Oneida County will spend more than $56 million on Medicaid this year, and county leaders say a large part of that is because people are abusing the system. Our Andrew Sorensen tells us how and what the county can do about it.

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UTICA, N.Y. -- Dr. Shravanti Halpern is the emergency department director at St. Elizabeth Medical Center.

In her 10 years in ERs, she says there's been an open secret that's hemorrhaging money: They legally can't turn people away.

"We cannot, our hands are tied," she said.

A look at her records shows a startling trend.

"A good 25 percent of the patients were brought in by the ambulance that did not really require ambulance transportation," she explained.

She said that's about 15 to 30 people a day, often for things that seem trivial.

"Medication refills, things like to find out whether they are pregnant or not," she said.

Halpern said, for whatever reason, they just need a ride.

"They use the ambulance as a means of transportation," she said.

It costs about $500 to $1,000 to run an ambulance call, but for them, it's free.

"Most of them are Medicaid, but quite a few of them don't have any insurance, they are so called 'self-paid,'" Halpern said.

And she says they even have a hard time getting some of those people to pay.

So when you do the math at $500 to $1,000, 15 to 30 times a day, it turns out to be a pretty big burden on the system.

"We're talking about vehicles, we're talking about manpower, we're talking about money here," said Halpern.

County Executive Anthony Picente said, "Well it's costing us millions. It's costing us the millions that we're paying."

Picente said the county's Medicaid costs are more than one million dollars a week, and something needs to be done.

"If you get a cold, you shouldn't be going to the emergency room, and you certainly shouldn't be going there by ambulance or by emergency vehicle," he said.

Picente said the system needs restructuring and ER visit restrictions.

"There's nothing wrong with that," he said. "You're not denying people health care, you're treating people in a way in which you or I or others who have standard health plans have to obey."

There are other solutions, area charities and non-profits say there are some transportation services for the disabled and elderly, but none for the poor that they know of.

The St. Elizabeth Emergency Department also says the abuse becoming a public health problem, with ambulances getting tied up on non-emergency calls.