According to the New York Times, Medicaid fraud investigators filed a civil fraud lawsuit against the New York City government. The lawsuit alleges the government used bureaucracy to run its own Medicaid mill.
Medicare advocacy groups and health care advocates argue that the lawsuit raises new questions about health policy, especially for aged and disabled people.
The lawsuit does not accuse any New York official of pocketing Medicare money for personal gain. Instead, case alleges that the city improperly authorized 24-hour-in-home-care for thousands of patients costing $75,000 to $150,000 per year. The service came without obtaining required recommendations from medical specialists such as doctors, nurses or social workers. The lawsuit claims due to these practices, Medicaid paid tens of millions of dollars in benefits that it should not have covered.
According to the city’s Human Resources Administration, the state’s Medicaid officials noticed because the city was so giving in approving the home care.
Homecare is a touchy subject for disabled individuals and Medicaid recipients. Many patients require in-home care, especially as they age with their illnesses and disabilities, this places cost concerns on the Medicaid program. In some cases, the city approved in-home care for patients that were disabled or ill enough to reside in nursing homes, according to the complaint.
Disability advocates fear this lawsuit might push the city to deny claims of home care to individuals who wish to age and live in their own homes. Some advocates believe it was better for the city to allow patients to live at home while receiving care rather than forcing them to nursing homes.
