Archive for the ‘Healthcare’ Category
The South is alone in having a higher proportion of adults without health insurance after Obamacare than they did before. This is thanks to the GOP state governors and legislators who went to extraordinary lengths to make sure that the poor would not have access to healthcare. As I have observed, you can usually predict GOP policy if you assume the GOP hates the poor and will do everything they can to attack and undermine the poor. In this case, it required not extending Medicare in the states (which was essentially free), refusing to set up health exchanges (Kentucky is an exception—and indeed, the number of uninsured in Kentucky dropped sharply), and refusing to inform people about benefits under the Affordable Care Act.
The above chart is from this article, which attempted to identify the remaining uninsured as of June 2014.
The simple answer is that Medicare was not reviewing its billing data and seemed to have little interest in stopping fraud. Charles Ornstein reports in ProPublica:
A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions.
Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.
And then there was this: The sessions were often being performed by obstetrician/gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled.
So Medicaid began cracking down, and spending plummeted after new rules were implemented. In July 2012 the program stopped paying for group psychotherapy altogether for residents of nursing homes.
Yet Illinois doctors are still billing the federal Medicare program for large numbers of the same services, a ProPublica analysis of federal data shows.
Medicare paid Illinois providers for more than 290,000 group psychotherapy sessions in 2012 — more than twice as many sessions as were reimbursed to providers in New York, the state with the second-highest total.
Among the highest billers for group psychotherapy in Illinois were three ob/gyns and a thoracic surgeon. The four combined for 37,864 sessions that year, more than the total for all providers in the state of California. They were reimbursed more than $730,000 by Medicare in 2012 just for psychotherapy sessions, according to an analysis of a separate Medicare data set released in April.
“That’s not good,” Eagleson said when told of the Medicare numbers.
Medicare’s recent data release has led to a string of analyses showing how waste and fraud is inflating the nation’s bill for health care. This work has echoed the findings of ProPublica’s investigation last year into Medicare’s prescription drug program known as Part D, which had fewer barriers to waste and fraud than other government health care programs – and was making less effective use of its own data.
Of the Illinois ob/gyns billing for group psychotherapy, . . .
Some of these physicians should face criminal charges for fraud and also lose their license to practice medicine.
They continue walking the earth even after they have been completely exposed as counterfactual. As Maher says:
What they do is they pass a zombie lie down to dumber and dumber people, who believe it more and more.
Hank Paulson may be over the one about climate change being a hoax, but it’s still good enough for Sean Hannity. Who then gets quoted by Michele Bachmann. Who forms the intellectual core of the thinking of Victoria Jackson. And when you think the zombie lie has finally gone to die at the idea hospice of the absolutely stupidest people on Earth, there it is being retweeted by Donald Trump.
But that’s just the summation of a very good rant about all the zombie lies about Obamacare. Maher goes through the list—lies that have been solidly refuted but never acknowledged by the GOP, which simply moves on to the next round of lies, leaving their litter of lies to blow around and soil our daily lives.
The eruption of the VA scandals showed clearly that the government does a poor job of investigating its programs. And now Medicare has been found to simply accept large-scale fraud, seemingly making no effort whatsoever to detect and punish fraud—until newspapers write stories about it. Charles Ornstein has an infuriating article in ProPublica:
The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions — and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.
Now it’s led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.
Last year, ProPublica chronicled how lax oversight had led to rampant waste and fraud in Medicare’s prescription drug program, known as Part D. As part of that series, we wrote about Dr. Carmen Ortiz-Butcher, a kidney specialist whose Part D prescriptions soared from $282,000 in 2010 to $4 million the following year. The value of her prescriptions rose to nearly $5 million in 2012, the most recent year available.
But no one in Medicare bothered to ask her about the seemingly huge change in her practice, Ortiz-Butcher’s attorney said. She stumbled across a sign of trouble last September, after asking a staffer to mail a fanny pack to her brother. But instead of receiving the pack, he received a package of prescriptions purportedly signed by the doctor, lawyer Robert Mayer said last year. Ortiz-Butcher immediately alerted authorities.
Since then, investigators have uncovered a web of interrelated scams that, together, cost the federal government up to $7 million, documents show.
In February, the U.S. Attorney’s office for the Southern District of Florida charged Maria De Armas Suero, who had been a secretary at Ortiz-Butcher’s Island Clinic from March 2011 to September 2013, with 11 counts of conspiracy, fraud and aggravated identity theft.
Suero subsequently agreed to plead guilty to two counts of conspiracy and identity theft. In a recounting of her wrongdoing, called a factual proffer, she acknowledged using Ortiz-Butcher’s paper prescriptions to “create fraudulent scripts for numerous Medicare beneficiaries…The prescriptions falsely represented that the Medicare beneficiary was seen by [Ortiz-Butcher] and that the listed prescriptions were medically necessary.”
Suero acknowledged that she was paid $100 for each prescription she generated. . .
Paul Krugman has a good blog post with links to graphs and stats about Obamacare. From one of his links:
In the NY Times Adam Liptak points out the Catholic old boys on the Supreme Court have now expanded significantly the restricted Hobby Lobby ruling. That didn’t take long, did it?
In a decision that drew an unusually fierce dissent from the three female justices, the Supreme Court sided Thursday with religiously affiliated nonprofit groups in a clash between religious freedom and women’s rights.
The decision temporarily bars the government from enforcing against a Christian college part of the regulations that provide contraception coverage under the Affordable Care Act.
The court’s order was brief, provisional and unsigned, but it drew a furious reaction from the three female justices — Justices Sonia Sotomayor, Ruth Bader Ginsburg and Elena Kagan — who said the court had betrayed a promise it made on Monday in Burwell v. Hobby Lobby Stores, which involved for-profit corporations.
“Those who are bound by our decisions usually believe they can take us at our word,” the dissent, written by Justice Sotomayor, said. “Not so today.”
At issue in the order, involving Wheaton College in Illinois, are federal forms that groups must fill out and send to their insurers and plan administrators as an alternate way to deliver free contraception to be offered to female workers under the Affordable Care Act.
Monday’s majority opinion in the Hobby Lobby case, written by Justice Samuel A. Alito Jr., seemed to suggest that the accommodation in which the forms played a role was an acceptable alternative to having employers pay for the coverage. He referred to it when he said the government already “has at its disposal an approach that is less restrictive than requiring employers to fund contraception methods that violate their religious beliefs.”
The difference between a form sent to insurance companies and plan administrators on the one hand and a letter sent to the government on the other mattered, the college told the justices, “because it believes, as a religious matter, that signing the form would be impermissibly facilitating abortions and therefore forbidden,” the brief said.
Monday’s “Hobby Lobby” decision was just the latest challenge to the Affordable Care Act. Details on the 5-4 decision and other challenges that could — if successful — have even deeper implications.
Video Credit By Carrie Halperin on Publish Date June 30, 2014. Image CreditDoug Mills/The New York Times
“To be sure, free citizens in a diverse nation will have different views about whether signing the form makes someone complicit,” the college’s brief said. “But that is a question of ‘religious and moral philosophy’ for Wheaton,” not the government. The quoted phrase came from the Hobby Lobby decision.
The court’s majority said Wheaton College need not fill out the forms. Instead, the order said, the college could just notify the government in writing. The government, it said, remains free “to facilitate the provision of full contraceptive coverage.” . . .