OK, that wasn’t the title on an article in the metro section of the April 7 New York Times. But there, buried
in the fine print of a story about Emperor’s Club VIP — the high-priced international prostitution service that serviced ex-NY Governor Elliot Spitzer — was this explanation of the financial distress that first motivated its founder.
"Its boss was Mark Brener, 62. He dealt with a stack of medical bills
for his late wife by starting the escort service, an idea that dawned
on him several years ago as he surveyed sex-related advertisements in
the weekly newspaper The Village Voice, an associate of Mr. Brener’s
said. The venture reinvigorated Mr. Brener. He dyed his hair black, donned a leather jacket and recruited three women to help him."
Brener, the article continued, "a 5-foot-5 tax man with thinning gray hair and crooked teeth, had never fit anyone’s image of a pimp." But after his wife contracted cancer, and eventually died, Brener found himself "broke and facing court judgments for unpaid medical bills." That’s when the ads for the escort services caught his eye.
Who says that private sector entrepreneurs can’t help the uninsured?
Categories: Uncategorized
, The right to swing my fist ends where the other man’s nose begins.’ Rights must apply to eevryone in the same sense at the same time. So rights must therefore be limited to claims of freedom to do anything which does not violate the freedoms of others. This requires recognizing, respecting and abiding by anyone else’s wishes to be left alone whenever he wants, and his wishes to be free to do anything which doesn’t violate others. This is why no one can claim a right’ to interfere with your life in any way without your explicit, personally-given consent for a specified purpose. There can be no such thing as a right’ for anyone (or any group) to mess with you whenever he wants (or whenever they want) since it obviously isn’t applying to YOU in the same sense at the same time.If Healthcare were a right, it would automatically necessitate the violation of another’s rights. That being the case, again I say, Healthcare is not a right. And as it isn’t a right, it means that Obamacare is nothing more than a giving of entitlements to some, at the expense of others. In short, redistribution of wealth.Reply
What I know we must do is start looking at hyvreteing pro-actively. Yeah, Insaine Hussien Obama and his every single democrat want to take over the entire country and completely put the ball in their court. They do want to wipe out, even from debate, any type of opposition. And they are not going to stop trying no mattter what happens,. If it’s not Obama care, it’s o’bama vision”news”,. Our rights are getting trampled on everywhere. So we must organize an agency of some offensive reality. A national legal team or agents, not under the direction of the gov’t but works almost like the FBI, and allow them to take to the powers that be any infractions, infringments of our rights. The buck must stop somewhere and if we don’t carryout some sort of level of “participation”, we will find ourselves in due time lost with out any clue as to how we can get back. Sorry to say but corruption is throughout the entire system, and the only way to rid it is to completely turn it upside down and replace everyone . come “election”.. EVERYONE
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.
Peter is right about the liar loans, it is Organized Crime corruption on Wall Street. But we didn’t see Eliot Spitzer do anything about the rampant “sub-prime” corruption on Wall Street when he was Attorney General, instead we saw Spitzer carefully pick and chose who to investigate and threaten prosecution. There should be no surprise that Eliot Spitzer did not prosecute any of the prostitution rings he was associated with, and only an idiot would believe that Spitzer was not obliged to protect the business ventures of the organized crime families which held this dirt on him. Could the $500 Million dollar Spitzer family fortune (could be more, especially if you consider financial relatives) have something to do with the consistent main stream media spin which is portraying the Client 9 scandal as being “just about sex”, when it is really about an official in charge of all organized crime prosecutions being associated with organised crime himself. Maybe, the prositution rings have dirt on the news editors as well. The more things change, the more they stay the same. If we want the truth, we’ll need a Federal Special Prosecutor to examine the Spitzer crime family connections and Eliot’s failures to prosecute criminal referrals. If we don’t mind the huge invisible tax on society by these lawyers who do business with organized crime, then we should just continue to be satisfied with the mainstream news spin.
At least this is one issue that we in the UK don’t have to worry about. While our health service may be drowning in middle management, at least it’s free.
Well if they did they don’t now as they’re unemployed. I wonder how they feel about now having to get a low wage legal job with no health insurance as opposed to being able to afford health insurance as a prostitute with a 6 figure income? Of course earning a 6 figure income on Wall Street passing off liar loans rated as AAA to investors is legal. It all depends on who’s f’ing who.
The question in my mind is whether his employees have health coverage…
“she wishes she’d taught my sister and I to value money above all else.”
Like those pillars of ethical standards on Wall Street? No thanks, that’s why we’re in such a mess now. It’s also the reason you can’t get insured and live in fear of financial ruin because of a condition you were born with. I wonder what condition Republicans were born with that makes them value money above all else?
It’s funny, my mom has often said that given my rare disease and no access to relevant health care, she wishes she’d taught my sister and I to value money above all else. She doesn’t quite mean it and I don’t quite agree, but some days, almost.
gotta love that new category tag!!!
Well I guess the prostituion business is organized just like any other business, but where was the corruption and blackmail? Unless Spitzer used state funds to pay. I think this story is about political hypocrisy. It usually looks better on righteous Republicans though. Especially the gay ones.
How is it that the New York Times printed the photographs of the assistant managers of the Emperor’s Club, but failed to print the photo of the actual boss…the pimp…the head guy…the money maker…the criminal mastermind, Mark Brener? I guess that would require some actual investigative journalism. Why bother when you can just ride the wanker wave and focus and the chicks.
The media keeps treating this like a sex story – showing us pictures of girls. It’s a story about organized crime, corruption, and blackmail. Wake up.
Who says it’s “Hard Out There For A Pimp”. Sex for a show and dinner – legal, sex for cash – illegal. Now would sex in exchange for healthcare be legal or illegal? Hard ethical questions.