Federal Government Sues NYC Over Medicaid Fraud

  1. 2
    The federal goverment is suing New York City claiming it has over billed Medicaid by "tens of millons" of dollars. Lawsuit claims NYC has billed the government for 24 hour care for thousands of patients that was not required.

    http://online.wsj.com/article/APe1ce...226d82f27.html
    http://www.nytimes.com/2011/01/12/ny...er=rss&emc=rss
    imintrouble and lindarn like this.

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  2. 10 Comments...

  3. 5
    I"m going to hazard a guess that most likely the person did need it but their need didn't fit the federal guidelines.
  4. 3
    This is most definitely a slippery slope, to be sure. On the one hand, I have no doubt that, unfortunately, fraud happens regularly with well-intentioned programs such as Medicaid. On the other hand, sometimes qualifying guidelines are extremely strict and tend to miss a significant amount of the population who "should" qualify (for example, there are a lot of families that don't meet the federal guidelines for 'below poverty level,' but who are very much struggling day-to-day), so that may be the issue here. Also, from what I can tell of the article, the argument is that a lot of the patients/clients involved should have been placed in institutions. I do completely agree that if home care is simply not possible due to the severity of a medical condition, it might be beneficial to consider inpatient care. However, many patients/clients wish to remain in the homes with family and friends, and if this is possible without causing any danger to the person themselves or those around them, that wish should be obeyed to the best extent possible.
    I would say, all in all, this would be a very difficult case to judge, and unfortunately, many patients/clients are going to get burned
    Kooky Korky, lindarn, and JeanettePNP like this.
  5. 4
    If you are not from NY it would blow your mind how many and how easy it is for patients to get 24hr home attendants. It is a major means of employing low skill minorities and keeping them off public assistance, and all funded by the US taxpayers, so it is a sweet deal for NYC and there are certainly many worse ways our tax dollars are ****** away
    CaregiverGrace, tewdles, subee, and 1 other like this.
  6. 2
    Looks like the problem is city administrators are over-ruling their medical directors. It's not always for the benefit of the client.
    The federal government cited one instance in which a medical doctor determined that a 65-year-old woman did not need 24-hour services, only to be overruled by a city administrator who authorized the services anyway.
    In another instance, the city caused a 75-year-old patient to get less care than needed by keeping the person in the 24-hour care program even though the local medical director said the patient needed to be in a psychiatric facility, the lawsuit said.
    SweettartRN and lindarn like this.
  7. 0
    NYS must be doing some things wrong. A few years back, through family, I met a lady who was doing 24hr care for her grandmother in her 70s. The so-called invalid was AA0x3, self pt, no needs, no med issues. Infact the LOL would prepare meals for the family and bbsit for friends. It is unbelievable to think that someone authorized that kind of situation because the daughter/caregiver was getting paid (she bragged about it), while going to school fulltime.
    So I am all for effecting changes in order to get services to those who really need it.
  8. 0
    Quote from d'cm
    if you are not from ny it would blow your mind how many and how easy it is for patients to get 24hr home attendants. it is a major means of employing low skill minorities and keeping them off public assistance, and all funded by the us taxpayers, so it is a sweet deal for nyc and there are certainly many worse ways our tax dollars are ****** away
    i beg to differ, i am from ny and it is incredibly difficult to get aid. it is a very rare instance when someone would go through the degradation, humiliation, systematic disrespect, already work out lies to questions to they don't know they'll be asked . . . there's no cheat sheet.

    i have experience as a coordinator in nyc working for a visiting nurse service and other non-profit agencies. there were a lot of checks and balances. patients were seen by home health nurses, doctors (specialty depending on need), and monitored by licensed aides. they were also interviewed regularly by interviewed regularly by case manager, and higher ranking administrators.

    the clients couldn't even move on to the next faze of their care program unless they attended their doctor appointments and received a referral, they are also assessed weekly by skilled nurses, and as we know, the nurses were responsible for writing detailed reports . . . and done irresponsibly . . would jeopordize their jobs.

    what does blow my mind is how we spread misinformation about things we really don't know about; and many don't know this, but many find the term "minority" a bit offensive.
  9. 0
    Quote from d'cm
    If you are not from NY it would blow your mind how many and how easy it is for patients to get 24hr home attendants. It is a major means of employing low skill minorities and keeping them off public assistance, and all funded by the US taxpayers, so it is a sweet deal for NYC and there are certainly many worse ways our tax dollars are ****** away
    This is very true, and socialized medicine would only make this kind of fraud more rampant, unfortunately. It's nice to see the Fed going after them, but it is JUST the tip of the iceberg. Taxpayers should not in any way be stuck with the bill for this kind of nonsense, and I welcome any politicians in the NY area to run on severe cutbacks as it has gotten completely out of control..
  10. 0
    What I find common in all programs about public aid, is that when it's time to tighten the belt. It's always someone elses belt. Medicaid and who's paying for what, is a system in which one side is always trying to get the other side to shoulder more load. The patients never benefit. It's not hard to imagine a healthcare system where hospitals start to opt out of medicare and medicaid leaving patients to overcrowd and drown their competition.
  11. 0
    Quote from CaptKris
    What I find common in all programs about public aid, is that when it's time to tighten the belt. It's always someone elses belt. Medicaid and who's paying for what, is a system in which one side is always trying to get the other side to shoulder more load. The patients never benefit. It's not hard to imagine a healthcare system where hospitals start to opt out of medicare and medicaid leaving patients to overcrowd and drown their competition.
    Both systems suffer from the problem that each are often considered as insurance, when they are entitlement programs. As with everything else, many equate government programs with instant cash, which leads to vast amounts of waste, fraud and abuse. Am not saying this is the case in the OP, but we as a country simply cannot continue allowing both to grow at rates >3x inflation yearly.

    When Medicare first came into being healthcare systems welcomed the plan because at least they would get something for beds that might otherwise lay empty. Medicaid along the same lines, in that again those providing health care for the indigent got some sort of payment.

    As for healthcare systems, doctors, and hospitals opting to leave Medicare/Medicaid, it's already happening. In many parts of the country it can take a very long search to find a doctor taking on new Medicaid patients. Medicare *may* be an easier search, but still even there it can be difficuilt in some areas.

    Many hospitals are already making noises about leaving the system, especially as Obamacare calls for slashing rates on one hand, but expanding the number of persons enrolled.


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