The City of New York is being sued by the federal government for Medicaid round-the-clock services for individuals who need assistance with personal care, grooming, house cleaning, bathing, shopping and some other services. In the U.S. District Court in Manhattan, administrators are accused of routinely reauthorizing round-the-clock continuous personal care for individuals who did not undergo local medical evaluations. The City is being accused of overbilling by "at least tens of millions of dollars."
People who are eligible for the program should have been assessed by a social worker, physician or nurse, the lawsuit stipulates. When round-the-clock care is required assessment should be carried out by a designated local medical director.
The lawsuit followed a whistle-blower's complaint.
The US attorney's office in Manhattan also implied that the city cheated the government after Medicaid rules were changed in 2006, relieving the city of having to contribute to 24-hour care.
Prosecutors accuse city administrators of sometimes overruling local medical director decisions, especially when continued care was deemed as inappropriate.
US Attorney Preet Bharara said:
"(the allegations) unfortunately reflect a systemic failure to responsibly administer the Medicaid program. It goes without saying that ultimate medical decisions about patient care should be made by doctors and nurses, not government bureaucrats, and they should be based first and foremost on the best interests of the patient."
The Human Resources Administration of New York City says it takes its responsibilities seriously and helps nearly 42,000 seniors and frail individuals.
Approximately 17,500 individuals have received round-the-clock personal care services from New York City over the last ten years, the lawsuit claims, at an annual cost of between $75,000 to $150,000 per person.
The lawsuit adds that the cost to taxpayers, who fund many services which were not deemed necessary, has been enormous.
The Wall Street Journal quotes an example, where a doctor decided that a 65-year-old female did not require round-the-clock care. This assessment was overruled by a city administrator, who authorized the services regardless.
The New York times quotes another case - a 75-year-old woman with dementia who a medical director said should be in a psychiatric facility, was kept in the 24-hour care program. The woman had tried to jump out of her window several times a day and had punched her daughter.
New York and several other states have become concerned about Medicaid spending. Gov. Andrew M. Cuomo recently appointed a task force to attempt to reign in Medicaid spending.
According to a recent study by the United Hospital Fund, the city accounts for 84% of Medicaid spending on personal care in New York city.
Sources: Wall Street Journal, Medicaid, New York Times
Written by Christian Nordqvist