Politics | Spotlight on Fraud

The federal government turned the spotlight on the issue of Medicaid fraud late last week when a Congressional panel held a hearing with a title that got right to the point: “Is Government Adequately Protecting Taxpayers from Medicaid Fraud?”

The short answer, of course, is absolutely not. In fact, as part of its inquiry, the House Oversight and Govern-ment Reform Committee issued a staff report that reached the following conclusion, “No one knows how much of Medicaid’s budget consists of waste, fraud, and abuse, but it may exceed $100 billion a year. If private-sector companies allowed even a fraction of this type of mismanagement, stockholders would demand immediate reform and that the individuals responsible for the mismanagement be fired.

Americans who work hard and pay the taxes that fund the Medicaid program deserve no less from their government.”

On the same day that this federal inquiry was taking place, I turned the spotlight on fraud from Washington, D.C., on to Albany. The numbers may not be as huge, but they’re still outrageous and Medicaid fraud remains a real story in New York. A 2010 report from the U.S. Department of Health and Human Services ranked New York 26th in the nation in Medicaid fraud recovery. According to the report, states such as Missouri and North Carolina recover about three times as much in Medicaid fraud, while six other states recover twice as much as New York.

That’s not good enough. Not when Medicaid is costing state taxpayers more than a billion dollars a week. Not when an analysis early last year in USA Today showed that New York has the nation’s most expensive Medicaid program. And not as long as estimates keep cropping up that as much as 10 percent of New York’s Medicaid spending is lost to fraud and other abuses.

In other words, in New York, the story goes that as much as $5 billion in Medicaid costs are misspent, wasted or, worst of all, ripped off.

That’s simply unacceptable to the responsible patients for whom the system was intended, the honest providers doing their best to make it work and, of course, the taxpayers.

Putting a stop to Medicaid fraud has to be a priority at every level of government. Here in New York, while the new state budget calls for beginning a state takeover of future growth in local Medicaid costs in 2013, state and local efforts have to be ongoing to prevent abuses and root out fraud.

Governor Cuomo has zeroed in on the need to control Medicaid spending. Over the past two years the state has set in motion the most dramatic and, we hope, the most successful overhaul of Medicaid since it was created nearly a half century ago. This year’s state budget set in motion important steps to get local property taxpayers out from under this burden, but we need to keep acting aggressively against fraud and other abuses.

Taxpayers deserve a “zero tolerance” policy and one of the most proven ways to prevent fraud is to put in place the necessary tools, including cutting-edge technology, to identify it and take steps to stop it.

Which, for me, means the cutting-edge, data-mining computer software developed and continually fine-tuned by the Horseheads-based Salient Corporation – and that’s why I’m once again sponsoring legislation to reimburse counties for the cost of purchasing this technology. I have long been convinced that it’s key to building the foundation of an overall more cost-effective, efficient, better managed system of Medicaid.

For counties willing to make the start-up investment and then follow where it leads, we know it works. We know because it’s being already used by a dozen of New York’s 62 counties, including Chemung,

as well as the Medicaid inspector general. Chemung County Executive Tom Santulli recently noted again, as he has so often in the past, that Salient’s data-tracking tool has already produced significant savings for the county

But it starts with a county’s investment in the technology. A state reimbursement for this initial local cost could help encourage its more widespread use, which I believe would be a smart state expenditure likely to produce a vastly higher return to taxpayers in long-term cost savings.

The bottom line is that the key question still stands: Can we do more to prevent Medicaid abuse, fraud and waste? Can we better turn on a spotlight on fraud? I think the answer is yes.

Tom O’Mara is a Republican senator from Big Flats.

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