New York State's Medicaid problem in the schools


New York State decided this week to agree on some methods to address fraud as it relates to the $46 billion dollar Medicaid program. Don't for a moment think that the discussion was all high-minded and oriented toward saving the taxpayers money; one of the sticking points that the Dems finally had to let go was letting their trial lawyer buddies get a whack at the money pinata by allowing whistle-blower suits.

So now we have a more fully funded Medicaid Inspector General's office, which has been pinched by the feds to pony up on several billion dollars worth of payments. Of course this means that the state turns around and pinches the counties that administer the Medicaid program, asking for proof of all the services that were provided. Then counties turn around and pinch the municipalities and school service providers for their paperwork. The problem here is that municipalities and school providers probably didn't keep good enough records because they don't know how to integrate the demands of a Medicaid-based reimbursement model with an educational model. What does a widget counter in a school's budget office understand about keeping a medical chart? It is not the same as an 'educational' record at all.

The collective hue and cry that you now hear is from the municipalities that will never be able to meet these auditing paperwork demands. You may also hear the death cries of several million trees as copy machines in municipalities kick into overdrive to start sending their documentation to all of the counties. The other odd sound you may hear is the gleeful rubbing of hands together by bureaucrats in Albany, who now have mountains of paperwork to look at for corrective action audits and who are now guaranteed jobs well into the 27th century.

The sound that you will hear in the coming years is the groan of the taxpayer who will have to pay higher property taxes because the municipality won't be able to meet the burdensome documentation requirements of the Medicaid program - but the children will still require the services.

Undoubtedly we need to combat fraud, and we need to combat it aggressively. The problem is that no one is really interested in combatting fraud - they are really just trying to kill off the Medicaid reimbursement altogether for related therapy services in preschools. No one asked me, but here are some REAL solutions for getting the toothpaste back into the tube:

1. Develop a Medicaid eligibility check for the counties that bill Medicaid. This already exists in the 'private' sector as health providers have to swipe the Medicaid card to determine if the child is even eligible. This will prevent municipalities from billing the state's Medicaid system for children who are not eligible.

2. Move to an integrated Medicaid documentation and billing system. The framework for this system already exists and is being implemented as the "IEP Direct" system. Go to www.iepdirect.com to see how it works. If every provider and every municipality and every county was on this program they could share the data to the state or feds with the click of a button: daily notes, quarterly reports, etc. The only paper that should exist is the original signature sheet that providers would have to have signed each time that they provide a service to a child.

3. Initiate a reasonable debate on entry and exit criteria into the school related services program. Buffalo Schools and the now infamous speech therapy debacle are perfect examples on why we need a reasoned and evidence-based approach to criteria for receiving services.

It is unfortunate that these ideas are all probably just pipe dreams. However, I offer to work for New York State for FREE if they are interested in asking me to spearhead any of the above initiatives.

Now I will go wait for my phone to ring...

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