Gary Stroh Gator Hunting in His Driveway

Submitted by Mike Sellazzo

Way to go, Gary!

Paul Stavis

This article, which quotes our own Paul Stavis, appeared in the Wall Street Journal on January 28, 2011.  By JACOB GERSHMAN  The state agency in charge of recovering money stolen from the state's $52 billion Medicaid program fell into negative territory in 2009. For the first time, it returned more money in fraud cases to Medicaid providers than it brought back to the state. The Office of the Medicaid Inspector General, which has a $90 million budget and a full-time staff of more than 650 people, reported fraud recoveries of minus $66,000 in its most recent annual report. The inspector general collected more than $1 million from fraud cases, but the agency lost more than that sum after an administrative law judge ordered the state to return fines paid by a Queens alcohol treatment center accused of fraud in 2005.

Agency officials defended their record, pointing to $100 million they recovered last year through audits that found Medicaid violations—often clerical errors—but made no determination of fraud. But to critics of the inspector general's office, the agency's inability to get big fraud recoveries indicates a lack of vigilance over the nation's most expensive Medicaid program.

"OMIG does not look for fraud, despite its statute clearly requiring it to do so," said Paul Stavis, a former senior lawyer for the state Health Department who also worked under the current inspector general, James Sheehan. "Fraud litigation is very difficult and expensive and OMIG has not equipped itself to cope with such cases. They don't look for fraud as a matter of practice."

Getting a grip on the Medicaid program is a big issue for the new governor, Andrew Cuomo. Growth in the state Medicaid spending, which makes up about a fifth of Albany's operating budget, is a major factor driving up the state's $10-billion spending gap in the upcoming fiscal year.

In 2006, after a series of high-profile reports about widespread Medicaid theft, then-Gov. George Pataki and state lawmakers created the Office of the Medicaid Inspector General to act as a central watchdog over the system. The legislation said the purpose was to create "a more efficient and accountable structure, dramatically reorganize and streamline the state's process of detecting and combating Medicaid fraud and abuse and maximize the recoupment of improper Medicaid payments."

Michael Little, who runs the agency's investigative unit and oversees about 60 investigators, said he was unsatisfied with the 2009 fraud total. But he said it represents a small part of the inspector general's function. He said the agency, which lacks criminal prosecutorial powers but can pursue civil charges, often turns over more complex cases to the attorney general's office or federal authorities.

In 2009, agency audits, which catch billing mistakes and other violations of state Medicaid law, recovered more than $100 million from hundreds of physicians, hospitals, managed care companies, pharmacists, clinics, and other providers. Little of that money is collected in lump-sum payments. Instead, the state usually recovers the money from providers gradually by docking 15% from future Medicaid billings.

Since OMIG's audits usually don't allege fraud, providers can repeatedly run afoul of the law without facing harsher consequences. For example, Healthfirst, a rapidly growing Medicaid managed carecompany, has been audited numerous times and has paid back millions of dollars to the state for failing to keep proper records and for billing Medicaid for patients who are dead or incarcerated.

Medicaid providers owing money can also suspend collections through administrative appeals or if they are able to demonstrate that repayment would cause financial hardship to their institutions.

In 2008, for example, OMIG stopped collecting payments from three health centers that each owed the state more than $3 million but ultimately paid less than 20% of the amount originally due.

"The distinction between 'audit findings' and 'recoveries' is a good example of this chess game to keep the public and press in the dark,"said Mr. Stavis, the former state health official.

A spokeswoman for the inspector general's office said the agency's recovery totals don't reflect other measures it takes to crack down on abuses. For example, she said, the office has a program that restricts recipients who show patterns of "doctor shopping" to using one doctor and one pharmacist. The agency has placed just under 10,000 Medicaid recipients under that restriction.

The attorney general's office, itself, recovered more than $280 million in 2009, helping the state meet a federally mandated collection target. More than three-quarters of that came from global settlements with pharmaceutical companies in federal cases in which state prosecutors in New York played little role, or from home-health agencies that hired people with fraudulent certificates.

The largest hospital case, which recovered $3.5 million, involved a Bronx medical center that over-billed for drugs more than six years ago. Another 2009 case that recovered $44 million centered on a Staten Island man who had been expelled from the Medicaid program in 1997 because of fraud charges but was able to keep billing Medicaid by forming new companies.

Carol Moshier Desiderio

Just to let you know we had a great time in early December at the Pow Wow!
Our "regulars" and even some new comers enjoyed meeting and greeting. I'm sure you
have seen our resident, Marianne's pics! (Link is on left sidebar.)

Seems
everyone is already looking forward to our spring meeting, after our winter
thaw!

Anyone that has a idea on the next get together please let me know!

Sending prayers and thoughts to our AZ friends!

Always, Carol

Carmella Gioio

I've been out of touch since the reunion because of a death in our household last year, but I want to become more active, and hope to attend some 65 tribe get-togethers this coming year.

Meanwhile, I just want to wish everyone Happy Holidays!

-Carmella Gioio

Gail Prosser

1/1/11 - Gail and her Grandson Danny at
Boston Common after the blizzard. 
It got upto 50 degrees that day!

Linden Avenue

I saw Lestie Zinner in Avon, Ct on the 28th after the December blizzard of '10.  I forget to take a picture of us. We met at Starbucks and saw each other for only 30 minutes. He had an appointment. I was on my way to Ossining to visit friends. 

I met Maryann Bater class of '63 in Ct also. We keep in touch. I worked with her at the bakery.  

I'm going back in May and plan on going out for dinner with Mary Ann and Leslie.

 While in Ossining, I drove around and saw the old house on  Linden Ave.

Eastern Avenue

Happy Holidays!

Wishing the Class of 1965 a joyous holiday season!
CLICK HERE to view the Class of '65 New Year's card.

William Jones

 Here is a little blurb about my book/pamphlet "Its Friday Again".

I started the compilation of emails because I was told to report-in for work by signing in on the computer each morning.  I didn't like that.  I had been working at Walter Reed for over 17 years and did not have to sign-in for work before.  I did not feel trusted.  I was looking for ways to retaliate.  But retaliation is not a part of my personality.  So instead I decided to report-in by wishing everyone on my emails a happy day.  The book is a compilation of those actual emails.  I just wanted folks to start their day with a smile.  Oh yes, I took all the pictures in the book.  I hope the book will be fun and maybe garner a laugh or two from the reader.  Who knows you may find out some interesting tid-bits about Walter Reed Army Medical Center.

Ossining Named #2 (out of 40) “Best Places to Live in Westchester” by Westchester magazine!

Thanks to Linda White Alexander for sharing this article. 

Ossining Named #2 (out of 40) “Best Places to Live in Westchester” by Westchester magazine!  Below is an excerpt from the article…

“We understand why Mad Men producers chose to locate their star couple (now, alas, divorced) smack in the middle of Ossining. This rivertown (population 24,146) scored two 10s—one for its nearness to the river and the other for its diverse population (45 percent of its residents are non-white). And in our pricey county, it’s actually among the most affordable towns in which to purchase a home: the average price of an Ossining house is $383,330, which is $341,670 less than the average price of a house in the county. Ah, but what about property taxes? They're among the county’s lowest; indeed $6,654 less than the county’s average of $16,689. And while it may not be a hop, skip, and a jump to New York City (it takes 50 minutes to get to Midtown), its schools are above average (SAT scores were 1659 out of a total 2400). Plus Ossining, architecturally, has a charming downtown with underappreciated cast-iron buildings (though the shops can use an upgrade), as well as a historic area (many village structures are on the National Register of Historic Places), and lovely streets that wend their way down to the shoreline.”

http://www.westchestermagazine.com/Westchester-Magazine/October-2010/Best-Places-To-Live/index.php?cparticle=2&siarticle=1

David Perugini/Paul McCartney Concert in NC

Eat your heart out, Beatle fans! David Perugini, while visiting his daughter Danielle in Charlotte, NC, caught none other than Sir Paul in concert at the Time Warner Arena! McCartney put on a show that lasted over three hours and according to David, it was "Totally Gear" (those of you who remember Liverpool-speak will know what that means). Paul looked trim, full of energy and was in great voice (sang everything in the original keys, no less) - not bad for a 68-year!  Below is a photo that David took during the concert.  (Be sure to check out "Comments" below.)

David Perugini and Philip Howe

During the month of March, Philip Howe (Class V.P. our Senior Year) and his lovely family took a break from the cold Illinois Winter to vacation in Hawaii. Their island visit brought them to the island of Oahu (home of Pearl Harbor) and the island of Kauai (home of David Perugini). The old buddies had several opportunities to get together during course of Phil's stay on the Kauai. The photos below were taken at Duke's, a shoreline restaurant, where the two classmates shared a lunch on the day of Phil's return flight to the mainland.

L to R: Sara (25), Philip, Kirsten, Susan (21) Howe; David & Martha Perugini