Charles Ragusa, the Democratic District Leader of the 47th Assembly District covering Bensonhurst and Bath Beach, this week claimed that several Adult Day Care Programs within the district are operating as “Medicaid Mills,” instead of offering health services for people with significant physical and/or cognitive impairments.
These “Medicaid Mills” are catering to people who are in better health and have fewer needs in order to make a nice profit, alleges Ragusa.
Ragusa compares these suspected Medicaid abusers to the “Poverty Pimps” of the 1970’s who “benefited unduly by acting as an intermediary on behalf of the poor, the disadvantaged, or other “victimized” groups, as defined by Wikipedia.
“They’re Medicaid Pimps. What they are doing is using precious Medicaid dollars and they’re allowed to do it, believe it or not,” said Ragusa, adding the centers entice people to come to their centers that really don’t need their services.
“These centers were originally setup for an Alzheimer’s patient, and another kind of Dementia patient, people who had trouble walking. Instead they don’t want to provide the services to those people because it cost a lot of money, instead they get people to sign up who are basically okay,” he said.
Ragusa said the problem stems from a 2011 New York state cut in the form of $2.8 billion to its Medicaid Program, through the Medicaid Redesign Team (MRT). Led by Governor Cuomo, the MRT was tasked with “finding ways to save money within the Medicaid Program without compromising services,” according to the Governor’s website.
One drastic change was that fees per service ended and now people had to enroll in mandatory “Managed Long Term Care” programs. This new program is an insurance plan that is paid a monthly premium (“capitation”) by the New York Medicaid program to approve and provide Medicaid home care and other long-term care services to people who need long-term care because of a long-lasting health condition or disability, according to New York Health.
Medicaid programs operating as managed long-term care programs are paid a flat rate per Medicaid recipient enrolled in the program. According to Ragusa, this is the factor that contributed to the abuse of the Medicaid system.
“Although adult day care clients are supposed to require significant help with personal care, some providers quickly realized that they could make a substantial profit if they selected clients who had fewer needs and required less care. Some of the independently operated programs are just Medicaid mills that select only those clients who have minimal needs for care. Clients may be paid to sign up for the program or they may receive cash or gift cards for saying that they need help, when in fact, they don’t,” alleges Ragusa
The Bensonhurst District Leader has taken the growing problem to the city. In the last couple of days, he has been sending out a letter to elected officials and advocates in order to gain support in combating these troubling Medicaid programs. So far his office has reached out to Mayor Bill de Blasio, Governor Andrew Cuomo and Congressman Dan Donovan (South Brooklyn, Staten Island) among others.
A Department for The Aging spokesperson said all social adult day care programs operating in New York City are required to register with the Department for the Aging.
“In addition, DFTA has a ombudsperson who receives and looks into complaints about SADCs. When warranted, DFTA makes referrals to city and state officials, including the state Office of the Medicaid Inspector General. The state has oversight for Medicaid,” the spokesperson said.
But Ragusa this form of Medicaid abuse is running rampart in his district, and action needs to be taken right away.
“Different elected officials have to do something about it. We’re pointing at the problem, now it’s up to the city and state comptroller,” he said.
