New York Medicaid Audits Become "Softer"

Corruption within the government has not been a new accusation. For years, people knew, understood, and acknowledged that it wasn't how strong your policies were, but how deep your pockets could go. The deepest pockets of all seemed to always be associated with the medical industry. This multi-billion dollar industry has influenced government and politicians for years, allowing (or not allowing) laws to be passed. It seems that, in New York State, this theory has proven fact.

New York State has the nations largest Medicaid Program, which reaches $53 billion. However, according to a 2005 investigate, thousands of fraudulent cases were missed, that cost New York State billions of dollars. For example, Health Department regulators missed dentists who billed for 991 procedures daily, and nursing-home operators with $1.5 million salaries. In retaliation to this investigation, the federal government gave New York State a deadline; recoup $1.5 billion dollars of Medicare fraud in 5 years or pay for the mistakes. A large task to take on, but one in which Gov. Eliot Spitzer assigned James G. Sheehan to accomplish. With this strict deadline, Sheehan took extra measures to gain back the stolen money. He exceeded these targets placed on by the federal government and reclaimed 1.2 percent of its total Medicaid spending - the highest in the nation.

This accomplishment came with some unhappy customers. Mr. Sheehan was accused to "gangster-like" tactics, and was supposedly "making up his own rules". The medical industry reached into their pockets, and Mr. Sheehan was fired last June. In his place, his successor, James C. Cox. Although many would agree that Mr. Cox would be a qualified replacement, he would be heavily restricted by the new governor's legislation. Sheehans successor must now answer to Cuomo legislation and try to come to a reasonable conclusion that both parties agree on when auditing. He will not be allowed the freedoms Mr Sheehan was given. 

Although it is not expected that Mr. Cox will achieve the goals that Mr. Sheehan accomplished, it should be noted how quickly and effectively the medical industry shut down the government opposition. It shows that government agencies are not controlled by the people who fund them, but rather the ones who take it. As Mr. Sheehan stated: "Medicaid is to New York what corn is to Iowa."

Sources : http://www.nytimes.com/2012/03/19/nyregion/new-medicaid-inspector-general-supports-less-adversarial-audits.html