The New York Times Reported on January 12, 2011 that New York City has been sued by the federal government for over billing the state and federal government for 24 hour home care since 2006, when the city was relieved of responsibility for contributing to the cost of home health care. The essence of a complaint filed in federal court charges that the City provided home health services to medicaid patients who did not need it and for patients who needed more intensive care than home health provides. Dr.Gabriel Feldman apparently filed a whistleblower or Qui tam case under the fraudulent claims act and stands to get a piece of the pie in any settlement. The Times article is careful not to use the word fraud, but the implications are there.
The idea that units of government would manipulate the medical payment system to their advantage is shocking. Remember Casablanca?
Captain Renault: “I’m shocked, shocked to find out gambling is going on here.”
Croupier: Your winnings sir.
Captain Renault: [sotto voce] “Oh, thank you very much.”
Apparently New York City accounts for 84% of the total cost of the New York State fund for personal home care, with 17,500 patients at an annual cost of between $75,000 and $150,000 per patient. Some may find it both ironic and refreshing to hear the statement of the U.S. Attorney involved in the prosecution of the case.
It without saying that ultimate medical decisions 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. -U.S. Attorney, Southern District of New York.