A social justice settlement
Dr. Gabriel Feldman i82 exposes fraud in New York Cityis health care system
He grew up in a modest home in Brooklyn, N.Y. and looked up to his grandfather who worked as a doctor. He spent a period during his time at Brandeis searching for the right career to pursue before settling on a pre-med track. He spent two and a half years fighting for a cause he felt passionate about when no one else would speak out. He won one of the largest whistle-blower cases of New York City last week in a $70-million settlement to achieve justice in the city's health care system.
Accusing the city of using taxpayer money to provide recipients of home health care with more expensive services than necessary, Dr. Gabriel Feldman '82 filed the Medicaid fraud lawsuit against New York City in 2009.
"In the settlement, filed on Monday, the city admitted that it had violated state rules governing the Medicaid program," according to a Nov. 4 New York Times article. Feldman will receive $14.7 million from the $70-million settlement.
As an independent medical reviewer with an M.D., Feldman has made thousands of visits to elderly and disabled patients in the New York area who are receiving health care services within their home. In a state that provides one of the most generous home health care programs, he has watched countless patients receive aid in their homes to prevent them from having to live in nursing homes.
"I've been to every bureau in almost every neighborhood in the city making my own home visits to see how people are and how well their care is working out," Feldman said.
"If we're going to help people, that's great. But there's no reason to spend three times as much on each program if you can get the same outcome for a dollar as opposed to three dollars," he said.
Feldman decided to bring the case against the city under the federal whistle-blower law that allows a person to expose dishonest or illegal activities occurring in a government department or organization.
Initially met with little enthusiasm by the lawyers he sought to hire for his case, Feldman worked hard to prove the importance of pursuing his case against New York City. "We have a Medicaid program that is wildly expensive and ineffective and does not produce great outcomes," he said. "New York has to get their Medicaid program together. They've got to cut out the waste and fraud. There's got to be audits and regulations and oversight," he explained.
Ultimately gaining the opportunity to bring his case before a judge, Feldman faced challenges from the city that requested the case be thrown out. "One of the reasons they felt that way was because they said, ‘Look, this is an altruistic program, we're trying to care for the elderly and disabled,'" Feldman explained.
"Which ... I support as long as the program is run legally," he said. Others accused him of trying to cut care for the elderly and disabled and force such people into nursing homes.
"I think that made the case extremely controversial and extremely difficult for me to navigate. Because as a public health physician, I want to make sure the individual is cared for, and I want to make sure the taxpayer is cared for, and I want to make sure Medicaid is fair for everyone," he said.
While Feldman found others who felt passionate about cutting Medicaid fraud and wasteful spending from the system, few were willing to speak up. "Everyone says we have to cut out the waste, fraud and abuse from these systems. But then as soon as you start trying to cut anything or adjust anything or downsize anything, people say ‘You don't like the elderly, you don't like disabled people,'" Feldman said.
"If we're going to become a country with a real working health care system that's fair with social justice, people are going to have to come forward and say, ‘We know that folks are wasting money. We know that some folks are getting more care and more services than they need and others are not getting enough.' And I think that that's the bottom line in this case," he explained.
Feldman therefore stepped up as the whistleblower in the case which was settled last week for $70-million dollars after a long fight from Feldman. The settlement came after the city conceded it had not followed all regulations of the Medicaid system and that certain patients were getting more expensive care than necessary.
"The city acknowledged that for a decade, from 2000 to 2010, it had re-authorized personal care for certain patients without having physically obtained the required assessments from doctors, nurses or social workers," according to an Oct. 31 New York Times article. The settlement requires New York City to pay $70 million to the federal government, $14.7 of which will go to Feldman.
"It's not as though folks are being deprived," Feldman explained for the future of Medicaid recipients. "What is going on now is [that] the program is being run properly. People are getting what they're supposed to be getting. Everyone gets the services they need, it might just be from a different program," he said.
And though he may be millions of dollars richer than just a few weeks ago, Feldman's simple lifestyle is still not far from his modest Brooklyn upbringing. "Brandeis University [instilled] in me the feeling that social justice is important. I feel strongly that justice was done here and hope to use whatever funds I get for good purposes," he said.
He plans to continue his job and the work he is passionate about and may now be able to visit Israel more frequently, where he spent time attending medical school.
"One of the things that constantly came running through my mind while I was involved in the case was something Justice [Louis] Brandeis said which was that, ‘Sunlight is said to be the best of disinfectants,'" Feldman said.
"You'll be amazed how simple and how effective that is. To this day, people would rather just push things to the side, push them under the table. To bring things into the light of day is always difficult for many reasons. But his words were guiding during this entire time," Feldman said.
Please note All comments are eligible for publication in The Justice.