Medicaid Abuse and Fraud

I read an article today that was published in an online news source in which the author reflected on the abuse that exists in the NYS Medicaid system. In it, he presented a sound overview of how the “system” is broken and in dire need of repair. While I fully agree with every detail he highlighted and am thankful for his insight, he failed to provide a solution.

He presented a reasonable perspective on how insured individuals are encouraged to do things that improve their health or at least reduce the risk of illnesses. He contrasted that to the person receiving Medicaid benefits who has no incentives for change and in fact often lives an unhealthy lifestyle.

You don’t need studies to know these statements are true. You only need to visit your nearby emergency room and take inventory of the people there. You will quickly observe obese individuals who likely have a bag filled with unhealthy snacks and need to step outside to catch a smoke while waiting to be seen for a toe ache. 

But I don’t need to do that for you see, nothing in the system has changed. 

Years ago, as a volunteer NYS EMT, I used to transport those people from their home to the hospital emergency room often at 2am – when the television stations went off the air for the night. I would arrive for an “emergency” call to find a suitcase packed and the “patient” waiting by the door. And because NYS has laws mandate that anyone presenting in the ER MUST be treated, there is no option to turn these people away.

Granted, there are responsible people who receive Medicaid benefits who are responsible and feel accountable and are grateful for the assistance. Unfortunately, they represent the minority of individuals whose life goal is to be old enough to receive their own benefits. I saw that too.

To change the system, you have to change society. 

This isn’t as simple as denying someone Emergency Room services on the basis of their ability to pay. This is a cultural issue that seeps into a multitude of areas that starts with a lack of responsibility and accountability. Until that root issue changes, we will have an out-of-control Medicaid problem. 

Tell a poor person they won’t be covered by Medicaid for an ER visit and will be responsible for paying the bill. They’ll shrug it off because they know they can’t pay and there won’t be a way to force them to do so. Deny their benefits? It’s a good start but you also need to deny their financial stipend and their food stamps. Then maybe you’ll get their attention.

Except then they will become homeless and that opens yet another list of issues. 

Recognizing the problem and defining it is a good start. There’s just so much more that must be done before we will see any solutions or improvements.