Wednesday, July 20, 2005

Responses to "The Agencies Stumble"

Posted here are readers' comments on my July 19 article on the lack of sufficient oversight of New York State Medicaid. Thank you, and please continue sharing your thoughts with us.


  1. Starquest,
    This is a wonderful and exciting series of articles from the Times. They're usually not my favorite people, but if they take on a true
    problem and work to redress it, it will amount to their greatest service
    to advance society since they uncovered Tweed in 1871.

  2. The enormity of medicaid fraud is shocking---and even more shocking is the
    > lack of concern by the NYS Senate and its disregard by the NYS Assembly.
    > No wonder there are no funds for basic maintainance and improvements---and
    > it probably will continue.

  3. northside10:10 AM

    Hi: Very helpful. The sheer size of the Times story is too much to take on at one time. Your article is like CliffsNotes. It gives the reader a very good idea of what's going on plus interesting insights.

  4. good article, Henry. Frustrating as hell.

  5. The Northeast-Midwest Institute published a compendium of per capita federal spending by state. Guess in which category New York State ranked number one? Medicaid fraud funding, and by a substantial amount..

  6. I share your view that I am very glad the NYT is running this series. It is long overdue. I'm sure there are vast amounts of fraud in the NY Medicaid system, and it's clear that no one is paying attention to it.

    At the same time, I think that characterizing the main problem as "fraud" is a mistake and takes our eye off the ball. Sure there are scammers. But the big problem is something not fairly characterized as fraud: honest people, over a long period of time, structure their behavior to take advantage of state giveaways.

    Let me describe a few examples. When I was a kid, pre Medicaid, my grandmother had to go into a nursing home. This was a huge burden for my dad and his two brothers, but they never thought of not shouldering it. She was part of their family. Today, the elderly mother is simply declared to be a different family unit. She has no income, so she is "poor," even though the sons may be earning comfortable six figure incomes. Voila, the state pays.

    Does the elderly mother have assets, like perhaps a house worth a million dollars in today's inflated market? No problem -- she can give it away to the children! Medicaid conducts a hopeless losing cat-and-mouse game with middle class families structuring their lives to make their elderly parents appear "poor" to the Medicaid system. Once middle class families figured out that all you had to do was have mom give the house to the kids, Medicaid struck back with complicated rules making it difficult and putting a three-year wait between the gift and Medicaid eligibility. Result: today there is an entire section of the American Bar Association devoted to what is euphemistically called "Elder Law," in other words, how to plan ahead to make granny appear poor so that Medicaid will pick up the tab and the family will never have to spend a dime for her health care in old age.

    And nursing homes are far from the only example. New York's Medicaid program is famous for paying for home assistants for people who claim to need help at home. I'm sure that many sick elderly people legitimately need help taking their medications, or cleaning their homes. But literally everybody could use more help around the house, and if it's suddenly free everybody wants it. The original idea of this was that it would help people go home from the hospital earlier, and thus save an enormous expense. But once people figured out that if you claimed to be sick enough the state would pay for your housekeeper, the floodgates opened. Are these people engaged in "fraud"? I would say that it's impossible to draw the line between legitimate and illegitimate conduct in this area. These people can really make a demonstration that housekeeping help is valuable for them for health reasons. But it's just not feasible for the state to pay for a housekeeper for every old person.

    So, keep up the good work. But no amount of chasing "fraud" is ever going to shrink Medicaid by more than maybe 10 or 20 percent. The real issue is making some tough decisions. It's going to take more than a few NYT articles to get that done in NY.

  7. Great-Keep it up Starquest.
    Be a Gia.
    Keep shaking Silver and the mob till their eyes pop.
    Finally The NYT is doing something right, I mean sound. It's about time and good to see.