I look forward to the dawn of a new era this week. My case managers who wade chest deep in grinding poverty, chronic illness both physical and mental, substance use and all its attendant joys on a daily basis for $25,000 a year will have their work reviewed...wait for it...by accountants. Both the federal and New York state governments have decided to "crack down" (don't you love that turn of phrase) on Medicaid fraud. Never mind that the work we do prevents people from being hospitalized, utilizing emergency rooms and other expensive services, we are clearly parasites bleeding the system dry. Never mind that the state has done research and proven that this intervention actually saves the state money, we are the problem. Never mind that they could never find anyone more gullible who will do the work as cheaply as nonprofits, we are the problem. In the case of my agency we are bleeding the system of a whopping $400,000 per year. Please contrast that if you will with another recent financial deficit of rather larger proportions and ask yourself where we really require more oversight and regulation.
I have nothing against accountants per se, I just don't think they know jack shit about how the work gets done or should be done with our clients. It would be like asking me (a social worker)to do your taxes. You would be in deep trouble and fast. I suppose, I chalk it up to the continuing mythology that financial folks have a business head, focus on the bottom line and are more reasonable and rational than us flighty emotion driven social work types. Anyone who believes this has never seen the miracles performed by nonprofit organizations with virtually nothing. I also trust that in the current environment all reasonable people can agree that 700 billion dollars later, that fallacy has been laid to rest. Plus, with a few marked exceptions you rarely find greedy masters of the universe working at your local nonprofit organization.
The other amusing dynamic in play here is that the thousands of new auditors who have been hired by the New York state and federal governments must find fraud and recoup payments to organizations in the form of fines to keep their jobs. New York State ( and the feds since they help to fund it as well) have actually given the New York State auditors a goal of recovering 250 million + this year from organizations that bill Medicaid for services. This figure is five times more than they have ever recovered in a single year in the past. Does it strike anyone else as problematic that the basis for their decisionmaking when auditing is not whether services have been delivered and documented properly, but rather having a dollar figure to find walking in the door in order to assure that their own employment is not terminated? The folly deepens when you realize that we are not allowed in these medicaid sponsored programs to offer billing or productivity incentives to the staff in the program, because the state sees that as ethically problematic. This boys and girls is called hypocrisy.
These auditors are canvassing the state and the country as we speak in programs that serve the mentally ill, mentally retarded and children and families, even hospitals. I know that oversight and accountability for where tax monies are being spent is a good thing and philisophically, I do not disagree with it, but in practice we seem to be once again making evident our prejudices and what we truly value. It is hard not to read these actions as a concerted effort to villify and shrink both Medicaid and the nonprofit sector. At the same time, there are billions of dollars being showered in other sectors such as defense or the financial sector with precious little accountability and we don't blink the communal eye. I am thinking now of the fact that one-third of the money set aside for "reconstruction" in Iraq was given to "security" contractors like Blackwater and, of course, the disappearing pallets of money. This is not an abstract discussion we all have friends and relatives who are touched by these systems of care. Their loss would make our communities poorer places. Why are these systems the first place that cuts are always made? What does it say about the value we place on human life?
I often ponder why as a social worker I am such a suspect character (my drunkenness and debauchery aside). It seems to me ironic that the people we want to extend the greatest autonomy to in our current systems are the very people who make no secret of their bald unwavering self interest, while those who pledge to use their talents for the good of the larger community and sacrifice their own desires are placed beneath the microscope. I suspect because we are out of touch with the spirit of the times.
Finally, for those folks who still want to maintain that the private sector i.e. the finance industry should not have to bow to government oversight since they generate their own revenue and are the engine of the economy I can think of 700 billion ways to tell you to go fuck yourself sideways with a sharp object. You lost that right when you drove the bus over the cliff with us chained to the bumper and made your fuck up everybody's problem. Thanks for that and if you need a lesson on fiscal accountability my little shop is still open and doing just fine. Call me anytime, especially if you want to ship me a pallet of unmarked bills. I could help a lot of folks with food, clothing, heat and shelter this winter.
Jake T. Snake