I submitted and published the following opinion on http://blog.timesunion.com/capitol/archives/70849/omigs-sheehan-is-leaving. As anyone who has even the least amount of knowledge of the NYS Medicaid system notes that there is nothing fabricated about it. As they say the facts speak for themselves.
Quite frankly anyone who did not see Sheehan’s termination coming should re-evaluate the strength of their monocle. I, for one, am actually surprised that under Cuomo’s regime Sheehan lasted as long as he did. I surely thought he would be out right after Cuomo’s assemblage of that grand Medicaid Redesign Team.
For those who aren’t familiar with my enormous admiration for the Medicaid Redesign team, you can read my written idolization at http://leplumefornewyorkers.blogspot.com/2011/04/who-is-really-ripping-off-nys-medicaid.html
Jim your forced resignation is nothing less than a signal that the citizens of this State have lost and the crooks have won. Hey but then that’s only my opinion, and all who know me, know how impulsive I am. After all, who in his right mind espouses the following belief: when arsonists roam the streets unchecked, don’t bother calling the fire department, step aside and watch the buildings burn to the ground.
And, really, that’s exactly what needs to happen to the New York State Medicaid Program – it needs to be completely trashed. Burned to a crisp; its ashes tossed into the coming storm and then a new system should be remolded to meet the needs of the decent few. This, of course, has implied in it that in the new form the Medicaid program be out of the reach of the politicians and in the hands of civil minded administrators —you know the type those who put the needs of the needy over those of the glutens.
And, really, that’s exactly what needs to happen to the New York State Medicaid Program – it needs to be completely trashed. Burned to a crisp; its ashes tossed into the coming storm and then a new system should be remolded to meet the needs of the decent few. This, of course, has implied in it that in the new form the Medicaid program be out of the reach of the politicians and in the hands of civil minded administrators —you know the type those who put the needs of the needy over those of the glutens.
For those unfamiliar with Medicaid corruption it is difficult to understand the depth of abuse and fraud that exists in the program. It simply cannot be comprehended by those who see Medicaid as a social philanthropy. The only ones who come close to seeing the depth of the abuse and fraud are those charged with trying to scoot away the vultures in a feeding frenzy.
Thirty years I had been with the Medicaid audits and investigations, under its various names, and in all those years, only under Sheehan’s leadership has the agency been able to make a slight mark on Medicaid corruption. And for this he was forced to resign.
How could that happen I ask?
It could not have been incompetence. He succeeded where others before him failed. Sheehan made the NYS OMIG. Intelligence and knowledge could not have been a factor either. The man was a Federal Prosecutor and a Harvard graduate, for God’s sake.
As I sit here contemplating the absurdity of the termination, I can’t help but realize just how influential Medicaid corruption really is. Not only has it caused the termination of Sheehan, but it is also causing the tearing down the whole OMIG organization — OMIG staff today have been advised that under: “…the Governor’s initiative to achieve cost savings…one or more positions within certain titles have been identified for reduction.”
Now doesn’t that seem just a little strange, especially since Medicaid audit titles are Federal mandated and paid for in part by federal funds?
Jim, what else is there to do? — When arsonists roam the streets unchecked all that a decent person can do is step aside and watch the buildings burn to the ground.
The following was a reply to the above. Again as anyone with the minimal amount of information of the Medicaid program can see the reply is not exactly correct.
2. Hold the Line
Retired, your blog/post is a little over the top. OMIG was suppose to combat fraud in identifying all those milestone amounts for CMS. Instead it concentrated on hammering legitimate providers providing much needed services to vulnerable populations–many auditor’s in OMIG seem to think that’s a crime in and itself. OMIG, by its director’s own admissions, was not designed to combat fraud–and Mr. Sheehan’s own testimony clearly indicates he didn’t care to differentiate between fraud and minor errors. That is a BIG problem. OMIG had its 15 minutes of fame. The demonstration agreement is almost over. It needs to reorganized with a new mission-to prevent improper or fraudulent billing before they happen. BTW, no OMIG titles are federal items.
And as the following reply indicates I’m not the only person aware of the fallacy of “HOLD THE LINE’s” the reply.
3. Baron Von Grumble
Hold the Line … now who’s playing fast and loose with the truth? OF COURSE there is a difference between fraud and “minor” errors. When there is a billing error, the provider must pay it back if they can’t produce the documentation to support what they billed for. Fraud is something else and carries additional fines and penalties. But if you didn’t want to hear/see that clear distinction in testimony and written statements, that’s your choice.
If you understood how Medicaid works, you would know that Dept. of Health is responsible for the ‘front-end’ of the system to try and prevent erroneous payments from being made in the first place. The system is constantly being updated but will never be perfect … which is why auditors and investigators will always be needed.
As “Retired from OMIG” correctly stated above, states are required to pursue Medicaid fraud and OMIG items are partially Federally funded.
I don’t know where you got your facts from but for your own credibility’s sake, please consider an alternative source.
I tried answering Hold the Line’s comment several times, but was unsuccessful in getting my answer published. So I’m doing the best next thing, I’m publishing it here.
Hey Hold The Line, I’m glad that Baron Von Grumble as made the point a lot more gentle and eloquently than I have the nature of doing.
You see, I have no desire to get in a debate over what was OMIGs function. To understand the scope of the OMIG one would have to have a detailed look at past administration’s runaway Medicaid policies. And then whatever OMIGs function was, as you stated it only lasted 15 minutes. But they were the longest 15 minutes unscrupulous providers have experienced in over twenty years. If 15 minutes had them defecating bricks, can you imagine what they would have passed had OMIG lasted a ½ hour?
What I have always been amazed at is how each provider that I audited (and I audited quite a few) swore that they were providing the best “needed services to vulnerable” population. They swore they were all saints. In fact, even a NY State senator proclaimed them to be saintly. Imagine the indecency of that in the conduct of State Business this public representative claimed that Medicaid providers are in fact “doing God’s work.” You just can’t make this stuff up.
Unfortunately, my experience has led me to conclude that, for the most part (the exception is only a handful), most Medicaid providers care more about stuffing their pockets than providing “needed services to vulnerable populations.” In fact, most of the providers who swore they were purer than snow were actually dirtier than curbside slush.
I, and those like me, care about the “vulnerable population.” We have been the ones who have cared about the level and quality of service they receive. And that is the reason why it bothers me to no end to see a bunch of vultures feeding on the “vulnerable populations”. The “vulnerable populations” you refer to are real people who for reasons beyond their control find themselves in the hands of those clad in priestly attire sucking their blood like hungry vampires. Don’t tell me Medicaid providers are providing “needed service to vulnerable populations.” Don’t even suggest it, I know better.
You suggest a distinction between minor and major errors. Let’s see how fraud is really dealt with. When OMIG auditors discovered fraud or potential fraud, the cases were (had to be) turned over to the Attorney General’s Office (AG). But here is the thing; the AGs office did not have to accept them. In fact, they turned down more referrals than they accepted. Some of us (I included) began to suspect that if there wasn’t a potential for a HEADLINE it did not serve AG’s scope. We never knew this to be a fact, for us it was just an educated feeling.
As for minor problems: it’s often been said that OMIGs was a “grammar mill”: if the “ i “ were not dotted or the “t” not crossed, the service was disallowed. There is only one answer to that it starts with a “b” and ends “t” with an “s” in the middle.
The only individuals who would say that are those unfamiliar with the internal processes of findings substantiation and those unfamiliar with the NYS Medicaid Codes or, perhaps, those familiar with the regulations but refuse to abide by them. The truth about findings is that only when a regulation is violated can the finding be processed. And the regulations can be found in the Provider Manuals, Title 18, Title 10, Title 14, Title 16 and so on. If you’re not familiar with them, give them a reading. You’ll be amazed to find that there is no distinction between “minor and major” infractions. They are all the same!
And while we’re talking about findings how does one classify the following?
What is lack of evidence for a billed service -- minor or major?
What is claiming a patient to be HIV positive (when the lab test clearly finds them negative) -- minor or major? (And you talk about “needed service to vulnerable population.”)
What is keeping patients on the same Physical Therapy for 5, 6 years -- minor or major?
What is billing for the same patient, same service same date of service at least twice and sometimes as many as four times –minor or major.
Do you really want me to go on? We can talk about DRGs; we can talk about Diagnostic and Treatment centers, Outpatient Surgery Clinics, OASAs & OMH programs, Home Aide services.
One final note, what I wrote was:
“Now doesn’t that seem just a little strange, especially since Medicaid audit titles are Federal mandated and paid for in part by federal funds?”
I never said the titles are federal items.
And for your suggestion “It needs to reorganized with a new mission-to prevent improper or fraudulent billing before they happen.” It was tried years ago, it didn’t work then and with the staff cut back it certainly won’t work now. The truth of the matter is that both approaches (Prospective and Retrospective) are needed and both need to work towards one goal -- get the vultures out of the program. To achieve that goal the program need to be gotten out of the hands of the Department of Health. Medicaid has to be an independent entity with its own elected director – much like the State Comptroller’s Office. As long as politicians have a hand in it the “needed services to vulnerable populations” is just talk.
So if I seem “a little over the top” to you, don’t despair. I assure you my bottom is well grounded (as well as well rounded). If it weren’t, there are at least several providers who would surely place me on a monthly colonoscopy plan. -- If only they could bill Medicaid.
