Consumer Law

New York?s Medicaid Trouble

By Joe Consumer

On July 30, 1965, when President Johnson signed the Social Security Act establishing Medicare and Medicaid, he spoke about ?planting the seeds of compassion and duty which have today flowered into care for the sick and serenity for the fearful.? 

But today, most of the discussion is about how to save money on the backs of the sick and fearful.  For example, recently we covered a new idea being bounced around Florida to let doctors off the hook for committing malpractice on the poor, i.e., Medicaid patients. 

Another thing happening is a huge federal Medicaid fraud lawsuit just filed by the federal government (here?s the complaint ) against New York City?s Medicaid program for:

"[C]heat[ing] the federal government after a 2006 change in Medicaid rules relieved the city of having to contribute to the cost of the round-the-clock care. In many cases, the government said, the city enrolled patients who did not need such services. And in some cases, the lawsuit alleged, the city approved in-home care for people who needed more intensive services, like nursing home care, but which would have required the city to contribute to the cost.

The lawsuit, which followed a whistle-blower?s complaint, also said the city ignored rules requiring recommendations from doctors, nurses and social workers before patients could be enrolled in the home care program, or sometimes rejected doctors? findings that the services were not needed. The lawsuit did not say exactly how much overbilling the federal government believed had occurred, but it asked the court to award it triple damages.

Home care, which provides aides who help with housecleaning, dressing, bathing, shopping and other personal needs, is one of the fastest growing services covered by Medicaid, the joint federal-state health care insurance program for the poor."

So the feds want their money back and they want more people thrown into expensive nursing homes.  We?ll leave that discussion for another time, but for now it?s clear that reforming the system is a high priority of New York Governor Andrew Cuomo.  Unfortunately, the way he?s going about it is highly disturbing.

The Wall Street Journal reported recently that:

Cuomo has put union leaders and hospital lobbyists in charge of a "Medicaid redesign team" and asked them to propose ways to cut spending by a target amount by April 1. 

"The governor was very clear in talking about not allowing special interests to dominate. But then he appointed a task force for Medicaid with the top special interests controlling it." said Judy Wessler, director of the Commission on the Public's Health System, a patient-advocacy group based in Manhattan. "This is why we're in this crisis, and he's just repeating it.

While Cuomo officials then ?released an expanded list of about two-dozen members, including Medicaid Matters, a coalition of patient groups, and several city and local health officials, ? Elizabeth Swain, head of the Community Health Care Association of New York State and a member of Mr. Cuomo's Medicaid team, said she was taking a wait-and-see approach. In an interview Thursday, she said she understood the governor's logic of putting 'key decision-makers in the same place as those who must change the way they see the world.'  But she added: 'I certainly understand why consumer and advocate organizations are offended. There wasn't even a tip of the hat to the ultimate recipient of these services.'"

What?s more, on Friday the Medicaid Redesign Team met for the first time - in secret! 

?How odd,? kindly wrote the Albany Times-Union, ?just a week into an administration we thought was so committed to open government and changing the political culture that prevails at the Capitol.? What is achieved by doing the public?s business in private? ? Where?s the harm in letting citizens ? those who use Medicaid and those who pay for it ? hear the many special interests on the panel debate why this service must go or that one must stay? ? Take careful note of the concerns raised already by Lara Kassel, coordinator of Medicaid Matters, the one consumer representative on the panel. She fears the repercussions of shutting out the public."

We can only imagine what Lyndon Johnson would be thinking now....

Full post as published by ThePopTort on January 12, 2011 (boomark / email).