Investigative Classics is a weekly feature on noteworthy past examples of the reporting craft.
They are called evergreens in the news business – stories that can be reported and run at any time because nothing’s going to change them. Some are the foundation of prize-winning journalism – the conditions of mental hospitals, homes for the elderly prisons, and today’s topic: Medicaid, the federal-state insurance program for the poor.
Last week NPR reported that more than two-thirds of Medicaid recipients are enrolled in managed care programs, a public-private arrangement whose beneficiaries have increased rapidly since 2014 under Obamacare. Yet the evidence is thin that patient care or Medicaid's financial indiscipline are improving. When auditors, lawmakers and regulators bother to look, many conclude that Medicaid insurers fail to account for the dollars spent, deliver necessary care or provide access to a sufficient number of doctors.
That report joins a long tradition. A classic of the unhealed-Medicaid genre is the 14-part series William Sherman reported for the New York Daily News in 1973. The opening captured the eternal elements of this investigative perennial:
Disguised as a welfare client complaining of a cold, a reporter with a Medicaid card wandered into a group medical home in Ozone Park, Queens, one day last week and asked to see a doctor.
The patient was first sent to a foot doctor, then twice to an internist with instructions to come back a third time, and then to a psychiatrist who arranged for weekly visits. On his second visit the patient was given an electrocardiogram, three blood tests, two urine tests and a chest X-ray.
He was handed six prescriptions in one day and doctors directed him to a pharmacy on the second floor of the center to have them filled. He walked out that day with a mixture of foot powders, a mild foot cream, a vial of sleeping pills, a bottle of powerful tranquilizers, penicillin tablets, and a bottle of cough medicine – all in response to his initial compliant of a cold – a feigned cold, at that.
Sherman’s series was pegged to an anniversary: “Exactly one year ago, a Manhattan grand jury made headlines with its finding that ‘50% of the money spent on the Medicaid program – or almost $1 billion – went down the drain.’ ”
The irony, then, is that his series was another piece of evidence documenting the limited influence of investigative work. It seems fair to assume that the system would be even more corrupt absent journalistic oversight, but the parade of abuses Sherman uncovered one year after the grand jury report is humbling:
· Ping-ponging of patients from doctor to doctor in several private owned group medical centers where the poor are rammed through an often needless but costly labyrinth of X-ray exams, lab tests and dental care.
· Cases in which doctors insisted that the patient fill prescriptions at a specific pharmacy even though Medicaid regulations demand that all patients be given a completely free choice of pharmacies.
· A deal in which optometrists and an optical company collaborated in charging Medicaid about $800,000 for eye examinations and eyeglasses even though most of the glasses were declared to be unsatisfactory by the Department of Health.
· Psychiatrists who billed the city for more hours that there are in a day – one for as much as 35 hours of consultations in a single day.
· A dentist who billed the city $800,000 in two years for treatment given 10,000 patients in his seven-chair East Harlem office. He is now under indictment, but is still billing Medicaid for his practice.
· A doctor who maintained he treated 300 patients - half of them Medicaid – in a single day; and others who double billed for services or billed for patients he never saw, for treatment never dispensed.
· Doctors who send all of their laboratory work – tests often found to be unnecessary – to a particular lab that, in return, pays them up to $3,000 a month for rent.
· Doctors who fail to take patients’ past histories or fail to thoroughly examine patients, but jot down only Medicaid numbers (for billing purposes).
