The County Executive’s Corner: Working To Stop The Medicaid Moochers

By Rockland County Executive Ed Day

Ed-Day-212x320Just last week, the County Legislature’s Budget and Finance Committee held a public discussion on the inherent shortcomings of Medicaid, which leave the federally-created, state-mandated program vulnerable to rampant fraud and abuse. The Committee’s recent efforts aside, know that my Administration has placed much focus on the program’s deep-rooted deficiencies since coming into office.

In 2014, nearly 88,000 Rockland County residents – 27 percent of the county’s total population – received Medicaid benefits administered by our Department of Social Services.

To comply with President Obama’s Affordable Care Act, New York State introduced sweeping changes that inadvertently made it much easier to defraud New York’s Health Benefit Exchange (the Exchange).

Far and away, the majority of Medicaid funds reach those residents who need them and are qualified to receive them.  However, a certain segment of recipients are not entitled to taxpayer-funded benefits and obtain them fraudulently.  In addition, most providers of Medicaid services are honest in the pursuit of helping those in need, but some “bad apples” do take advantage of the program. These dynamics are unacceptable.

As detailed by Department of Social Services Commissioner Susan Sherwood during the March 10th meeting, DSS and the Office of Rockland County District Attorney Thomas Zugibe are working in partnership to identify and prosecute individuals and entities engaged in defrauding our public assistance programs.

We believe that with aggressive investigations at the source and aggressive prosecution by the District Attorney’s office, there will be a much greater amount of money to be saved by the County.

That said, more must be done to harden our Medicaid system. Electronic enrollment, while efficient, leaves the system vulnerable to criminal activity.  “Self-attestation” during the enrollment process is a recipe for fraud.

Today, I call on the entire Legislature to formally push for change at the state and federal levels. Help me advance common-sense solutions to improve the access, quality, efficiency and value in the state’s health care delivery system.

Below, please find the platform of my Administration:

  • Require means testing/resource testing for all programs. (Long-term care applicants must “spend down.” All applicants must utilize their own resources to some degree before accessing publically-funded assistance programs.)
  • Increase in-person interaction with local DSS staff to confirm income and citizenship status. This includes comparison/coordination with other DSS programs.
  • Ensure ALL online applications originate from an IP address within New York State.
  • Develop term limits for Medicaid, ensuring that Medicaid does not become a lifetime “right.”
  • Strengthen New York State fraud controls involving the Exchange.
  • Hire additional County fraud inspectors with the ability to utilize revenues recovered for investigative purposes. (only in conjunction with necessary enhancements to existing Medicaid fraud safeguards, to ensure return on investment to County.)
  • Push New York State to integrate improved technology to find other resources and share that technology with local Departments of Social Services to reduce fraud.
  • Partner with the New York State Medicaid Inspector General (OMIG) to develop a process aimed at preventing fraud, as federal and state programs adopt an entirely “paperless” system.
  • Create a united-front lobby to state and federal elected for common-sense changes.

Simply put, we need new tools to preserve Medicaid and protect our residents who rely on it each day.

Our hardworking residents invest millions of dollars each year in public funds to assist their neighbors who need help – people who meet strict eligibility requirements to receive public assistance for the basic necessities of life.  Dishonesty within our Medicaid system diverts precious taxpayer dollars, drives up the cost of health care and jeopardizes the strength of a program that serves our most vulnerable residents. The abuse of Medicaid prevents our neediest population from getting help.

Together we must send a strong message that Rockland County will not tolerate fraud of any kind. We are committed to maintaining the integrity of our public assistance programs to ensure the health and safety of our clients, protecting the interests of those in genuine need, while conserving taxpayer resources.

I call upon the Rockland County Legislature to join me in supporting these critical enhancements. I will not stand idle and allow further fleecing of the Medicaid system on the backs of our county taxpayers.

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