July 20, 2005

Exposing fraud yields quick response

How do you get state government to respond to a problem quickly? Apparently articles in the New York Times can work. After the embarrassing revelations in Monday and Tuesday's papers, Governor Pataki has ordered changes:

Gov. George E. Pataki yesterday ordered a broad overhaul of the state agencies that protect Medicaid from fraud and abuse, creating an independent inspector general's office and bringing in a former federal prosecutor to help reorganize the policing of the program, which is New York State's largest expense.

The inspector general is expected to take over some authority from the State Department of Health, which administers the overall $44.5 billion program but has fared poorly in detecting Medicaid fraud and waste compared with its counterparts in other states. The changes will be carried out by executive order, the governor said, and will not require the approval of the Legislature.

Mr. Pataki said he was also appointing Paul Shechtman, a former federal prosecutor who led the governor's criminal justice initiatives early in his tenure, as an unpaid adviser to develop new strategies for combating wrongdoing in the program and revamping the agencies. The current antifraud system was put in place after the nursing home scandals of the 1970's....

Administration officials said the current system was governed by a patchwork of formal and informal agreements between state and federal agencies that was probably outmoded and that Mr. Shechtman would be asked to evaluate and streamline it....

Using a laptop computer, reporters for The Times analyzed millions of Medicaid billing records and found numerous instances of spikes in claims, a telltale sign of fraud, that were never scrutinized by the state. The billings of a Brooklyn dentist, Dr. Dolly Rosen, rose to $4 million in 2003 from zero in 2001. Dr. Rosen, who was paid by Medicaid for as many as 991 procedures a day in 2003, was indicted on charges of stealing more than $1 million from the program after The Times questioned the state about her billings.

Addressing precisely this kind of technological shortcoming, Mr. Pataki said the inspector general would work with the State Office for Technology to find better ways to analyze Medicaid billings.

It's remarkable what a few good stories can do.

Posted by simon at July 20, 2005 8:51 AM in ,
Note on photos