Pieces of the health care portion of the Obama budget are leaking out.
Based upon published reports, the Obama “down payment on health care reform” will include:
- $634 billion to help pay for health care reform over the next ten years.
- $318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.
- Charging wealthier seniors more for the Medicare Part D drug benefit—as is done for Medicare Part B now.
- Cutting Medicare HMO payments by $175 billion over ten years.
- Reducing Medicare hospital payments by $17 billion over ten years by bundling inpatient and outpatient reimbursement to include the 30-days after discharge.
- Cutting Medicare hospital payments by $8.4 billion over ten years for re-admissions resulting from substandard care.
- Requiring drug makers to increase the rebates on drugs sold to Medicare patients from 15% to 21% saving $19.5 billion over ten years.
The biggest spending reduction is the cut to Medicare HMO payments. This one is hardly a risky political move as everyone has expected it. That said, in no event would they
get the full $175 billion in savings because it is simply impractical
to implement such a major change in the Medicare Advantage program by
the next enrollment season which begins late this fall.
Interestingly, the Obama budget reportedly calls for creating a system where the private Medicare plans will bid market to market
to compete with the traditional Medicare plan rather than continuing
the current system where the government tries to set the rates for them.
Ironically, that was the original Republican idea for using the competitive value of managed care to reduce long-term Medicare costs
and is what should have happened in the first place rather than this
temporary system of overpayments the HMO industry has been fighting to
keep permanent.
With $318
billion in tax increases and another $175 billion in Medicare HMO cuts,
the $634 billion "down payment" only contemplates a total of another
$141 billion in federal health care cuts <>over ten years (which amounts to about 1% of annual federal spending each year).
That is hardly a rounding error on a federal health care budget that
CMS just announced will already total $1.19 trillion in just 2009.
This week, CMS estimated that at present trends annual national health care spending would reach $4.35 trillion or 20% of GDP by 2018.
If
the Obama administration is serious about not “kicking the can further
down the road” then any overhaul of our health care system has to do
more than fritter around the edges with spending reductions.
More,
it needs to be paid for from real savings—not half of the "down
payment" coming from tax increases as they are reportedly proposing.
If
the plan is to raise taxes to pay for a big part of health reform that
just means they better raise enough taxes to pay for the $4 trillion
health care system CMS says we are going to have in 2018.
As
the budget details come out over the next few days the question we all
need to be asking is, Just what is this administration willing to do to
make health care affordable over the next ten years?Affordability
will have a lot more to do with the how this administration deals with
the $2.5 trillion we already spend every year not whose taxes we can
raise.
Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.
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Do not let the public go. We need public healthcare. We are willing to finance bow & arrows in Utah, but not health care.
I am for the health public option. What do I need to do to help get this passed though.
One point that none of you get here is that you are not getting free health care from the Government. The way this is going to be financed is by forcing each and everyone of you to go out pay for Health Insurance. Pretty much the same way the government forces you to pay for car insurance. If you don’t get health insurance on your own you are going to be fined.
The people that are behind this bill are Hospitals and Doctors. In the past factories covered workers and now that they have moved to China, cause they don’t want to pay heath coverage or American wages. That leaves Doctors without large Corporations paying for health care. Now most Doctors are making good money, but it is never enough for them.
So folks this is what you get for buying cheap goods from China. Your job is gone and now you have to pay for your own health care. For most of the young healthy people out there you have to pay for all the sick people.
After the government takes over health care insurance the next step will be to keep costs down. One way they are going to keep medical costs down is by forcing you to have healthy habits. They are going to force you to stop smoking. Two, they are going to take away your beer. Alcohol is not good for you, liver damage. Three, they are going to take away sugar and sweets. Sugar makes you fat and causes heart problems. Four, they are going to make you go out and walk everday. Exercise is good for your health. This will be inforced by the neighborhood police scout. Five, you will be required to buy 4 vegetables everyday. Your local neighborhood scout will make sure that you eat all 4 everyday. Six, you will be required to eat dinner in the government cafeteria so that healthy eating can be monitored and enforced.
Does this sound silly to you? Remember you are forced pay for car insurance, ticketed for not wearing your seat belt or talking on your cell phone to name a few.
Little by little your rights and freedoms are being taken away.
Ok I guess I’m missing something. Your going to fix the problem without costing us the americans any money. So if this bill is passed the middle class will not be hit with any new taxes hidden in the bill the Senate and Congress pass again(as always)? Second and most upsetting is the President said it will be mandatory for us WHO can afford it to get coverage(middle class again). And those who still can’t are exempt and will be covered. No I didn’t warch him on tv but read what was said on the net from the farce.
What bothers me the most is the President is going to make it MANDATORY to carry insure guess we are just giving up and letting first steps of a dictatorship moving in. Thought this was America where we have the right to choose. These are my oppions. Not happy with the President,Senate,Congress and my represenitives from NJ.
My wife is a Family Practice physician. We have seriously started to consider which country we should move to. Physicians as a whole are intelligent individuals. If they see their opportunities in this profession shutting down they will be able to go to another profession and become successful. If our brightest individuals leave or don’t even enter the profession what will the status of our health care be then?
Many people appear to denegrate socialized medicine, but some simple facts are hard to swallow.
There is a free national health service in England. Also there is health insurance like here in the US and you can just pay cash. So there are options. All this for only 20% income tax for the vast majority of tax payers.
Here in the US there is no free socialized medicine, but we have to pay around 30% income tax. All this for a health insurance system that most consider a national; scam that is far greater than a Bernie Madoff Ponzi scheme.
Socialized medicine may not be the best system, but having it and a 10% reduction in taxes and then having to pay $0,000 per month to the insurance vampires looks very appealing.
Please read the following article regarding Britain’s health care. If we embrace Obama’s Nationalization Health Care Plan we, too, could have stories like this:
http://www.dailymail.co.uk/news/article-1218927/Plumber-shattered-arm-left-horrifically-bent-shape-operation-cancelled-times.html
107 PEOPLE DIE WORLDWIDE EACH MINUTE.
THAT’S 153,000 DEATHS EVERY DAY.
HOW GOOD OF HEALTH CARE YOU HAVE WILL
MEAN NOTHING WHEN THAT DAY COMES FOR
YOU TO BE AMONG THAT 153,000.
ARE YOU A CHRISTIAN ON YOUR WAY TO
HEAVEN…OR ARE YOU STILL BOUND FOR HELL?
What happened to……..WE THE PEOPLE!
It is no longer about …….you and me!
For the “1st time in my adult life” I am afraid for OUR Country and the direction those leading it.
CHANGE! We are getting change and not the kind of change most of us expected.
For the Government to make the drastic kind of healthcare reform being pushed by Obama is going to be one more push to ruin our country. Not fear, FACT!
I pay one third of my $3,000 dollars a month income for my health insurance and my medicine. I like knowing that if I need to see my specialist I can pick up the phone and be in his office within two – three weeks. If I have a sore throat I can see my doctor the next day and sometimes on the same day that I make the call. I sacrifice the new car, fancy clothes, vacations, for what is important to me!
Obama has refused to tell the American people that have insurance what HIS CHANGE is going to do for everyone. I feel like he is punishing those that have insurance and forcing us to pay for those without and and make everyone wait in the same long government lines for doctor care,(but unfortunately not everyone is equal to everything we do and have in life! And yes his plan does include illegal’s, don’t let him tell you it doesn’t, because later he will say that he did not add them but congress did). Therefore, forcing EVERYONE to wait in long lines and months to see a family doctor, even longer for a specialist and tests. Private insurance companies that will continue operating for a short time will have to follow federal laws. So will the doctors. Eventually, there will be no private insurance, just the lousy government run healthcare similar to the one in Canada and England. Less people live in England than in the U.S. but more people die from breast cancer there than here every year because it takes too long for tests. The delays don’t save lives.! Also, there is going to be penalties on doctors when they don’t know what is wrong with you and have to run several tests……forget the effort on the doctors part when he is fined for running too many tests! ( I THINK THE LIMIT IS 4)! I want the same coverage I pay for today when I am a senior citizen. I want Obama to tell me that my coverage will NOT change!!
IF THE GOVERNMENT CAN DO A BETTER JOB PROVIDING HEALTHCARE THAN LET THEM START WITH THE VETERANS HEALTHCARE AND HOSPITALS FIRST. FIX THEIR GOVERNMENT MESS AS PROOF of being capable of effectively adding billions to a healthcare program!
HAVE YOU BEEN IN A LOCAL VETERANS HOSPITAL LATELY?????
It is a BIG mess!
Another thing that bothers me is that Obama said that he was going to do things differently from the Bush Administration………….
His first complaint was all the spending Bush did while in office 8 yrs……
Well, Obama has outspent every President ever in office and he managed to do it in the first 100 days in office without the effects of 9/11 on our country or the expense, without a Katrina and all its expense and those supported by the move for over a year along with all the damage . No Rita! Just handing out money in a variety of directions that has put this country into more debt! HOW MUCH MORE DEBT WILL WE BE IN AT THE END OF HIS TERM??????????
Number two was the war in Iraq that he blamed on the Bush Administration. But now instead of one war we have two. He is slowly moving men and women out of Iraq but since January added military to Afghanistan where we are fighting the same bad people that Bush went after and Obama was against! THESE ARE ONLY TWO EXAMPLES! I DON’T HAVE TIME FOR THE REST!
CHANGE…………….OR ………………….MISTAKE!
One more thing I would like to ask. If the Clinton years were so great why did so many companies and industries merged together to survive? We had more mergers in the 90′s than in the years prior! Why did many companies falsify their records to make it look like they had better numbers than they really did? If the 90′s were so great why lie about profit margins? Obviously the problems were already there but revealed when 9/11 hit and took a toll on our economy like it did! The problems were already starting in the 90′s, grew in the 2000′s, and going to explode if Obama does not STOP spending OUR money!
I WOULD LIKE TO KNOW WHY OBAMA, CONGRESS, AND THEIR FAMILIES ARE NOT INCLUDING IN THIS WONDERFUL HEALTHCARE PROGRAM. I WANT THE SAME PROGRAM THEY ARE PROVIDING TO THEIR FAMILIES!
There are many different universal health care plans.
I am wiling to support any plan that moves this country toward universal health coverage for all Americans. But, I can understand ,best the one outlined by John Edwards.
_________________
Alargamiento De Pene
The Obama Plan, at first, seems to be the logical thing for a nation in a recession and time of economic difficulty. As you know, many of the residents of the U.S. are having trouble finding work and a means to pay for necessities such as health care. The Barack Obama website states that the plan will “Offer a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice.” The Obama plan may provide for these people but at the expense of those who, although struggling to pay for their own health care, can afford basic health care insurance. The health care plan will raise the taxes of those who can afford to pay for the insurance. Also, by making a public health insurance option, the Obama plan will cause an increase in insurance rates from independent insurance companies. The plan will create a “health choices commissioner” who will decide what insurance companies have to provide as “essential benefits”. The commissioner will decide how much insurance companies can charge for basic health insurance so naturally, the cost of health insurance will rise.
The plan will also affect the pharmaceutical industry here in the United States negatively. My family, and many other families are concerned about what may happen to our relatives jobs and thousands of others jobs across the country. The pharmaceutical industry employs millions of people across the U.S., it also spends billions, and makes billions of dollars each year developing and distributing new medication to Americans. Under the Obama health care plan, President Obama plans on using “safe and affordable” medications from foreign countries, such as Canada, to lower the cost of drugs for people here in the United States. Although this seems like a great plan to some, others like myself, don’t see it in the same light. The money that the pharmaceutical industry puts into our economy can only be a good thing in this time of recession and if the industry is set aside to bring in new “cheaper” drugs then this would cause a negative effect on an already struggling market.
The Proposed Budget to the Healthcare Plan seems to fit the description of benefits Obama is promising as an out come to the changes being made to the healthcare system in the united states. Even if in order for this plan to work our taxes need to increased by a small portion, i think it is worth it, and the ten year goal will hopefully be reached. For this will effect not only our generations health but it will secure a stable healthcare plan to out children in the future. It will be worth the pay for and the wait for if we get a stable insurance system with low cost, and a system where you don’t have to declare bankruptcy for getting sick or taking your uninsured child to the hospital.
The Proposed Budget to the Healthcare Plan seems to fit the description of benefits Obama is promising as an out come to the changes being made to the healthcare system in the united states. Even if in order for this plan to work our taxes need to increased by a small portion, i think it is worth it, and the ten year goal will hopefully be reached. For this will effect not only our generations health but it will secure a stable healthcare plan to out children in the future. It will be worth the pay for and the wait for if we get a stable insurance system with low cost, and a system where you don’t have to declare bankruptcy for getting sick or taking your uninsured child to the hospital.
no one here in massachusetts noticed but now for those who use MassHealth or its other 2 plans, a not for profit dental provider can (and do) recoup $19.00 per patient per visit. this is mass general law. the net result is that it takes 4 visits to get your teeth cleaned, 6 visits for a crown (which you pay for yourself). it also provides incentive for your dentist (if you’re over 21) to pull rather than save your teeth because only the upper and lower 4 anterior teeth are covered for various degrees of restoration. should you have trouble with your back teeth as you get older, you won’t be able to afford to get them worked on. get your pliers out. at a rate of 10 patients per dentist per day, a crew of 8 dentists (both supervising and students) and this figure is conservative, will realize $1,520.00 per day before even looking into a patient’s mouth. the not for profit avenue encourages quantity of care rather than quality to be its governing factor.
in addition, i do not want my doctor to be forced to pay excessively for his insurance, nor is he in the business of buying custom software and hiring specialized staff to just file a simple claim form for reimbursement from the insurance company.
i favor global coding for medical procedures so no matter who your insurance is, the administrative duties will be lessened. BCBS uses one set of diagnostic codes, aetna uses another, cigna uses one similar to both but with its own quirks. adminstrative costs for your doctor’s staff to enter one covered procedure and follow it through to actual payment of the claim may even rival your monthly insurance premium. information technology has added another layer of costs and duplications to the high cost of health insurance. insurance billing procedures is now a field unto itself requiring a two year degree in order to obtain an entry level position. as far as electronic medical records are concerned, it would be prudent to keep both paper and electronic records until laws can catch up with the technology. imagine yourself as a plaintiff trying to explain to the judge that you ‘spoke with tons of people,’ what they told you and what action was taken. you will have no proof. “They told me it was all in the computer” would be laughable as an offer of proof even though it may be true.
i want access to any and all records with regard to my care. i want safeguards and firewalls so records might be secured from additions, post-dating, deletions, ‘corrections’, changes, and any other ways of altering a record.
hay people of earth how are u going to raise taxes when the people that pay taxes are out of work and can no longer pay taxes oh do u pay taxes on your unemployment check that will do it and then ill get sick and die because there is no health care ,it never got passed
My best friend had state ins for a year, she moved away for 6 mths and came back 3 mths ago. Her income has not changed, she still cannot find a job, she started college today. She completed the state paperwork again, for her and her 4 yr old daughter, and mailed it to them over a month ago, she is now having health problems and they keep telling her they do not know where it’s at, who has it etc…If the State of Ohio (wood co.) cannot even get this right, how are they expected to get anything else that has to do with health care right?
Obama’s health care plan has nothing to do with health care just follow the money. Who is going to benefit and who is going to foot the bill for his health care plan? His whole plan is to get the government off the hook and the citizens of the United States on the hook. Everyone being forced to have health insurance will benefit the health insurance industry and take the health-insurance costs away from government responsibility. There is no limit put on the cost of health care at all. That will remain the same and insurance costs will only rise higher and higher. Guess who is going to be responsible for paying for the higher insurance costs along with higher health care costs. What we need is affordable health care. Health care that doesn’t bankrupt the household. Right now you have to mortgage your house in order to pay for the health care bill. You think it’s going to change in the future? Guess again. You are the one who will be responsible to come up with the dollars for hire health care and higher insurance costs!
It seems to me that the opposition puppets (GOP’ers)of health care reform have no clue or desire about how to reign in the exploding cost to our nation or to any American citizen.
The biggest problem is, everyone keeps pointing the finger at why they are irresponsible, unethical, and lack truth in their decision making all in the name of making profits!
I say slice all health care industries into little local co-ops where the insurance is paid for by community service initiatives and local and state subsidized bonds. Allow health care escrow accounts to be invested in the facilities and local businesses that provide health care and use a federal program to allow outside exceptions for things not produced in the local area.
Dismantle the insurance super-giants and retrain their innocent employees who would normally get mulched like old leaves for the big shareholders and CEOs stakes! Reinforce insurance regulation and start handing out jail time for those who think they can steal from the American taxpayer for being sick!
Sooner or later, we all get sick! Why should the insurance companies pretend they are our fairy god-mothers only to turn out to be hyenas and vultures when we are at our weakest and most vulnerable moments?
I have listened sporadically to the debate and have
not heard one word mentioned about the best of patient
care first, then cost.
I fully understand the dilemna between health care and cost.
If my doctors during the past 46 years were concerned
about cost for my health care, this note may have not
been possible. I have had the best care money can buy
due to concerned doctors who put my care ahead of cost.
Because of their decisions, this handicapped individual
has been a tax paying contibutor to society for the last 55 years. And I have enjoyed every minute.
Put the patient care first in the hands of the doctors not the insurance companies.
Simply discontinue the healthcare coverage of the house and senate until the American people has sufficient health care equal to the care we pay for for those who are suppose to work for us. I know this will get them off of the pot and make something happen for the American public. the same concept of asking one little boy to divide a candy bar in half and let the other choose first. Put the decision maker in the position of equal consideration for the other party or risk loosing something valuable
John Singletary
Transparency is lacking in the Health Care debate.
When Pres. Obama invited other points of view t a summit where all the issues would be “on the table,” he put his presidency on the line.
If reform is passed, what’s keeping insurers from covering everyone, and jack up the premiums? If my insurance goes up 100%, it’s just as useless to me as if they just refused to cover me due to preexisting conditions. I can’t afford it.
As much as I’m not enthused about the current bill, I see no reason at all to believe that “starting from scratch” or spending more time to get a bipartisan bill will result in anything better. I feel absolutely certain that it will only be weaker, weaker, weaker.
If this health care bill was any good then Obama and the white house would not have to bribe or blackmail anyone for their vote.
What does America fear from a universial health care system? Surely it is important that Governments look after the most in need. USA has the worst record of any 1st world country in meeting the health needs of its people. Some third world countries have a better health system. It is obviously an American thing? The rest of the world believes in looking after the health of its people, the invisable hand of the market cannot look after the most in need – it requires intervention? The rest of the world looks on with amazement that such controvesy and debate is occuring over a basic human right such as access to an affordable and quality health system? Who cares about the cost? Don’t buy one aircraft carrier this year and you may be able to look after your own people. Caring for people is the mark of a advanced democratic civilisation, America should be ashamed of the current system.
If the health care law is so good, lets require Obama, his cabinet and the entire congress to be subject to it as well. What’s good for the goose …..
Agree totally – get rid of insurance companies and have one universal health care service for all, not much chance of that happening though is there?
Seriously, the changes in law will provide access to 40 million people who otherwise do not have medical cover, surely that in itself should be celebrated? Better this then a large % of the population missing out altogether or have American’s become so concerned for themselves that they are happy to maintain an underclass of people who do not have access to first world health facilities?
This whole healthcare plan gives me themhercrum. I mean, whose to say that it won’t be the precursor to the development of the American socialist state?!? Obama’s treading a fine line with his power here, and I for one, am not going to sit here and tacitly take whatever he spoon feeds us…
I’m willing to let anyone out of the insurance mandate, if they want. When you get in a car crash, or get sick, we’ll let the nurses put you in the “dying pretty soon” room. But you aren’t getting care.
The whole point of insurance is to have everyone in the pool of insured. If people want out, that’s fine, but you won’t get any care either. And don’t bother trying to get insurance after you get sick. You can’t do that with car insurance: it isn’t fair to do it for any insurance.
For the people that don’t want the insurance mandate: I’d seriously like to know what you expect to happen. Write it here. Are you 1) planning never to get sick? 2) independently wealthy & don’t need insurance: you’ll just pay cash? 3) just going to go to the hospital & plead poverty and let the govt pay? I’ve heard incredible amounts of complaining, but I haven’t heard how this would play out in your mind, with things the way they were. People are having to stay with jobs they hate, just to keep insurance. Self-employed people have incredibly high rates (going up) & have no options to shop around if they have the slightest pre-existing condition. Insurance companies are raising rates to squeeze more $$$ from existing customers, and forcing others to go without, so when they inevitably get sick, the govt has to pay. No bumper sticker phrases: how are you going to do it?
Go.
Coventry healthcare/Health America/Health Assurance is one of the worst insurance companies. They put pressure on physicians not to prescribe more than 1 medication. They harass physicians that perform procedures. They deny all claims. Insurances should not be able to get away with this. They are so powerful that they arm twist physicians if they bring any issues to their attention. They have the worst customer service.
Beatrice Wilkinson Welters is President Obama’s nominee for ambassador to Trinidad and Tobago. No surprise, her husband Anthony Welters, is an executive with UnitedHealthGroup which brought in $200,000-$500,000 in campaign donation for the election and another $100,000 for the Obama crowning inaugural. Beatrice Welters donated $4,600 to the Obama campaign in each of the years 2007 and 2008. Her husband, Anthony donated $4,600 in 2008. The Welters’ two sons were also $4,600-donors: Bryant, reportedly 19 years old today, donated $4,600 in the second quarter of each of the years 2007 and 2008, when he was an unemployed student, and Andrew, reportedly 17 years old today, an unemployed student, donated $4,600 in the second quarter of 2008.
http://maggiesnotebook.blogspot.com/2009/11/beatrice-wilkinson-welters-ambassador.html
BACKGROUND*
Anthony Welters has been President of Public and Senior Markets Group at UnitedHealth Group Inc. since September 2007. Mr. Welters has been Executive Vice President of UnitedHealth Group Inc., since December, 2006. He serves as Chief Executive Officer of AmeriChoice Health Services, Inc. He served as Head of Public & Social Markets Group of UnitedHealth Group since August 2007. Mr. Welters co-founded AmeriChoice Corporation (AmeriChoice) in 1989 and served as its Chief … Executive Officer and President from 1989 to December 2006. He served a number of senior positions in the federal government and in private industry. He served as an Attorney for the securities and exchange commission and an Executive Assistant of U.S. Senator Jacob Javits. Mr. Welters served as Director of Federal Affairs and as Assistant Vice President of corporate development of AMTRAK. He served as an Associate Deputy Secretary of the U.S. Department of Transportation. Mr. Welters serves as Chairman of the Board of Morehouse School of Medicine Inc. Mr. Welters served as Chairman of AmeriChoice Corporation from 1989 to September 2002. He serves as Vice Chairman of New York University, Morehouse School of Medicine the NYU Hospitals Center and the Library of Congress. He serves as Vice Chairman of the Board of Trustees of the Morehouse School of Medicine in Atlanta. He serves as Trustee of Morehouse School Of Medicine Inc., The. Mr. Welters has been a Director of Qwest Communications International Inc., since July 25, 2006, CR Bard Inc. (formerly known as Bard C R Inc.) since February 1999, West Pharmaceutical Services Inc., since March, 1997 and AmeriChoice Corporation since 1989. He serves as Director of Horatio Alger Association, The Congressional Black Caucus foundation Inc., The An-bryce Foundation and the Wolf Trap Foundation for the Performing Arts. Mr. Welters serves as Council Member of the National Museum of African American History and Culture. He serves as Trustee of the Healthcare leadership Council, New York University Law School and Medical Center and the National board of the Smithsonian Institution and is a Member of the Young presidents’ organization. He is a recipient of the Horatio Alger Award in recognition of his achievements and contributions to society and serves on the board of that charitable organization. Mr. Welters holds a JD from New York University of Law and a BA from Manhattanville College. He is admitted to the bars of New York and DC.
FEDERAL JUDGE SAYS IF THEY DID NOT PROMISE OR SIGN ANYTHING, KICKBACKS ARE OK??? WHICH IS NOT TRUE BY THE WAY.
Turning next to relators’ claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’ state law claims and refused to grant relators leave to amend.
MEDICARE FRAUD, MEDICADE FRAUD, AND KICKBACKS AND BRIBES BUSINESS AS USUAL,INSIDER INFORMATION GIVEN. 9B BS ONE THING BUT WHAT ABOUT YOUR “HANDS OFF POLICY” BY THE DOJ AND CMS AND HHS, AND WHY NO INVESTAGATIONS OR AUDITS TO CONFIRM OR HELP? “SELF DISCLOSURE BY CARRIER ANOTHER JOKE”.
WHAT ABOUT “TAXPAYERS TO PREVENT AND STOP AND PREVENT FRAUD FOR MEDICARE AND MEDICADE” WHAT ABOUT WILLIS AND WILKINS BEING FIRED FOR NOT WANTING TO BREAK THE HEALTH FRAUD LAWS?
NJ CEPA CLAIM NOW ON FILE…..FALSE CLAIM UNDER APPEAL AND FILED….. WHERE WAS ANY HELP FROM THESE DEPARTMENTS?
The U.S. District Court for the District of New Jersey dismissed May 13 a qui tam action alleging violations of the False Claims Act (FCA) by United Health Group and its subsidiaries. According to the court, the complaint failed to state a claim upon which relief could be granted under the FCA. Relator Charles Wilkins began employment with United Health Group and its subsidiary AmeriChoice in October 2007 as a sales representative. Relator Darryl Willis began employment with United Health Group and AmeriChoice in 2007 as the general manager for Medicare/Medicaid marketing and sales.
In their qui tam complaint, relators allege 11 violations of Medicare and Medicaid regulations. The United States declined to intervene in the case and the relators filed an amended complaint that stated one federal count—violation of 31 U.S.C. § 3729(a)(1)-(3)—and nine state law counts. United Health moved to dismiss under Fed. R. Civ. P. 12(b)(6), arguing relators failed to plead the elements of a “false certification” claim, they failed to plead any anti-kickback violations, and failed to adequately plead a conspiracy. Relators alleged that because United Health entered into a contract expressly certifying that it agreed with all “terms and conditions of payment,” they made a false claim when they submitted claims despite any one of the 11 purported regulatory violations alleged in the amended complaint. Rejecting relators’ express false certification claim, the court found “[not once in the Amended Complaint have Relators identified even a single claim for payment to the Government.”The court also held relators’ implied false certification claim failed. According to the court, relators argued that because United Health agreed to comply with all CMS regulations when it contracted to become a prescription drug plan sponsor, and because at times it was in violation of some regulations, it therefore committed fraud each time it submitted a claim for payment. The court found such a theory of liability overly broad. “If Relators' theory were correct, the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,” the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government's payment decision. While that argument is true, the court reasoned, “Relators must still show a claim . . . and [t]hey have not done so.” Turning next to relators’ claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’ state law claims and refused to grant relators leave to amend.
United States ex rel. Wilkins v. United Health Grp. Inc., No. 08-3425 (D.N.J. May 13, 2010).
FCA claim alleging aggressive marketing tactics by health plan provider dismissed
Publication: Health Law Week
Date: Friday, June 4 2010
The U.S. District Court for the District of New Jersey dismissed a qui tam action brought by two former employees of healthcare plan providers alleging violations of the False Claims Act (FCA) arising from excessively aggressive marketing methods. United Health Group Inc., a provider of access to healthcare services, had as its subsidiaries AmeriChoice and AmeriChoice of New Jersey, which each offered Medicare Advantage plans. Charles Wilkins and Darryl Willis (the relators), who were each employed by United Health Group and AmeriChoice, initiated a qui tam claim against United and its two subsidiaries under the FCA alleging numerous violations of Medicare and Medicaid regulations governing administration of the Medicare Advantage plans. The complaint alleged that the defendants engaged in unauthorized and aggressive sales methods in marketing the plans — including the provision of illegal cash payments to providers to induce them to change beneficiaries to AmeriChoice and the provision of illegal kickbacks to doctors for obtaining the names of patients they could call and approach. The defendants moved to dismiss.
The district court concluded that the complaint failed to identify a single instance in which the defendants submitted a false claim to the government for payment as required to prosecute a qui tam claim as relators under the FCA. Under applicable federal appellate court precedent, the absence of such an allegation was fatal to the relator’s false certification claim. The relators’ theory of liability at base was that because United Health agreed that it would comply with all Centers for Medicare and Medicaid Services regulations, and because it was at times in violation of some regulations, it committed fraud each time it submitted a claim for payment. The district court concluded that this contention confused the conditions of participation in a Medicare or Medicaid program with the conditions of payment, and would open the door to a flood of tort claims of a type not contemplated by the FCA. Moreover, the complaint failed to allege that the violation of any regulation was actually relevant to any funding decision. As a result, the complaint failed to state a claim on which relief could be granted and, accordingly, the defendants’ motion to dismiss was granted.
Source: Health Law Week, 06/04/2010
Copyright © 2010 by Strafford Publications, Inc. http://www.straffordpub.com / All rights reserved. Storage, reproduction or transmission by any means is prohibited except pursuant to a valid license agreement.
2009 and 2010 $120,000 from your tax dollars.
Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools.
These checks came from AmeriChoice Health and on the surface seems like fine gifts.
Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind in order to promote its share of the market place.
Honest Kickbacks Honest Bribes
Judical decision, It’s true there is email thanking AmeriChoice health for their $25,000 gift and requesting a larger amout for the pending year etc. from Community Health Center located in Bridgeton N.J. etc. It’s true a licensed Health Agent was fired for his refusal to deliver these checks. It’s true this behavior violates all the laws concerning bribes, kickbacks,fraud and Stark laws.
What is Bribery Any Way? a form of corruption,is an act implying money or gift given that alters the behavior of the recipient. It’s also true that the various Government agencies were notified of these frauds as well as a FCA case being filed.
It’s true this taint’s all the business then received from Community health center to AmeriChoice Health Company and then submitted to Mediciad and should be then held accountable and subject to all the violations of the health laws involved.
Are Kickbacks becoming a normal way of doing business ?
It’s true that relators argued that because United Health agreed to comply with all those trivial regulations when it contracted to become a prescription drug plan sponsor,as well as sign a formal contract of compliance.
The court found such a theory of liability overly broad. “If Relators’ theory were correct,the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,”the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government’s payment decision. While that argument is true, the court reasoned, “Relators must still show a claim . . . and they have not done so.”Turning next to relators’claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’state law claims and refused to grant relators leave to amend.
It’s true many additional laws were broken and proof furnished but no copy of checks to suppot the bribes only the unapproved forms and email etc.
I think the Federal courts have already decided that not only is Honest Fraud OK but Honest Bribes as well as Honest Kicbacks are OK. It’s amazing a Federal Judge thinks bribes and kickbacks and fraud are to trivial for the court system to waist their time on. What should courts spend their time on and since when do you have to certify compliance for non-violation of any Federal And State Kickback laws??
THE DIFFERENCE in the law of the land AS APPLIED.
The difference in the law as applied to a “person vs a corporation” on one hand the corporation, has a formal contract signed with the government not to break the health laws,, rules and regulations, so any violations that occur now become trivial, as well as evidence recovery denied, jury trial denied, and of course any claims submitted to the government really don’t exist. The person a doctor not a corporation, jury trial allowed, evidence gatherning allowed, of course no formal contract signed with the government his mistakes are real. The very same laws ,rules and regualtions in place apply to both but this means that any person is now screwed and must go to jail.There are a lot of lessons to learn from this unfortunately don’t violate the law is not one of them.
It’s true that relators argued that because United Health agreed to comply with all those trivial regulations when it contracted to become a prescription drug plan sponsor,as well as sign a formal contract of compliance. The court found such a theory of liability overly broad. “If Relators’ theory were correct,the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,”the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government’s payment decision. While that argument is true, the court reasoned, “Relators must still show a claim . . . and they have not done so.”Turning next to relators’claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’state law claims and refused to grant relators leave to amend.
Case1
Fifth Circuit Ruling Affirms that Psychologists are Not immune from Fraud and Abuse Scrutiny September 6, 2010 Posted In: Compliance , Stark and Anti-Kickback By The Health Law Partners on September 6, 2010 9:13 AM | Permalink
Dr. Sam Smith Hill, III’s 2008 healthcare fraud conviction was affirmed by the 5th Circuit on August 25, 2010 (US v. Hill, No. 09-40749 (5th Cir. Aug. 25, 2010). Found guilty in five counts of healthcare fraud by a jury, Dr. Hill’s indictment alleged that he fraudulently billed Medicaid from 2001 to 2008. Having founded a children’s behavioral clinic in Corpus Christi, Texas that provides psychological services to underprivileged children, the indictment contended that Dr. Hill billed Medicaid for services performed by his Licensed Psychological Associates (LPAs). The Texas Medicaid guidelines prohibit billing Medicaid for services not rendered by a physician. Dr. Hill asserted that he only billed for the work he performed; however, the 5th Circuit disagreed, citing Dr. Hill’s statements to FBI agents claiming “that he knew he was violating Medicaid billing rules, but that the rules were ‘wrong and immoral.’” The court, thus, found there to be “sufficient evidence from which the jury could conclude that the billing included the LPA time,” affirming the lower court’s conviction.
While not given as much attention as other fraud and abuse violations, even mental health professionals must be aware of increased fraud and abuse scrutiny.
For more information, please contact Abby Pendleton, Esq. or Robert S. Iwrey, Esq. at (248) 996-8510, or visit the Fraud and Abuse specialty page, the Compliance specialty page, or the HLP website.
Case2
FCA claim alleging aggressive marketing tactics by health plan provider dismissed
Publication: Health Law Week
Date: Friday, June 4 2010
The U.S. District Court for the District of New Jersey dismissed a qui tam action brought by two former employees of healthcare plan providers alleging violations of the False Claims Act (FCA) arising from excessively aggressive marketing methods. United Health Group Inc., a provider of access to healthcare services, had as its subsidiaries AmeriChoice and AmeriChoice of New Jersey, which each offered Medicare Advantage plans. Charles Wilkins and Darryl Willis (the relators), who were each employed by United Health Group and AmeriChoice, initiated a qui tam claim against United and its two subsidiaries under the FCA alleging numerous violations of Medicare and Medicaid regulations governing administration of the Medicare Advantage plans. The complaint alleged that the defendants engaged in unauthorized and aggressive sales methods in marketing the plans — including the provision of illegal cash payments to providers to induce them to change beneficiaries to AmeriChoice and the provision of illegal kickbacks to doctors for obtaining the names of patients they could call and approach. The defendants moved to dismiss. The district court concluded that the complaint failed to identify a single instance in which the defendants submitted a false claim to the government for payment as required to prosecute a qui tam claim as relators under the FCA. Under applicable federal appellate court precedent, the absence of such an allegation was fatal to the relator’s false certification claim. The relators’ theory of liability at base was that because United Health agreed that it would comply with all Centers for Medicare and Medicaid Services regulations, and because it was at times in violation of some regulations, it committed fraud each time it submitted a claim for payment. The district court concluded that this contention confused the conditions of participation in a Medicare or Medicaid program with the conditions of payment, and would open the door to a flood of tort claims of a type not contemplated by the FCA. Moreover, the complaint failed to allege that the violation of any regulation was actually relevant to any funding decision. As a result, the complaint failed to state a claim on which relief could be granted and, accordingly, the defendants’ motion to dismiss was granted.
Source: Health Law Week, 06/04/2010
Copyright © 2010 by Strafford Publications, Inc. http://www.straffordpub.com / All rights reserved. Storage, reproduction or transmission by any means is prohibited except pursuant to a valid license agreement. “
Fried Chicken? Mediciad Inducements?
The 101 Dumbest Moments In Business 2003 EDITION Whiffed pitch No. 6: blatant stereotyping. By Mark Athitakis April 1, 2003 (Business 2.0)– GRAND PRIZE WINNER, DUMBEST MOMENT OF 2002 Which leads to the question, Who is Chicken Man? & Why were whole fried chickens selected?
In September, insurance company AmeriChoice brings trucks to blighted neighborhoods in New York City and gives away coupons for “free chickens” as an incentive for the underprivileged to switch their Medicare coverage. New York state senator Carl Kruger files a complaint with the state attorney general. The 101 Dumbest Moments In Business 2003 EDITION – April 1, 2003 Apr 1, 2003 … Just don’t tell him about the “Chinese health balls.” ….. In September, insurance company AmeriChoice brings trucks to blighted … New York state senator Carl Kruger files a complaint with the state attorney general….. Falling on his sword, Welch announces he’ll give up most of the perks,…2009 and 2010 $120,000 from your tax dollars.
Chicken Feed? Chicken Pox?
Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools. These checks came from AmeriChoice Health and on the surface seems like fine gifts. Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind in order to promote its share or induce its share of the market place. This is not allowed as a use of your taxpayers dollars, yet it happens.What does it really cost the City of Philadelphia to receive this money? Americhoice Health has a long history of corruption over the years yet seems to be protected by those who are responsible to over see their actions why is that? PS… Did the Mayor send for Chicken Man or was he approached by Chicken Man? The Mystery Widens! Can Chicken Man save the Liabraries?
Dirty Birds? Chicken Wings Take Flight?
CEO of AmeriChoice Health Bolts.. Was that Chicken Man? John J. Kirchner – Director, Operations John Kirchner joined Healthfirst in May 2010 with over 25 years experience in health care management. Mr. Kirchner’s background includes responsibility for health plan P&L, strategic planning and operations, and government and regulatory affairs. Mr. Kirchner will be responsible for supporting all aspects of NJ health plan operations. Prior to joining Healthfirst, Mr. Kirchner held a variety of positions at AmeriChoice of New Jersey serving as President from 2007 through 2009.
Chicken Gate Returns? Bad Eggs?
Will this mystery man or woman or chicken ever be caught? Will the “secret eggs” given out to housing authority officers Clinics, Doctors and whoever, make it into through that crispy crust prepared by their Home Office Line Chefs?. Will the Doctors who collected all those extra eggs for sharing thier patients recipes with the Home Office Line Chefs ever really be rewarded? Will the Great Head Chef Chicken Man or whomever that directed and approved all to avoid, overlook the rules, laws and regulations Menu, ever be really compensated for their true worth or will Salmonella remain the dish served for Medicare and Mediciad Industry.
PS Is the Chicken Man a Blues Brothers Wanna B??? HEALTH INSURANCE COMPANY PROFITS IN 2007:A Whole lot Of Chicken UnitedHealth Group —$ 4.654 BILLION. UnitedHealth Group owns, AmeriChoice Health.
Aren’t all of the previous comments above about the symptoms of something much more basic? The only area of health care that has stayed at the same rate of inflation as the overall economy is elective cosmetic surgery. We must find a way to establish incentives based on market forces. But we have a public (not just a President) who are so addicted to subsidies of one kind or another, that past Republican plans such as health savings accounts and catastrophic insurance only have not gotten off the ground. The public (even the “poor” of Las Vegas) are so debt ridden that this proposal couldn’t be considered even if the public realized its merits.
For all the rhetoric, for all the economic pain it would cost MOST of us (including me) health care costs will ONLY be controlled by MARKET FORCES. We need to be telling the American people what the real needs are to be able to control health care costs. And besides all of this, the Medical Industry enjoys the capability of developing any medical product or procedure that comes to mind, knowing in some cobbled together fashion it will be paid for. It doesn’t matter WHAT the costs are, just that they’re always paid. We wouldn’t be talking about any of this if everyone was on their own as a health care consumer. See my blog (http://www.revive-america.us/politics/obamacare/) about the BASIC issues behind all the noise about “health care reform”.
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I try to look at both sides of the issue. Basically, this law allows for health care to be more affordable for all families by placing a limit on the coast of health care services. Since the coast of health insurance is reduced by this law. This new law also states that students can be claimed on their parents’ health insurance until you are 25 years-old. The new law would also prevent insurance companies from dropping people due to new policies, which insurance companies have been known to do in the past. While health care is a good thing, there are drawbacks to this law.
It was predicted by congress that the nation’s spending was going to increase because of this law. In order to keep up with the all of the new consumers, insurers began to eliminate child-only policies that they once held. This could lead to many children without the health care they need. Wall-Mart, who had started giving health care to part-time employees, has recently abolished this policy. The store chain insists that the new law had nothing to do with this decision, but it is public knowledge that their profits have gone down since the law was put into place.
While making sure every person gets health care might be beneficial to low income families, it will cost insurance agencies more money. As a result, insurance agencies might have to adjust their policies to fit spending habits, such as reducing the benefits on their plans. It might be better if both sides had to make sacrifices, and not just one.
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