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New York-style Medicaid fraud opens eyes from coast



Published: Mon, July 25, 2005 @ 12:00 a.m.



The New York Times reported last week on an investigation that uncovered horror stories in New York's administration of Medicaid, the program funded by federal and state governments to provide medical care for the poor.

Much of what The Times reported focused on fraud, particularly the egregious types of fraud that simply should not be able to happen if anyone is minding the store.

In one instance, Dr. Dolly Rosen 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. Her fraud was uncovered by The Times, which went on line and did a computer analysis of New York's Medicaid billing records that were a matter of public record.

The newspaper also examined records for ambulance trips, speech therapy referrals and nursing home operation, finding abuses in all those areas and others.

Thousands unseen

Federal investigators found that one Buffalo school official referred 4,434 students into speech therapy in a single day without talking to them or reviewing their records. A nursing home operator took $1.5 million in salary and profit the same year that he was fined for neglecting the home's residents.

These cases involve more than the theft or misuse of public dollars. They represent a threat to Medicaid programs themselves, which in millions of cases provide needed services to people who cannot afford health, dental or nursing home care.

What The Times found was that New York state has been negligent and penny-wise, pound-foolish in monitoring its Medicaid program. There is a bright spot in the report -- but not for New York taxpayers, rather for Ohioans.

In a comparison of Medicaid enforcement efforts The Times did between New York and five others states, Ohio came out on top. For instance, in a year that New York spent $44.5 billion on Medicaid, it performed only 95 on-site audits of service provides. Ohio, which spend a fourth of what New York did ($10.6 billion), conducted four times as many audits (393). Likewise, New York referred only 37 cases to prosecutors, while Ohio referred 112.

The office of State Auditor Jim Petro says Ohio has gotten even more aggressive in recent years in pursuing Medicaid fraud. Since Petro has taken office in 2002, it has recovered $54.7 million in misspent Medicaid money. In the previous eight years, about $35 million was recovered.

States take note

In these times of tight economics, no state, from Maine to California or from Florida to Washington, can afford to allow Medicaid providers to rip off even a small proportion of these expenditures.

Petro suggests that a complete reorganization of state government may be necessary to get better control of spending, not only for Medicaid, but in dozens of other areas. And he may be right.

Too many different state departments are dolling out Medicaid services, which makes it more difficult to keep track of where the money is going and whether the state is getting its money's worth.

As encouraging as Ohio's figure may be, at least in comparison to New York's, more can and should be done.

For every dollar that is diverted into the pocket of an unscrupulous health care provider, a poor senior citizen or a child is likely to be deprived of therapy or treatment that he or she needs and should get.

Such abuses are not as visible as a New York dentist who claims to have treated nearly a thousand patients in a day, but they are intolerable nonetheless.




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