Wednesday, July 22, 2009

State, City Settle Case Alleging Medicaid Fraud

We have posted on a variety of settlements of cases alleging health care fraud, but this one has a new twist, as reported by the NY Times,

New York State and New York City officials agreed this week to repay the federal government for more than half a billion dollars in improper Medicaid claims, averting a potential court battle but adding more red ink to the state’s and city’s finances.

The settlement, which federal officials said was the largest recovery of Medicaid funds in history, ends a lengthy dispute with the federal government over whether school districts around the state improperly sought Medicaid payments for speech therapy and other services dating to the early 1990s.

Under the agreement, which was announced Tuesday, the city will repay about $100 million. The state will pay about $332 million in 10 installments over the next five and a half years and will also give up $107.9 million worth of Medicaid claims now owed by the federal government.

Though neither city nor state officials are required to admit wrongdoing under the agreement, it does require the state’s Department of Education to submit to independent monitoring of its Medicaid-financed programs.

Since the 1980s, Medicaid has helped school districts pay for the cost of services like speech therapy and psychological counseling for schoolchildren, including the cost of transportation to therapists’ offices. School districts in New York have been among the most aggressive in the country in seeking such aid: one federal study found that New York accounted for 44 percent of all student health services.

Those lawsuits, filed under the federal False Claims Act, spurred several audits by the Department of Health and Human Services of city and state programs that finance speech therapy and other programs for disabled children. Those audits found substantial potential for fraud, reporting that a vast majority of the claims submitted did not meet federal requirements, and that in many cases there was no evidence that the services had actually been provided.

This may be the first settlement of health care fraud allegations we have discussed in which all the involved parties were government agencies.

The current fervent debate in the US about health care reform has focused on ever rising health care costs. However, this debate has largely ignored the ethics of health care, and the sorts of leadership of health care organizations that has lead to rampant and costly mischief, of which this case is just the latest example. How can we control costs while so many health care leaders are seeking every angle to make more money, whatever the consequences?


Brittanicus said...

It tends to make a lot of good people despondent and at the least susceptible, when they read, watch and listen to the maverick storm of media ads, thumping down President Obama's health care initiative? Much of the rambling artifacts are the Simon and Lois ads of the Clinton administration, heavily armed against any revisions in this issue that wealthy insurance companies and subsidiaries won’t tolerate.

They insulted the senior citizens with their propaganda and bald faced lies about the European government run health care system. Being originally an Englishman myself, I guarantee in the 1960's, we had a unique form of medical services, inclusive of eye and teeth. Even government run medical care in Australia was exceptional. It did plummet down somewhat, when business starting recruiting foreign labor from the commonwealth and Northern Europe. Many were out for a free financial ride and got it, along with their large families that British citizens have to support with their limited pounds sterling.

Just as the anti-governmental health care extremists have been pounding the airwaves, the open border, globalist is now subjecting the American people to a torrent of inflaming immigration polls. But like all polls they can be intentional manipulated, in exactly how the questions are worded? Sure they can keep their co-pays, deductibles and pre-existing small-print clauses, squeezing every penny from a hurting economy, but tell the--BLOODY TRUTH!

It's a sad fact that you cannot trust the Liberal slant regarding this searing problem, although not all Liberals are favorable to another AMNESTY? The Democratic leadership, hiding liberal views behind closed drapes tried to annihilate any good, workable illegal immigration enforcement laws. In an earlier session of the Senate an error was made with E-Verify, so it's was fortunate to survive Sen. Reid and Pelosi’s notion? Anything that has an impact on removing illegal immigrants is intercepted by business oriented free traders.

GOOGLE---illegal immigration--to find out their sinister intention, to just throw open the gates, ports and airline entrances to cheap labor, that also become the downfall of the European Union. the polling I have seen has been calculatedly --ENGINEERED--to get results, that they can brandish around, declaring the majority of Americans believe in a path to citizenship and open borders? Already the Democrats are ready to flag the Save Act, 287(g) local police enforcement to weaken these laws.

Currently both issues have heavy fallout, and you the voter should let your Senator or Representative know your opinion on either matter at 202-224-3121---BEFORE IT'S TOO LATE. Both have massive consequences in costs and quality of life in your future and generations to come.WE MUST SAY NO AMNESTY! SEAL OUR BORDERS AND NO MORE FREEBIES TO ILLEGAL ALIENS. THEY ARE THE CRIMINALS, NOT AMERICANS WHO SACRIFICE TAXES? GOOGLE--NUMBERSUSA for details our government and the media have a nefarious talent, for keeping facts under wraps?

Anonymous said...

When you read stories such as this and pick up the paper and find such things as the July 22 WSJ article Surgeon Faces Probe of Research where another spine center director is placed on leave due to unreported income.

Or, again the WSJ, on July 20 Drug Makers Criticized for Co-Pay Subsidies where the drug companies are "cost shifting," I would say, gaming the system to maintain product dominance at a great cost to the system.

The ACC situation, as reported on HCI, with income of nearly $100,000,000.00 coming in great part from drug company interaction.

We just have to ask: Is it people or a corrupt system? My personal feeling is the medical community has become so corrupt that it is almost impossible for anyone not to be touched in some way, all too often as a victim paying higher prices, or lacking access. Front line doctors are left with the choice of playing along, or often, loosing their ability to practice through economic pressure.

Sad for what once had been a nobile profession.

Steve Lucas

Mr. Econotarian said...

"However, this debate has largely ignored the ethics of health care, and the sorts of leadership of health care organizations that has lead to rampant and costly mischief, of which this case is just the latest example. How can we control costs while so many health care leaders are seeking every angle to make more money, whatever the consequences?"

As Adam Smith pointed out, "It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their self-love..."

The desire for money (what some people call "greed") won't be eradicated until we have some powerful genetic engineering, and even then it is unclear if that would be a good idea.

The challenge is to align the known human motivators, including greed, with enhanced outcomes.

No one is more greedy of their own money than themselves, thus one has to wonder if our medical costs would be lower with a higher percentage of out-of-pocket expenses. Currently, only France has a lower percentage of out-of-pocket health care expenses than the US. We are over-insured, in part due to regulatory mandates and the low diversity of plans due to the employer tax link.