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Commentology: Government vs. Corporate Bureaucrats

Bob Bourque of Los Alamos writes:

Do I want government bureaucrats deciding on my health care?  You bet I do!  Because the other choice is to have corporate
bureaucrats deciding on my health care.  I have some control over the
government bureaucrats:  I can vote out their bosses who tell them what
to do.  I have no control over the corporate bureaucrats.  They can do
what they please, and pay off politicians to stay out of the way.

Government bureaucrats will charge a few percent for the administrative
work they would do, which is like what they do for Social Security and
Medicare.  Corporate bureaucrats now charge 30% to pay their CEOs
hundreds of millions of dollars and billions to their investors.


"Health care" companies do not
do health care.  They simply collect premiums from us, get the bills
from doctors and hospitals, decide how much they are going to pay, and
pay it.  They are just pass-throughs.  And they skim that 30% right off
the top while doing it.  Of course they are going to fight
tooth-and-nail against a government-run health plan:  It would make
them irrelevant and put them out of business.  And of course they don't
want to give up that cushy gravy train. In all the talk-show
bickering, these simple facts above are being obscured.  The health
care companies don't care about us.  Like all corporations, they are in
it to make money.  And what an easy way to do it.  Why should their
ease and comfort be at our expense?  Get rid of these corporate
bureaucrats and let health care be run by people we have control over –
our elected officials.

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14 replies »

  1. 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.

  2. If the government paid the doctors and hospitals what their services were worth, private companies wouldn’t have to compensate the facilities for the Medicare and Medicaid underpayment.

  3. So, who do you think it would be easier to resolve a dispute with, the IRS, or a private creditor?

  4. We need to stop pretending that the ‘evil’ corporations are run by these mysterious lords of the universe and focus on reality.
    The government has their hands all over the ‘private’ insurance companies. The DOI’s in each state have limits on product offerings, solvency, cash requirements, payment requirements. Do you know what happens when Honeywell doesn’t pay one of it’s parts suppliers within the contracted number of days? The supplier complains. What about when the insurance company pays late?…fines and payments based on state regulation.
    The point is, the states regulate insurance companies tightly. If you want more competition in the insurance market limit government intervention don’t increase it. If you don’t like the profits that these companies make go to your state officials and complain.
    Your argument is incredibly flawed because you are claiming to be able to vote out elected officials who you also admit are bought by the private industry. We can predict where the profit motive will take us, but the behind the scenes dealings of government officials are another story.

  5. Americans spend twice as much on everything. Why is health care taking a beating for it? Most health care spending is discretionary, not necessary. Other countries are providing a different array of services for their citizens. They really laugh at what some Americans go to the doctor for in the first place.
    Government like a cancer grows. We as a country are spending and borrowing our country into oblivion. Government must stop spending, period. Government is a black hole which consumes wealth and returns nothing that could not have been purchased cheaper privately.
    Time to come to grips with reality, folks. Nobody should be forced to finance other people’s health care. That is what charity has always been for.
    Yes, I am for eliminating Medicare and Medicaid, too.

  6. The other inconvenient fact/truth for many against healthcare reform is that government run healthcare works better in just about every other industrialized country on the planet. No other country wants the U.S. private healthcare system. Foreigners just laugh at Americans for even having this debate. I would be laughing too, if it was not so sad. U.S. healthcare is made up of islands of excellence in a sea of mediocrity. And we pay twice as much for it.

  7. You can vote elected officials out, but you can’t select to not pay taxes. If I am unhappy with my insurance premiums or benefits, I can stop paying them and go to another company in a second.
    No matter who you hold accountable by ‘voting them out’, you aren’t going to be able to stop what they started. They are taking your money for what they claim is your own good.
    Insurance is HIGHLY regulated. No rate increase goes through without getting approval from the government in each state. Every policy must be approved by the government before insurance companies are allowed to offer it.
    If the private insurance companies were run the way the government runs Medicare and Medicaid, all private insurance companies would be out of business. Private companies can’t force people to pay like the government will. Private companies can’t depend on federal borrowing of money to compensate for their not having enough money for claims.
    If the government paid the doctors and hospitals what their services were worth, private companies wouldn’t have to compensate the facilities for the Medicare and Medicaid underpayment.

  8. I wonder if forcing the insurance companies to cover pre-x while also adding more healthy individuals to the overall insurance pool would not help to solve some of the problems. I’m still not convinced that govt run health care will provide an overall fix.

  9. Do you really think it is easier to vote out a Senator once every 6 years then it is to change insurance companies? After 20 years of Harry Reid I’ll try my luck with the corporation, they can be fired at will unlike our politicians for life.
    “Government bureaucrats will charge a few percent for the administrative work they would do, which is like what they do for Social Security and Medicare. Corporate bureaucrats now charge 30% to pay their CEOs hundreds of millions of dollars and billions to their investors.”
    There is the problem you can’t even get the basic facts right. Private insurance doesn’t charge anywhere close to 30% and part of that is taxes to your supposedly efficient government. To further make a mockery of your argument it is the same private insurance companies you claim take 30% that administer Medicare and Medicaid.
    Notice this post is unsigned, no one wanted to catch flak for the obvious distortions?
    “In all the talk-show bickering, these simple facts above are being obscured.”
    To bad you got everyone of them factually wrong.
    “Both Medicare and Medicaid have lower costs and expenses than private insurance so we do see the potential here.”
    BS, Medicare is no cheaper to administer then a self funded private plan and the only reason they are even close is they skimp on fraud protection and case management. When you factor in fraud and waste they are both considerably more expensive. This argument was settled a year ago. I was just thinking how nice it was not to hear this BS anymore about 30% margins and Medicare being more efficient and bam someone drops it again.
    “They won’t insure you with a ‘pre-existing condition’ and they will drop you if you get a serious illness. “
    More BS MarkS, look up the word HIPAA and then repost your comment.

  10. Some of you folks want the government to interfere.
    The point you’re missing (or ignoring) is that the government is going to interfere with me too. You don’t have that right.
    Reform, yes. But not these abominations (I’ve read HR3200).

  11. Duane,
    Both Medicare and Medicaid have lower costs and expenses than private insurance so we do see the potential here.
    You don’t have a choice with private insurance. They won’t insure you with a ‘pre-existing condition’ and they will drop you if you get a serious illness.
    I’d like to have the option to vote with my money and buy government run insurance. I’d be happy to pay for Medicare insurance (I’m 62 and hoping that I can stay healthy until I’m eligible).

  12. Government already has two healthcare programs and if they lived up to their promise this debate would not be taking place. When you say you have some control over your elected officials, what are you thinking? Your vote with your dollars is a far more powerful vote. Voting with your money is immediate. Believing there are only two parties and accepting one or the other is a diluted alternative at best.

  13. Drug manufacturers should be able to charge whatever the market will bear, and when people are in pain, and afraid, the market will bear quite a bit. What right does government have to interfere in the Pharma-patient relationship?
    I want the government to interfere. The government can bring drug prices down. Take a look at the bargins that the Veteran’s Administration has secured. On average, the VA pays 58% less than Medicare for prescription drugs. I want government to do that for Medicare.
    The VA has a formulary, a list of drugs that it has approved for its patients. The Mayo Clinic has a formulary. Why shouldn’t Medicare have a formulary? Formularies protect patients.
    When Mayo saw that Vioxx was no more effective than other pain-killers for most patients, Mayo stopped giving it to most patients, as did the VA. They both acted more than a year before the manufacturer was forced to pull a dangerous and over-priced drug from the market.
    This is how an efficient medical system creates a formulary that puts patients first. And this is the goal of the Comparative Effectiveness Research already funded by the administration’s fiscal stimulus package. Unbiased physicians and medical researchers will sift through head-to-head comparisions of various treatments and assess which work best for patients who fit a particular medical profile.
    If a new drug isn’t any better than existing medications, why include it in Medicare’s formulary? If it is better, it would be included, even if it’s more expensive.
    What if the new product is as good as older products? Medicare and a public sector insurer might well agree to include it in the formulary, if the manufacturer is willing to sell it for less. That’s what is called free market competition: one company makes a product, another comes along with a similar, equally effective treatment product, and offers it at a lower price. That’s how efficient markets keep quality high and prices down.
    But someone has to have the power. First to make a disinterested comparison of the two products, and secondly to say, “no we won’t pay that much.” Cancer patients don’t have that clout. They can’t wait for a cheaper drug to come down the pike. Private insurers don’t fight for the deep discounts that the VA manages to secure. Insurers simply pass exorbitant prices on in the form of higher premiums and co-pays.
    We need a large government insurer, like the VA, who can say, “We represent millions of people. We are protecting their interests.”
    Medicare can do that. So can a public-sector insurer. Anyone who is not comfortable with the public-sector insurer’s decisions could chose a private sector insurer instead.

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