Recent Brook-Krasny Bust Tip Of Medical and Social Program Fraud Iceberg

The recent bust of former Assemblyman Alec Brook-Krasny (D-Coney Island, Bay Ridge) for his alleged involvement in a $6.3 million “pill mill” scheme operating since 2013 that flooded the black market with deadly pharmaceutical  opioids is just the tip of the iceberg to ramped Medicaid and Medicare fraud throughout Brooklyn, according to Bensonhurst Democratic District Leader Charles Ragusa.

Ragusa has been raising the alarm on the issue for some time as KCP exclusively reported in January. While Ragusa’s earlier story focused on social adult day care programs, he said the bust of the three clinics that fraudulently received Medicaid funding for unnecessary tests and procedures in the “pill mill” bust has validated his concerns.

Charlie Ragusa

“We keep hearing about these cases where tens of millions of dollars of public funds are being paid to unscrupulous physicians, clinics, laboratories and other facilities,” said Ragusa. “I have been trying to call attention to the lack of stringent standards and monitoring for social adult day care programs. However, the only response I get is that if people suspect something, they should report it. It is now obvious that the lack of oversight is widespread.”

Ragusa believes that supervision and oversight of Medicaid funding is inadequate, ineffective and in some cases, totally absent. “Why aren’t the agencies doing their jobs?” he said. “There is something inherently wrong with the monitoring process because these problems keep recurring.”

He added that social adult day care programs are especially problematic because they only need to self-certify that they are in compliance with various requirements.

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.

But Ragusa says that healthy seniors are steered into these programs, which were created for those with dementia, Alzheimer’s and other disabilities while there has been little reporting about the real victims of this tragedy, the people who desperately need Medicaid services. 

“There is only a certain amount of money available,” he said. “The crooks are leaving less for those in need. People literally have to bankrupt themselves or are forced to divorce their spouses in order to qualify for nursing home care, because funds are so limited. Meanwhile, the crooks who are stealing the funding are living in luxury. These precious dollars are limited and should be used for people’s needs, not to line the pockets of the greedy.”

Ragusa said similar steering occurs much like the ‘Pill Mill’ scam, wherein patients are steered to radiologists, pharmacists and other specialists for tests they don’t need resulting in either unnecessary payouts, or in the recent Brook-Krasny bust the flooding of pharmaceuticals on the market.

Ragusa reached out several months ago, as reported in the previous KCP story to various agencies and elected officials to alert them to this problem, only to be told the agencies in question look into complaints once they are received.

Ragusa feels that enforcement agencies need to become more proactive in policing these clinics and says they way it stands these clinics are allowed to police themselves, and only when there is a major drug bust involving drug enforcement agencies do they become proactive.

Previously, Ragusa reached out to Mayor Bill de Blasio, Governor Andrew Cuomo and Congressman Dan Donovan (South Brooklyn, Staten Island) among others about the problem.

He said he will again intensify these efforts.

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