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Carl Strock THE VIEW FROM HERE
Carl Strock can be reached at 395-3085 or by e-mail at carlstrock@dailygazette.com.
Medicaid
fraud: where
it comes from

    Every once in a while we are treated to a story about a marginal citizen who was caught cheating at welfare, usually by concealing some modest income so as to receive benefits that he or she was not entitled to, and the impression is created that that’s why these welfare programs are so expensive. The unworthy poor are stealing from them.
    I’m never willing to draw that conclusion myself, noting the amounts involved are usually paltry — a few thousand dollars.
    Now I am interested in a slightly different perspective provided by the state comptroller, Thomas De-Napoli, who has discovered that in the seven-year period from August 1999 to October 2006 mental-health providers, meaning psychologists, psychiatrists and psychotherapists overbilled Medicaid $1.3 million. Yes, $1.3 million. Just in the mental-health field, and never mind all the other areas of medical care and nursing-home care.
    Some of that overbilling may have resulted from an honest misunderstanding of Medicaid’s complicated rules, but some of it sounds suspiciously fraudulent, like a psychiatrist repeatedly billing for more than 24 hours worth of treatment in a day, which, even with the help of an orgone box, seems hardly possible. (The orgone box is something that mental-health professionals today would rather not remember.)
    Indeed, that particular case has been referred to the attorney general “for determination as to whether further investigation and criminal prosecution is appropriate,” in the words of the comptroller’s report.
    This follows a series of articles in The New York Times a couple of years ago which found that Medicaid fraud by providers — not recipients — probably runs into the billions. It includes everything from blatant recruiting of patients with Medicaid cards simply for billing purposes without any services provided to kickbacks for unnecessary medical transportation.
    The Times discovered a whole culture of crooked doctors, dentists, ambulette companies, nursing homes and so on — every level of the health-care industry.
    In response to the comptroller’s report, the state Health Department, which oversees Medicaid payments, promised to make the necessary reforms, but let’s be honest, ladies and gentlemen. Corruption in health care exists because the health-care industry is one of the largest donors to our state politicians and vigorously resists efforts at closer policing. The more freely the Medicaid spigot runs, the better they like it. We’re talking about big money.
REWARDING BEHAVIOR
    As for the Conditional Cash Transfer program in New York City, which pays poor people for acting responsibly, like, for example, by keeping medical appointments, getting job training, or attending parent-teacher conferences, maybe we could apply its lessons at a higher level. Maybe we could apply it to our state politicians.
    I mean, Mayor Michael Bloomberg is pleased in his city that some 1,400 families qualified for payments averaging $524 each during the first two-month period of the program, because, supposedly, those families were induced to behave better, to behave in ways that will eventually lift them out of poverty.
    Following his principle, how about paying our state legislators a bonus every time they ignore the solicitations of health-care lobbyists or New York State United Teachers and vote in the interests of the majority of their constituents? They could submit coupons just like poor people in New York City, have them verified, and pick up their checks.
    Just a thought. It probably won’t go anywhere.

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senders December 17, 2007, 2:00pm  


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13 days 8 hours 44 minutes They dont get cash benefits---it is a card carrying system--and there is no nail polish alotment or the like....as for the cell phones---check the 'baby's daddy'........if we think this is an awful system the NYS politicians are welfare recipients too--just on the other end of the 'body' of society and not much cleaner(if at all).......



...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......

The replacement of morality and conscience with law produces a deadly paradox.

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In response to the comptroller’s report, the state Health Department, which oversees Medicaid payments, promised to make the necessary reforms, but let’s be honest, ladies and gentlemen. Corruption in health care exists because the health-care industry is one of the largest donors to our state politicians and vigorously resists efforts at closer policing. The more freely the Medicaid spigot runs, the better they like it. We’re talking about big money.