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  1. “My understanding is that the issue is eligibility. These are people that would otherwise be uninsured.”
    Well I guess there goes the problem – how do we provide a system that makes sure everyone gets affordable healthcare so people don’t have to resort to fraud. Another way families game the system is for the husband and wife to divorce. The partner with the high medical bills declares little to no income and gets free care with no bankruptcy problems. You see when one family member gets sick they drag the entire family down financially. Great system eh.I would be for finger printing medicaid recipients when docs billing medicaid submit to lie detector tests to prove they don’t commit fraud.

  2. JD,
    I appreciate your insight into the Medicaid fraud issue into New York. I would be interested in any ideas you have that New York (state or city) could implement to mitigate Medicaid fraud by providers, aside from significantly increasing its audit staff.
    Does the state track, for example, aggregate payments to individual providers and compare those to what might be typical for a solo or small group physician practice? Does it try to cross check provider payments against income reported on tax returns (net of normal practice expenses)? I understand that some states (Texas, I think, was an early adopter) have beneficiaries swipe their Medicaid card though a reader at the doctor’s office when they are called in for service and again when they leave to document that the patient was, in fact, treated.
    The rich employee benefits are not likely to be addressed except as part of collective bargaining. To the extent that the closing and downsizing of facilities related to the current program to restructure the hospital system in New York creates some short term unemployment among healthcare workers, it could exert some downward pressure on wages and benefits, other things equal.
    As for the robust ID card, I still think it’s a good idea, and people with nothing to hide should have nothing to fear. Even the 9/11 commission recommended a national ID card for all of us. I think, on balance, it would be a good thing, privacy concerns notwithstanding. At least if we all had one, the poor would not feel that they were being singled out.

  3. Barry,
    I have to side with those who say that fingerprinting is the wrong way to go, at least with the NY Medicaid population.
    First, it will absolutely intimidate many and come across as an attempt to gather information on possible criminal activity aside from falsifying Medicaid eligibility. Some people who are eligibile will not sign up. If our goal is to get everyone who is eligible and reduce uninsurance (that is the goal, right?) then this is a mistake.
    Second, there are many problems with NY Medicaid, but fraudulent eligibility is not one of them, to my knowledge. Instead, the main issues have to do with terrible controls on providers gaming the system or committing outright fraud, as well as extensive subsidies to the healthcare workforce and a very rich benefits package.
    Eligibility determinations involve an enormous amount of paperwork that the state would be wise to reduce by streamlining the process and allowing for more presumptive eligibility.
    I do agree that people need to verify who they are, and I don’t think the state has a moral obligation to pay for the healthcare of those who are here illegally and don’t pay (much) taxes, except in emergencies. It may have a practical interest in doing so, though, from a public health point of view.

  4. Peter,
    My understanding is that the issue is eligibility. These are people that would otherwise be uninsured. New York City also has a very large immigrant community.
    Separately, I don’t view fingerprinting as treating people like criminals. I work in financial services, and many of us are routinely fingerprinted as a condition of employment. My son worked for the Department of Defense for six years in a position that required a high level security clearance. Not only was he fingerprinted as a condition of employment, but every five years, he (and others in similar positions) have to pass a CIA administered lie detector test!
    I’m all for helping poor people, but I expect them to prove that they are who they say they are, and I expect the government to verify that their income falls within the eligibility limits for means tested programs. I don’t think that’s an unreasonable position.

  5. >>>”New York City started to require fingerprinting of Medicaid recipients to reduce fraud.”
    Barry, how were medicaid reipients receiving cash for medical treatment – or were they just getting medical treatment from medicaid but were not eligible? I guess if the answer is for the latter I would want to know why they couldn’t/wouldn’t get medical treatment from other than medicaid?

  6. Reasonable to prove who you say you are? Absolutely.
    Reasonable to intimidate those who are not in any way trying to game the system by treating them like criminals who have to prove they’re not guilty? Absolutely not.
    Why is it that we always think only of the guilty and in doing so punish the vast majority of innocents? Because punishment is all we seem to know how to do.

  7. If you live in New York and you don’t understand why fingerprinting Medicaid recipients is a politically unacceptable alternative, you just don’t understand the way this city works. Either way, it would be much better to use a higher tech method like a secure digital ID card.
    Or perhaps you’d prefer we use RFID tags?

  8. According to a recent article in the New York Post, New York City started to require fingerprinting of Medicaid recipients to reduce fraud. Governor Spitzer, however, put a stop to the practice. If he’s interested in reducing fraud, this was not a good move.
    As a taxpayer, I do not think it is unreasonable to require applicants for government benefits of any kind to be prepared to prove that they are who they say they are. For means tested benefits (including Medicaid), government should have the best possible tools to verify income and residency. If people don’t like it for privacy or other reasons, they can forgo the benefits.

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