R Block that he will lose. It is a failure of his duties as AG not to persue the outrageous amounts in Medicaid Fraud.

I am sure there are Billions in fraud and that any investigative unit will pay for itself 10 fold.