Senior Spotlight By John Toscano
City Joins State In Program To Fight Medicaid Fraud

New York City has joined a pilot program to expose Medicaid fraud and abuse that will also attempt to end the drain of funds for the program, Mayor Michael Bloomberg announced recently.

Bloomberg stated in announcing the city's action, "Medicaid is projected to cost the city nearly $5 billion in 2007, and this innovative program allows us to play a key role in rooting out fraud and waste committed by certain unscrupulous Medicaid providers.

"We expect that the city's efforts could eventually generate millions of dollars in fraud recoveries and will contribute to restoring the integrity of the Medicaid program."

Medicaid is the federal- state- city program that provides healthcare coverage for low-income families. It includes many seniors on its rolls.

Under the city's participation in the pilot program called the Medicaid Fraud, Waste and Abuse Demonstration Project, the city plans to hire about 50 special investigators to go after potential fraud cases involving doctors, hospitals and healthcare providers.

The Medicaid program has been plagued by losses of millions of dollars and currently costs the state about $45 billion a year, the largest portion of the state's budget. Half of the Medicaid funding is provided by the federal government; the city and state each pay about a quarter of the remainder.

Savings resulting from the demonstration project will help New York State to meet goals set by the federal government this past October. The state was given up to $300 million annually to invest in reforms and anti-fraud programs.

The city Human Resources Administration (HRA), which already has experience fighting Medicaid fraud, is to establish a special office to work with state health agencies to try to meet the goals set for the program.

LIU CHARGES SENIORS MISLED INTO CHANGING HMOS IN PART D PLAN: City Councilmember John Liu held a meeting last week to warn seniors about the danger of being misled by HMOs into switching from one Part D plan to another and sometimes being left with inferior coverage.

Liu (D- Flushing) said that some dozen seniors from his district complained that they were distraught after they unknowingly switched plans.

Liu stated, "We are investigating the claims made by these seniors and the deceptive tactics practiced by certain health plan salespersons to enroll clients. Unfortunately, there are always a few bad apples in every industry who prey on the most vulnerable members of our community with false advertising and misleading scams.

"In this instance, it is our seniors who are paying the price with their health and well-being, and we will do everything possible to rectify this situation. At best, it's aggressive marketing, but at worst it's Medicare fraud."

Liu cited one case described by a 72- year-old victim. Liu said the victim, a woman, told him: "I was approached on the street by an HMO representative who offered gifts and incentives to sign up for their health plan. They filled out the form for me and they said all I had to do was to sign it."

The woman continued: "I had no idea this would force me to see another doctor who didn't speak my language. I felt helpless and scared because I had no one to turn to when I was sick."

The incidents, called "bait and switch tactics" by the lawmaker, occurred during the November 15- December 31 period when Part D members had the opportunity to change plans if they so desired.

Liu said his office has been working to switch the plans back for the seniors who have already come forth. "Yet these seniors are just the tip of the iceberg," he said.

Any senior who feels he or she has been misled into signing up with another HMO is encouraged to contact Liu's office at 718-888-8747, ext. 116.

AARP BACKS DEMOCRATS' BILL: One of the earliest bills introduced by majority Democrats in Congress last week gives Medicare the right to negotiate discount prices for prescription drugs.

Among its supporters now is the American Association of Retired Persons (AARP), the nation's largest lobbying group for seniors. In full-page ads in many major newspapers, the organization complains: "Medicare has 43 million members. And zero bargaining power when it comes to prescription drug prices. Urge Congress to give Medicare the bargaining power it needs."

Generally, large organizations, such as the Veterans Administration, use the leverage of their purchases of large amounts of drugs to bring down the price of medications. Medicare, with its 43 million members, would likewise be able to negotiate lower drug prices, but it is barred from negotiating for them under a law signed by President George W. Bush which established the Part D drug prescription program. The program is subsidized by the federal government.