For your convenience, we have installed the link below to make donations to this website easier. Now you can utilize your PayPal account or your credit card.
Click on the logo above to visit the website for Cornell Cooperative Extension of Schuyler County
Guest Column: State Sen. Tom O'Mara
"A system that keeps on giving"
ALBANY, July 17 -- It’s the system that keeps on giving. I’m referring again, of course, to New York State’s Medicaid program – the massive, $52-billion-plus health care delivery system that’s long been plagued by abuse, fraud, and waste.
The latest alarm, from a recent article in the Wall
Street Journal, highlights New York’s ongoing and increasingly
costly effort to modernize its Medicaid billing system. According to the
WSJ report, “Over the past decade, the state has paid a Virginia-based
IT company nearly $1 billion to
New York’s Medicaid management information system, known as eMedNY, is the largest of its kind in the nation. It’s intended to serve as Medicaid’s operational base, if you will, for financial reporting, quality control measures, auditing and fraud prevention. In other words, it should function as the hub of New York’s administrative oversight and, as such, it should be the place to ensure effectiveness and efficiency.
But it hasn’t worked. According to one top state health official
quoted in the article, “eMedNY admittedly limits the state’s
ability to introduce programs that could help control fraud and abuse
through better claims management.” That speaks for itself. It also
leaves me asking a few questions. For one, does the current system prevent
the more widespread utilization of cutting-edge technology like that developed
and fine-tuned by the Horseheads-based Salient Corporation? If it does,
that has to change. The Salient technology can work to prevent fraud,
For proof, we can look at its successful utilization right here in Chemung
County. Salient is a key piece of Chemung’s Medicaid managed care
project, Priority Community Health Care, and it’s already produced
significant savings in its first year of operation. By having the right
information in a timely manner, physicians and staff can better identify
the needs of patients and better oversee the system’s utilization.
Salient allows the clinic to see if patients have filled their prescriptions,
But maybe most of all, the WSJ analysis begs this question: why has the state tolerated, for so long, such a key oversight mechanism that clearly doesn’t work? The state began looking for a replacement system in 2007 after numerous reports kept pinpointing these shortcomings. According to the state comptroller’s office, state audits conducted between 2006 and 2010 revealed an alarming lack of oversight of Medicaid’s payment functions, and revealed that eMedNY’s failure to prevent billing mistakes resulted in more than $450 million in overpayments.
All of this comes on the heels of a new study in Health Affairs showing that the nation’s mid-Atlantic region, including New York, has the highest Medicaid spending in the nation – spending per beneficiary was $1,650 above the national average, with most of this overspending, in another important revelation, the result of overuse of medical services. That’s a point that sometimes gets overlooked in the more dramatic and sensational reports of fraud. But overutilization, clearly a product of mismanagement, is a prime driver of unnecessary costs – and, again, it’s exactly what Salient can address so effectively.
Which brings me back to the overall oversight of this sprawling and
enormously expensive system. It’s why the WSJ article remains so
troubling. Governor Cuomo’s administration remains committed to
the change so clearly needed, but cites the need to carefully consider
On a related note, the governor recently nominated a new Medicaid Inspector General, thereby opening the door to a new era of combating Medicaid abuse, fraud and waste. We have to walk through that door. We’re coming off a 2011 legislative session that’s being recognized as productive in many key areas. But there’s important work ahead. Just ask any local official about the ongoing burden of affording Medicaid and its impact on local property taxpayers. It’s the single mandate that these officials pinpoint for reform, and it clearly deserves all of the priority attention we can give it.
Photo in text: State Senator Tom O'Mara
Schuyler County Officials
Top row (from left): Dennis Fagan, Thomas Gifford, Doris Karius, Glenn Larison
Bottom row: Michael A. Yuhasz, Barbara Halpin, Phil Barnes, Stewart Field
Dennis Fagan, Tyrone 607-292-3687
Michael A. Yuhasz, 535-4967
Doris L. Karius, 546-5544
Barbara Halpin, 594-3683
Glenn R. Larison, 594-3385
Thomas M. Gifford, 535-9517
Phil Barnes, Watkins Glen 481-0482
Stewart Field, Watkins Glen 535-2335
County Clerk: Linda Compton, 535-8133
Sheriff: William Yessman, 535-8222
Undersheriff: Breck Spaulding, 535-8222
County Treasurer: Margaret Starbuck, 535-8181
District Attorney: Joseph Fazzary, 535-8383
State, Federal Officials for Schuyler County
Sen. Charles E. Schumer
United States Senate
Sen. Kirsten E. Gillibrand
United States Senate
State Senator Tom O'Mara -- Chemung, Schuyler, Steuben, Yates, western Tompkins, Enfield, Ithaca (Town and City), Newfield, Ulysses(Trumansburg)
Room 812, Legislative Office Building
Assemblyman Christopher Friend --
Chemung, Schuyler, Tioga
P.O. Box 365
Odessa, New York 14869