Highest NY Medicaid Billing in Middle Class Queens Nabe by Chris Glorioso - NBC New York

Watch original...

Small Middle Class Enclave Generates Many Medicaid Bills

View more videos at: http://nbcnewyork.com.

Medicaid is a health care program reserved, primarily, for the poor.

Benefits are based on federal poverty guidelines. To be eligible in New York state, a single person must earn less than $17,000 a year.

With that in mind, you might expect the most impoverished neighborhoods would be the ones that generate the most Medicaid bills.

That's not true.

It turns out the state’s highest Medicaid billing total can be found within a relatively affluent community: Rego Park, Queen

The analysis found Rego Park -- a neighborhood with a median income above $50,000 -- generated more than $1.5 billion in Medicaid reimbursements in 2010. Because the health care program is aimed at helping poor people, the findings had regulators scratching their heads.With the help of the New York Office of the Medicaid Inspector General, NBC New York examined Medicaid data from all of the state’s nearly 15,000 zip codes.

“Why is Rego Park the highest? It’s something we have to look at,” said Deputy Medicaid Inspector General Michael Little.

Rego Park occupies a triangular plot of central Queens, roughly bordered by Woodhaven, Yellowstone and Queens Boulevards. The enclave is dotted by dozens of pharmacies, dentists, and medical device makers, but the neighborhood has no major hospital.

With 7 percent of the state’s $20 billion Medicaid budget passing through the 1.9-square-mile neighborhood, some observers believe Rego Park is the kind of community that deserves more regulatory scrutiny.

“These are places where the Medicaid Inspector General’s Office need to look at more closely to make sure that there is real honest alignment between the services that are provided and the needs of the patient,” said Paul Howard, a senior health policy analyst at the conservative think-tank Manhattan Institute.

Investigators who police New York’s Medicaid program use software designed by Salient Management Company, an upstate developer of data management tools. The data-mining computer program helps find suspicious patterns and unusual trends in health care billing. The office of the Medicaid Inspector General has about 50 investigators to battle fraud all over the state.

“Fifty investigators for billions and billions of dollars in claims. That means they have to be able to sift through data very quickly to get to the most likely targets for recovery,” said John Amisano, Salient senior health care adviser.

After learning the state’s single highest Medicaid billing total is within Rego Park, Michael Little’s office began to use the software to look deeper into the numbers.

“Why are they the biggest? Is it normal? Is it expected,” Little said.

By running data queries, Little discovered one of the state’s largest Medicaid managed care contractors uses a Rego Park address to process bills -- a clear reason for the high billing volume.

That doesn’t mean investigators won’t continue to have their eyes on the Queens neighborhood.

In his data query, Little also discovered pharmacy reimbursements make up the second largest share of Medicaid bills in Rego Park. That is significant because Rego Park pharmacists have been snared for fraud in the past. Most recently, federal prosecutors busted Rego Park’s ASA Pharmacy for taking part in a $2.5 million kickback scheme.

There are 13 Rego Park medical service providers who have been banned from participating in Medicaid.

“Our job is to prevent fraud, waste and abuse in the Medicaid program and New York State Legislature, when they established our office, did not want us to wait around for it to bite us,” Little said.

Readers who have information about Medicaid fraud in New York, New Jersey, or Connecticut, can report tips by clicking on the links.

Robbers Kill Woman in Struggle for Purse by Alice McQuillan - NBC New York

Read original...

A woman walking with her husband on a quiet Queens street Sunday night was shot and killed by robbers in a struggle for her purse.

The couple was outside in Hollis around 8:30 p.m. Sunday when three men wearing hoodies confronted them.

They demanded the 23-year-old woman’s purse and a struggle erupted. The robbers fired and the woman was shot twice in her torso in front of a home on 204th Street.

The unidentified woman was rushed to Jamaica Hospital where she was pronounced dead.

Her killers escaped.

Detectives ask anyone with information to call 1 800 577-TIPS.

The Kids Need Good, Experienced Teachers by Gabe Pressman - | NBC New York

Read original...

A battle is going on across the country for the soul of public education.

I went to public schools in the Bronx. They provided a pretty good education. The public school system has experienced ups and downs since then--but basic principles have remained intact: that every child deserves a good, free education, that teachers with experience are cherished, that parents should be invited into the educational process to work with teachers and administrators for the good of their children, that politicians and other outsiders have no business meddling with our educational system.

Today’s assault on public education is led by politicians across the country. Here in New York, Mayor Bloomberg and his advisers have far-reaching control over public schools. The mayor’s motives may be good but he is not an educator. And his main goals now appear to be to save money by eliminating veteran teachers [they get higher salaries than their juniors] and breaking the power of the teachers union.

Listening to members of the Bloomberg team talk, one might get the idea that the union members are horrible people who value their salaries more than the children they teach. As a reporter who has covered the public schools for many decades, I find that notion absurd. I also confess to a bias based on my life experience. I had three aunts who were teachers and I remember how dedicated they were to the kids and how they pursued courses to improve their ability to teach. And how they never lost their sensitivity to children nor their love of the teaching profession.

City Hall’s actions are somewhat sneaky: helping charter schools in their competition with public schools, without letting citizens know about it. The Independent Budget Office has just disclosed that, in the last year, charter schools received $649 more per student than regular public schools. The Daily News reports that charter schools are getting a windfall increase of 9 percent in New York City even as public schools are cut by more than 4 percent. Clearly the point seems to be: help the charter schools by starving the public schools.

The people of New York have not voted for such a policy. Do the taxpayers count for nothing?

Leonie Haimson, a parent leader, is angry at the way matters are unfolding. “Parents count for nothing in the way our leaders are handling the educational issues,” she told me. “We’ve been completely left out of major educational policy decisions.” Recently, she attended a Congressional hearing on education and, she says, “four parents testified and not one was for public schools.”

Haimson and other parents are organizing a group called Parents Across America, “to represent mothers and fathers in many school districts across this country. I don’t think it benefits our kids to create a system where there are so few incentives to make teaching a life’s work.

It’s interesting that this debate is not going on in Scarsdale or on Long Island. They’re looking to get rid of senior teachers in our most congested urban areas. The twin objectives are solely to destroy unions and save money.”

What is so sad, as this debate continues, is that our political leaders seem to place so little value on the wisdom of experienced teachers. Good teachers are essential to educating our most valuable resource, our children. The politicians seem to think that saving money is more important than saving children.