Tuesday, December 8, 2009

Medicaid police terrorize providers

The New York Nonprofit Press has an interesting article which it published on November 30, 2009 entitled "The OMIG Who Stole Xmas."

The title is a bit of a misnomer because OMIG (Office Of Medicaid Inspector General) is not stealing Christmas, it is destroying a system of behavioral health care in New York.

It seems that the Governor and the Legislature is intending to balance the budget on the backs of health care providers by auditing their paperwork. The way the game is played is to send in auditors to comb through patient's medical records with a fine tooth comb to find any medical record deficiencies that do not meet regulatory requirements. Where paper work is deficient, the Office Of The Medicaid Inspector will demand reimbursement for the services provided and extrapolate from that deficiency to assume that the deficiency found is a symtom for futher deficiencies and so guestimated deficiencies will be alledged and further reimbursements demanded.

The rallying cry is "Medicaid Fraud!" and health care providers are criminalized. Providers are anxious and scared of third party agendas that intrude into treatment processes in very punitive ways. For counselors and supervisors the coercive power of the state has become an Orwellian nightmare which becomes the primary consideration in delivering supposedly therapeutic services to patients.

This has nothing to do with patient care mind you or the fact that services were provided. These severe and significant financial penalties are simply based on the failure of paperwork to be 100% accurately completed.

What are the consequences of this?

“These audits and onerous financial penalties are going to destabilize individual providers and weaken the entire system at a time when it is already under extreme stress,” says Philip Saperia.

Service delivery processes become focused primarily on paper work compliance and to a lesser degree on patient care. An old proverb from Total Quality Management is "Be careful what you choose to measure because it will skew organizational behavior in that direction."

You can read the article by clicking here.

No comments: