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News of the Day ... In Perspective


New York may lose billions to Medicaid fraud

A year-long investigation by The New York Times found that the program has been misspending billions of dollars each year. A computer analysis of records obtained under the state Freedom of Information Law turned up numerous examples that the state had never looked into.

The New York program, by far the largest and most generous in the nation, spends $44.5 billion annually, or about $10,500 on each of its 4.2 million recipients—one in every five New Yorkers.

One Buffalo school district sent 4,434 students into speech therapy in one day without talking to them or reviewing their records. Schools in New York were said to have misspent $1.2 billion in Medicaid payments for speech services between 1993 and 2001.

A dentist, who simply fabricated reports of doing 991 procedures in a day, reaped $5.4 million in two years.

A series of scams to divert Serostim, a synthetic growth hormone intended to treat wasting syndrome in AIDS patients, to bodybuilders stole tens of millions of dollars.

“This is an age-old problem in New York,” wrote Malcolm Sparrow of Harvard, author of A License to Steal.

(Clifford J. Levy and Michael Luo, New York Times, July 18, 2005).

Additional information:

“The Medicaid Penny,” by Lawrence R. Huntoon, J Am Phys Surg, Spring 2005.

Doctor sues prosecutor over abusive Medicaid Fraud Control Unit tactics, AAPS News, July 2005

AAPS amicus brief in case of Taj Becker, M.D., v J. Denis Kroll: Download PDF file

“Medicaid Contract Treacherous,” AAPS News, June 2000

“Reports from a Medicare Whistleblower” by Theresa Burr, J Am Phys Surg, Fall and Winter 2003

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