The New York Medicaid Case

The New York State’s Medicaid program became the focus of much discussion in 2005 due to the blatant abuse of the government funded medical assistance program by opportunistic entities and wasteful utilization. The year revealed abuses from different sectors of the healthcare delivery system resulting in expenses that are well above and beyond the average expenditure of other states.

Once the beacon of the Great Society era, the New York State Medicaid program in 2005 became a breeding ground for fraud, waste, profiteering and this has resulted in the program misspending billions of dollars annually. Because of this unregulated situation, the “New York’s Medicaid program [became] the most expensive and most generous in the nation” (Levy and Luo, 2005, p. 1), spending $44. 5 billion annually, making the New York’ Medicaid budget to be larger than most state budgets.

The state is known to spend nearly twice the national average with figures estimated at $10,600 spent for each of its 4. 2 million recipients. Breaking down the figures, it is estimated that 10% of the Medicaid dollars were lost to fraudulent claims while, 20-30% were siphoned by system abuses – revealing that about 40% of all claims maid to Medicaid were of questionable nature. The actual value represented by this portion? A staggering $18 billion annually (Levy and Luo, 2005, p. 2).

Several elements threatened and continue to threaten the NY Medicaid program. As it were, the program was and still is highly susceptible to abuses by those enrolled in the system. Opportunistic practitioners, business owners and institution heads would always try to make money from the system; unscrupulous outside groups, businesses and third-party elements would always abuse the system; negligent practitioners will always be unknowing accomplices; and indifferent and lax regulators would always passively propagate these negative elements.

As most of these problems are primarily rooted in human behavior, these threats will always be in existence and thus continuously pose dangers to the New York Medicaid system. However, opportunities to address these problems are not hard to come by. The situations presented in the article written by Levy and Luo (2005) are not beyond control or surveillance.

For example, in the case of the dentist from downtown Brooklyn who reported and charged 991 dental procedures on a single day in September 2003 (which for that single month charged Medicaid roughly $725,000 for 9,500 individual dental procedures), the sudden spike in services performed and the sheer impossibility of performing 991 procedures in a single working day (roughly 100 procedures per hour) should have alerted officials once the claims were filed. This case, and many others like it, could have been detected early only if diligence was applied every time enrolled practitioners file claims.

An annual or bi-annual and more intensive auditing scheme could have also prevented these improprieties from occurring. As demonstrated by the Times investigation into the matter, the case of the dentist and other similar practices were easily detected “using a laptop computer and commonly available software after spending a few hours studying New York Medicaid billings. ” Another instance where diligent auditing and surveillance could have been of great help would be in the reported case of ambulette abuse. According to the Times report, the service originally designed to transport patients who cannot walk has also become a front for abuse.

According to a 2003 audit, “[m]any doctors, therapists and clinics regularly order ambulette transportation for their patients when cheaper alternatives should have been used instead” and this has resulted in questionable practices such as establishment of business relationships between transport providers and medical practices who appear to receive commissions for ordered trips. Abuse of this service has resulted in a jump in New York State’s Medicaid transport expenditure from $700,000 in 2003 and 2004 to $2 million in 2005.

These aforementioned incidences and the others like it are all a result of the system becoming lax with monitoring Medicaid activity and “state regulators [losing] interest in bringing Medicaid thieves to justice, preferring instead to focus on recouping money through …

It is important that we all understand the basics of the Medicare and Medicaid programs as we will all eventually come of age where it is necessary to seek their assistance. The purpose of this paper is to give a …

Over the years, the demands on nurse-to-patient ratio has been increasing and alarming in the United States. There are proposals to the US Congress to enact several legislations for mandatory, inpatient nurse-to-patient staffing ratios to improve the working conditions in …

Biorobotics Just as there have always been advances in medicine and technology, the two have now come together to form biorobotics. Biorobotics studies ways to emulate living biological organisms mechanically or even chemically. Biorobotics is a fairly new technology that …

David from Healtheappointments:

Hi there, would you like to get such a paper? How about receiving a customized one? Check it out