Saturday, April 7, 2007

Here are some shocking details about the Medicaid fraud we've been hearing about.

>In response to questions about D and T Centers and associated facilities, the answer always was that the clinics had an "all inclusive rate." No one was able to explain what that meant, although they took great pride in saying it. There was never a definition of what was or was not included, nor did the application request such information.

One frequent method of overbilling or fraud, is "unbundling" where a provider separates the various services so that the total of the reimbursement items, exceeded the all-inclusive rate. These subcontractors were usually owned by the same corporation, or subsidiaries of the parent or by individuals with a financial interest in the clinics.

One example is dialysis centers, where the equipment and reagent manufacturers have bought almost all the dialysis centers from the physician or hospital owners and hired the same people back to operate the clinic. Then the manufacturers started buying the clinical laboratories that monitor both the patient but also the water and chemicals used in the instruments. Patients now have little or no choice in provider as most are owned by the same one or two corporations. Despite numerous prohibitions against such arrangements as, as well as mulitiple fraud prosecutions throughout the country and NY law that prohibited such arrangements, DOH acceded to the requests of the high powered lobbyist and created opinions that made these arrangements legal.

Other troubling arrangements include large, out of state, and for-profit group practices buying physician practices and clinics in New York. The so-called professional corporations that were set up to run these services were often headed by physicians neither located nor practicing in NYS, making them unreachable in the event of a malpractice or regulatory violations. Despite NYS restrictions on the corporate practice of medicine, DOH also ignored these groups and they are operating in oncology, reproductive medicine and other specialties.

Many believed that these close relationships were prohibited by the law. At minimum, the arrangements required special oversight to assure the proper arms length business practices. I had the occasion to review some of the records of the reimbursement requests from many of these facilities. What I discovered is that "all-inclusive" meant whatever the clinic owner said it did. There was nothing in the file to specify what services were included and which were not. Because the clinics all mentioned "clinical laboratory" as being included, when excesses were found in billing by laboratories on work referred by clinics, the clinics were all able to say "those tests weren't the ones we included," escaping both prosecution and recovery of excess amounts. Pharmacy services were also whatever the clinic said were included.

The worst case I found was a for-profit abortion clinic in NYC. I do not know if the facility still exists or is under the same ownership. The cost report submitted, on which the rate was based, included $600,000 in salary for the owner, a physician who did not practice OB-GYN. The request included rent for the space, to the owner, the same physician. I think it also included administrative and secretarial salaries, and possibly nursing and medication. It DID NOT include the salaries of the physicians providing the services or the clinical laboratory testing which is a major component of this service. When I questioned this, the staff told me that they approved the requested rate as it was below the peer average in the area. In fact, they suggested that had the facility asked for more, it would have gotten it.

When I asked with which facilities the comparison was with, they listed some of the major non-profit family planning operations that really HAD rates that included all the necessary services.

The rest of the story is that the physician services were provided by a GYN- specialist PC, owned by the same physician, who was not a GYN and the laboratory services were offered by the laboratory owned, again, by the same physician.

The rate setting system for ambulatory services needs to be extensively revised.
I am still new at this so please bear with me. Here is one of the many leads I've received. I'm still sorting them out as I get the time. Keep them coming at

>The Civil Service Commission is composed of three members. The President is also the Commr. of the Dept of Civil Service. The other two "Members" formerly met for three days each month (except for August). They are paid in the $80,000 range, have offices and a secretary, and now meet one day each month, for a grand total of 11 days. They also get travel money and perdiem money. You can look it up, as Casey Stengel said.

Sunday, February 18, 2007

Some bloggers on Capitol Confidential have raised a good point about my first post, so I should clarify. If you see a wasteful policy, tell me about the policy, but not the administration responsible for it. I will not post any mention of whether it's a Spitzer policy or a Pataki policy or a Cuomo policy or a Giambra policy. All I care about is exposing the fact that it's there and having it taken care of. Here are some links to some allies in our war on waste.

I have also figured out how to allow people to comment without having to log in.

Friday, February 16, 2007

Hello. My name is Brian, and I'm a taxpayer. I'd like to believe that I have just given you enough information to justify the existence of this website, but at the risk of being redundant, let me explain.

Mario Cuomo once said, "we believe in only the government we need but we insist on all the government we need." I agreed with him then, and I agree with him now. We need our government. We need it to keep us safe, to maintain our roads and to provide a safety net. But I have just finished hearing my last horror story about the waste taking place in our government, particularly in Albany. It strikes me as bizarre that in an age where we have such amazing technology at our disposal, we fail to employ it to expose such egregious violations of the public trust as people literally sleeping on the job. It happens. I've seen it. And today, I'm going to do my part to change that. I've set up an email account,, for you to send your stories. I want to see everything you have to offer, whether it's at the federal or villiage level. Any place where taxes are being squandered, I want to know about it.

An important note: I don't want to hear blame. I don't want to hear about policies or politics or progams or personalities. I want facts. Excess, laziness, theft, dishonesty, anything that you believe to be a waste of our tax dollars. Remember,
photographs don't lie: if you can take a picture, please do so. At the end of March, I'm going to upload your pictures and your stories. Be sure to be as specific as possible.

Here's to doing some good.