Medicaid Mess

New York’s Medicaid program, once a beacon of the Great Society era, has become so huge, so complex and so lightly policed that it is easily exploited. Though the program is a vital resource for 4.2 million poor people who rely on it for their health care, a yearlong investigation by The Times found that the program has been misspending billions of dollars annually because of fraud, waste and profiteering. A computer analysis of several million records obtained under the state Freedom of Information Law revealed numerous indications of fraud and abuse that the state had never looked into. … New York’s Medicaid program is by far the most expensive and most generous in the nation. It spends far more – now $44.5 billion annually – than that of any other state, even California, whose Medicaid program covers about 55 percent more people. New York’s Medicaid budget is larger than most states’ entire budgets, and it spends nearly twice the national average – roughly $10,600, more than any other state – on each of its 4.2 million recipients, one in every five New Yorkers.

It has drawn dentists like Dr. Dolly Rosen, who within 12 months somehow built the state’s biggest Medicaid dental practice out of a Brooklyn storefront, where she claimed to have performed as many as 991 procedures a day in 2003. After The New York Times discovered her extraordinary billings through a computer analysis and questioned the state about them, Dr. Rosen and two associates were indicted on charges of stealing more than $1 million from the program.

The governors hope that by staying on message they can lend legs to a proposal before Congress to dramatically overhaul the state-federal program that funds health care for 53 million poor and disabled Americans. Without reform, governors say the program — which recently eclipsed elementary and secondary education as the largest single portion of state budgets — will collapse under its own weight.