BUFFALO, NY-- A 2 On Your Side investigation has found that Medicaid recipients are taking taxpayers for a ride with thousands of unnecessary ambulance rides to emergency rooms every year at a cost of hundreds of thousands of dollars.
Each time a Medicaid recipient is taken by ambulance to a hospital it costs about $190. And because there is no co-pay for Medicaid patients, that means the entire $190 per trip is paid for by taxpayers.
There are some people who call 911 for an ambulance so often that they're known as "frequent flyers" within the medical community.
According to figures provided by Kaleida Health Care, which operates five hospitals locally, there were 2,500 unnecessary ambulance trips to its hospitals last year.
Rural Metro Ambulance tells 2 On Your Side that of the top ten people they transported most often to the hospital last year, seven were on Medicaid.
Scott Brown: "Right now, if you're on Medicaid, is there any disincentive to call an ambulance if you feel like it?"
Kaleida Health CEO Jim Kaskie: "There's no disincentive to call an ambulance, there's no disincentive not to come to the emergency room. No where else in our economy, no where else in our society, do we have absolute open doors with absolutely no individual accountability."
Scott Brown: "Right now, if I'm on Medicaid, is there any disincentive for me to call an ambulance?"
County Executive Chris Collins: "Other than your conscience being your guide, the true answer is no, there is no disincentive for people doing something like that and we have a few cases of abuse."
And the County Executive is right when he says a few cases- it's a small number of people who are taking a large number of trips.
For example, last year one person took an ambulance to ECMC 80 times, which cost taxpayers over $15,000.
Another took an ambulance to ECMC 78 times, which cost about another $15,000.
And a third Medicaid recipient took an ambulance 60 times to Millard Fillmore Hospital, which cost over $10,000.
And what are some of the most frequent diagnoses for these people?
You would think heart attack, stroke, or trouble breathing.
But that's not the case.
According to Kaleida, they were abdominal pain, headaches, backaches and coughing, yes coughing.
Erie County Health Commissioner Dr. Anthony Billittier, an E.R. doctor himself, did a study about 15 years ago where he found that about seven percent of all 911 calls by Medicaid recipients were unnecessary.
Dr. Billittier said the most common reason for those unneeded trips was because Medicaid recipients had no transportation of their own to get to the hospital, so they call 911.
Scott Brown: "As opposed to sending an ambulance out on every 911 call, would it be possible after talking to the person to maybe send a medical van or something else that's not as expensive?"
Erie County Health Commissioner Anthony Billittier: "Yeah, absolutely, there are probably more cost effective ways to do it that will probably be just as safe- ambulates or taxi cabs. Some people just need a ride to the hospital, they don't need care, they don't need oxygen, monitoring or an IV or anything like that, so I think those are good solutions."
Scott Brown: "So why are we not doing that?"
Dr. Anthony Billittier: "Well the question is who is 'we', It probably rests at the state level."
Another reason for some Medicaid recipients going to the hospital so often is the system itself- some of them have no primary care physician because some doctors refuse to take Medicaid patients because the pay they get from the state for treating them is so low.
Kaleida CEO Jim Kaskie: "We need to step back and redesign the system so that people can have a medical home, where the health system and physicians and the department of health can work together to create a new model of care."
State Senator George Maziarz (R): "Clearly when it comes to Medicaid reform this is an area that must be addressed."
State Senator Maziarz of Niagara County was on a state Medicaid Reform Task Force about ten years ago. It was successful in having recipients required to be finger imaged and show up in person to receive their benefits, but recently, those rules were reversed.
Scott Brown: "If there was something like a small co-pay, like two dollars if you call the ambulance or five dollars, do you think it would cut down on this?"
Senator George Maziarz: "I think that would be a disincentive if you will, so I would be very supportive of that."
Scott Brown: "Would you be willing to introduce something like that?"
Senator George Maziarz: "I definitely would, and I have introduced legislation in the past that would've required co-payments for Medicaid recipients for certain services."
Scott Brown: "If you could get something like that passed in the Senate, do you think there's any chance it passes in the Assembly?"
Senator George Maziarz: "I think a lot of that is going to be up to Governor Cuomo and how he reaches out to individual Assembly members."
And so recently, we asked Governor Cuomo, who has formed his own Medicaid Reform Task Force, about ambulance abuse by Medicaid recipients.
Scott Brown: "Right now there's unlimited usage of ambulances, is that right?"
Governor Andrew Cuomo (D) "Are there abuses of the program, there's no doubt, there's no doubt. Of course it's not right, of course the level of spending is unsustainable, people of the state haven't been getting their money's worth, but it's the people of this state speaking up which is actually going to stop it."
Overall, the total Medicaid program costs state taxpayers over one billion dollars every week, by far the costliest in the nation, with some of the most expensive pieces of the program going to pay for long term care, especially for senior citizens, and all of the optional services that New York provides to Medicaid recipients.
Dr. Anthony Billittier: "Less than five percent of health care dollars are spent right here in emergency departments, so we're focusing a lot of effort on emergency departments thinking we're going to save lots of money, and the reality is we're not going to save lots of money, even if we're successful."
Still, there is abuse of the 911 system and it's costing local taxpayers hundreds of thousands of dollars a year.
Scott Brown: "Do you seem this as symbolic of the problems within the Medicaid program?"
Kaleida CEO Jim Kaskie: "I think the level of utilization, the uncontrolled level of utilization, is symptomatic. Absolutely no patient responsibility, either in terms of lifestyle, wellness, adherence to the medical plans, it's just an open ended system. We need to step back and redesign it.
Earlier in the week, the governor announced his new budget, which cuts spending on Medicaid by one billion dollars, about two percent.
Cuomo's Medicaid Reform Task Force is due to report back to him on March 1st with specific recommendations on reforms to reach the governor's spending goal.
2 On Your Side will continue to follow this important issue to taxpayers.
NY Governor Andrew Cuomo
Assemblyman John D. Ceretto 138th District
Assemblyman Stephen Hawley 139th District
Assemblyman Robin Schimminger 140th District
Assemblywoman Crystal Peoples-Stokes 141st District
Assemblywoman Jane Corwin 142nd District
Assembly Dennis H. Gabryszak 143rd District
Assemblyman Sam Hoyt 144th District
Assemblyman Mark Schroeder 145th District
Assemblyman Kevin Smardz 146th District
Assemblyman Dan Burling 147th District
Assemblyman Jim Hayes 148th District
Assemblyman Joe Giglio 149th District
Assemblyman Andy Goodell 150th District
Senator Catharine Young 57 Senate District
Senator Tim Kennedy 58th Senate District
Senator Patrick Gallivan 59th Senate District
Senator Mark Grisanti 60th Senate District
Senator Mike Ranzenhoffer 61 Senate District
Senator George Maziarz 62nd Senate District