Who's Minding Medicaid?

New York Times Editorial  July 20, 2005

New York's Medicaid program has always had a reputation as the Cadillac of state health care programs. The 4.2 million people in the state's program have access to some of the best and most complete medical coverage in the country. The very fact that it's so generous makes it particularly critical that the public is assured that money is not being wasted. Unfortunately, the opposite seems to be true. As revealed by a year's investigation by Clifford J. Levy and Michael Luo of The Times, New York's $44.5 billion Medicaid program has become a honey pot for unscrupulous practitioners.

As one former prosecutor said, the pursuit of Medicaid fraud by Gov. George Pataki and Attorney General Eliot Spitzer is now so lax that New York State's Medicaid program "almost begs people to steal."

Better management of Medicaid and expanded enforcement should pay for itself - especially since there are federal funds available if New York steps up its pursuit of those ripping off the state. Yet the number of investigators has been cut so badly that, with 400 million claims paid last year in the state, Health Department regulators uncovered only 37 cases of suspected fraud.

Albany's politicians are scrambling to blame one another for this scandal, and whipping up plans for reform. But Governor Pataki, who is now nursing presidential ambitions, is going to have to explain this one to the voters he's been courting in Iowa. Mr. Spitzer, who is running for governor, now has a big question mark on his r￩sum￩ as a reformer. The Legislature deserves its share of the blame as well. The State Senate, dominated by Republicans, has failed to beef up the attorney general's enforcement budget and the Assembly, controlled by Democrats, has rebuffed the Senate's ideas for Medicaid oversight.

What all state officials share is the ability to cower like Harry Potter's Dobby before the lobbyists from health unions, nursing homes, hospitals and big pharmaceutical companies. It's time for them to stop catering to this powerful shadow government. New York was once in the forefront in investigating Medicaid fraud, with charges against "Medicaid mills" a routine item on the docket. Now the state spends the most money but ranks way down the list for the number of on-site audits or cases referred for prosecution.

Every dollar stolen from Medicaid is a dollar taken from a single mother with a feverish child or an elderly person who needs a steady doctor. This is a scandal and a disgrace for the government of New York State and those who run it.