New York Medicaid Overcharges

[clarencebunsen]

According to my wife this has the potential to make a very negative impact on NY healthcare providers.

U.S. begins new audit as Cuomo tries to deal with $15 billion in Medicaid overcharges

Gov. Andrew Cuomo is confronting a multibillion-dollar problem that will result in a substantial loss of Medicaid funding for a variety of hospitals and providers. While the impact on the health care industry's workforce could begin as soon as April, the complications for state budgets might linger for years.

The fiscal predicament rises from the federal government's finding that for 20 years New York overcharged Medicaid an estimated $15 billion for the care of developmentally disabled people in what federal investigators described as a system of massive waste and illegal billing. A new audit by a team of federal health agency officials is about to begin, according to state and federal officials.

As Cuomo plans amendments to the budget he introduced Jan. 22 — a fiscal plan that includes $56 billion in expenditures for Medicaid — the state Department of Health is being pressed by federal regulators to figure out how to sustain a cut of $1.1 billion in Medicaid funding per year starting April 1 while also repaying for some of the years of excessive payments.

www.timesunion.com/local/article/U-S-begins-new-audit-as-Cuomo-tries-to-deal-with-4247643.php#ixzz2KhiBCaFl


As I read this the feds have determined that NYS has over billed Medicaid for developmentally disabled people who were moved from institutional to non-institutional care and Medicaid payments to NY will be reduced by $1.1 billion starting April 1. That part seems to be a done deal.

In addition the feds want NY to return $15 billion of past over charges. Gov. Cuomo feels they cannot do that. From what I've seen the past couple years, they can & they will. The only negotiation terms will be the repayment terms.

As a side issue the state feels that the payment reduction will be devastating to the providers involved in the over billing and proposes spreading the pain around.

[dave]

I'm unfamiliar with this particular issue, not yet being in need of institutional care ... according to me, at least ... but as I peruse the bills, statements, and whatnot flying back and forth between my medical providers and Medicare I am impressed with the outright daring-do of doctors and test clinics. By the amounts they attempt to charge, you'd think they'd spent a significant period of their time in medical school learning how to rob banks and overcharge the government. I wrote elsewhere on these thread about the medical supply company that rents me my cpap machine for a monthly amount roughly one half of what I can purchase one online. Meaning that six times per year the company would be given the entire value of the machine by Medicare. After the "discount" it's only two complete machines a year. Still ...

I'm afraid I don't have much sympathy for medical providers after watching that game being played. And others I won't bore you with.

That said, I am aware that hospitals are in a bind. I am not sure I understand why. I once asked a hospital administrator if she could provide me with something like an Annual Report, as provided by private and publicly held companies. Such a document is quite standard and details income, expenses and most important, who owns the company and how much cash they're hauling out the back door. The hospital administrator said she would not be able to give me an annual report.

Still .... I wonder what the solution will be. If the government through Medicaid and Medicare continues to pour money into the hospitals, guess what we'll eventually have? Yup,
and you can count on it happening. Socialized medicine, some call it.

[Clipper]

There is definitely room for reform of the billing for medical services. Our hospital here in Bristol is manned by doctors and other specialties that are all "contracted." The billing is a nightmare. You go to the hospital and for months afterward you receive billing from people that you have never heard of. They have people bill you for administering the test, another for reading it. You pay for a surgeon to do your operation, and then for a hospitalist to attend to you while you recover in the hospital. Your blood is drawn by a contracted lab tech, and then you are billed separately for the actual testing of the blood by the contracted lab. What happened to the days when the hospital billed for ALL the services that you received while in their care with the exception of the doctor? Now the hospital has become nothing more than an overpriced hotel, with all other incidentals being provided and billed by independent contractors.

It seems like the system is specifically set up for ALL to be able to achieve maximum billiing from your insurance and medicare.

The incident that pissed me off the worst was when I went for a colonoscopy last year. Medicare and my insurance paid the doctor, a nurse practitioner, the lab, and anesthetist. About three months later I got a bill for $125 dollars not covered by insurance for "use of the facility." The facility is owned by the three doctors that practice there. When they called me to schedule an annual follow up I told them I needed to speak to the male practitioner that assists the doctor. I told the him that I was double billed. When he asked me what had occurred, I told him outright that they had "stuck it in my ass twice" and I only remember having the one procedure.

[dave]

And I'd like to believe that the reason for all this blizzard of billing and paperwork is so that the poor underpaid doctors, who tell us they are getting killed by high rents, malpractice insurance and whatever may be their complaints, can continue their struggle up from poverty and make a decent living. But so far as I know, there aren't any doctors living in my neighborhood and they're probably not even driving through and waving. Well, maybe with one finger.

[Clipper]

I will clue you in to a little tidbit of information Dave. In the area where you live, if there is not a fairway or cart trail bordering your property, or there is no golf club membership included in your HOA agreement, there will be few doctors residing in your neighborhood, lol. In fact if you are not adjacent to a PGA course, the president probably won't visit your area either.