Michigan Did Not Get Its False Claims Act Together, Again

Pay attention to the whom the review was addressed.  Mike Cox is no longer Attorney General.  It is now Bill Schuette. 


HHS OIG Review of Michigan False Claims Act 2011

San Francisco Endorses Hr-676 Press Conference June 19, 2008

John Conyers Talks about Healthcare

Pay may be hot issue, but other factors push harder on health costs

By Megan Woolhouse

Globe Staff / March 13, 2011

Blue Cross Blue Shield of Massachusetts has captured the public’s attention, although not the way it would have liked, as reports of millions paid to the insurer’s former chief executive and hefty stipends paid to board members sparked outrage.

The outcry grew big enough to force Blue Cross board members to vote to suspend their own payments and to lead the insurer to make promises to curb excessive payouts to executives. There’s just one problem: Those steps will do little to fix soaring health care costs.

“I have the same outrage,’’ Stuart H. Altman, a national health policy professor at Brandeis University, said about Blue Cross’s payments. But, “We need to put executive pay and board salaries in perspective. It is not the major force, or even close to the major force, in driving up health care costs.’’

US health care spending hit $2.5 trillion in 2009, increasing by about $600 billion from 2004, according to the Centers for Medicare and Medicaid Services. Nearly two-thirds of the increase was driven by rising costs in three areas: hospitals, which accounted for 33 percent of the increase; doctors, which accounted for 19 percent; and prescription drugs, which accounted for 10 percent.

Administrative costs, which would include payments to board members, accounted for about 5 percent of overall health care cost increases. Altman said Massachusetts health insurers spend about 10 percent on administrative costs, lower than the national average, which is typically 15 to 20 percent.

In a report last year, Attorney General Martha Coakley concluded that price increases by providers accounted for 90 percent of the growth in Massachusetts health care costs between 2006 and 2009. The report also found that prices varied widely, but the highest prices were charged by the biggest providers with market power to push insurers to pay more. Insurers, in turn, passed at least some of the those costs to consumers.

Health care costs are growing much faster than the economy and wages, the report warned.

“Such increases, if unchecked,’’ the report said, “threaten the financial stability of individuals and businesses, and the future viability of our gains in health care access.’’

Under the state’s universal health care law, about 98 percent of Massachusetts residents have insurance. Blue Cross is the state’s largest insurer, insuring more than 3 million residents.

Health care providers and insurers have long clashed over who was responsible for rising health care costs, leaving Massachusetts employers to deal with double-digit premium increases. Many firms criticized Blue Cross and other insurers for the relentless increases that crimp hiring by raising the costs of adding workers.

But it is the compensation issue that has provoked populist anger, as workers struggle with stagnant wages and rising health insurance costs.Continued...

Senate Dems Consider Health Care Fix That Could Hit Poor Consumers The Hardest

Senate Dems Consider Health Care Fix That Could Hit Poor Consumers The Hardest

MONDAY, MARCH 7, 2011

Dr. Margaret Flowers, a pediatrician from Maryland who volunteers for Physicians for a National Health Program, knows what it is like to challenge the corporate leviathan. She was blacklisted by the corporate media. She was locked out of the debate on health care reform by the Democratic Party and liberal organizations such as MoveOn. She was abandoned by those in Congress who had once backed calls for a rational health care policy. And when she and seven other activists demanded that the argument for universal health care be considered at the hearings held by Senate Finance Committee Chairman Max Baucus, they were forcibly removed from the hearing room.

“The reform process exposed how broken our system is,” Flowers said when we spoke a few days ago. “The health reform debate was never an actual debate. Those in power were very reluctant to have single-payer advocates testify or come to the table. They would not seriously consider our proposal because it was based on evidence of what works. And they did not want this evidence placed before the public. They needed the reform to be based on what they thought was politically feasible and acceptable to the industries that fund their campaigns.”

“There was nobody in the House or the Senate who held fast on universal health care,” she lamented. “Sen. [Bernie] Sanders from Vermont introduced a single-payer bill, S703. He introduced an amendment that would have substituted S703 for what the Senate was putting together. We had to push pretty hard to get that to the Senate floor, but in the end he was forced by the leadership to withdraw it. He was our strongest person. In the House we saw Chairman John Conyers, who is the lead sponsor for the House single-payer bill, give up pushing for single-payer very early in the process in 2009. Dennis Kucinich pushed to get an amendment that would help give states the ability to pass single-payer. He was not successful in getting that kept in the final House bill. He held out for the longest, but in the end he caved.”

Rally, Hearing for Single Payer in Salem Friday

Dissatisfied with Obamacare, single-payer advocates are taking their message to the state capital

By: 

 David Rosenfeld

March 7, 2011 -- Advocates for single-payer healthcare in Oregon plan to make their voices heard in Salem on Friday.

Supporters of HB 3510, which calls for a universal state health plan, will rally in front of the capital at noon, March 11, followed by a hearing in the House Health Care Committee. 

That could be as far as the bill will likely get, though, according to chief sponsor Rep. Michael Dembrow (D-Portland).

“There is obviously a strong base of support out there for single-payer and clearly a frustration that it hasn’t been a part of the government’s conversation,” Dembrow said. “But this will do that and people will become more educated and organized about it. In the long run I think single payer is where we’re going to end up.”

Dembrow and other supporters point to existing programs such as Medicare, Medicaid and the Veterans Administration, as current examples of single-payer healthcare in America.

Supporters are buoyed, too, in Oregon from a strong turnout in January at a single-payer conference that drew close to 500 people, including national leaders such as Congressman John Conyers (D-Michigan) and Dr. Margaret Flowers, a fellow at Physicians for a National Health Program.

Oregon joins Vermont and California in attempting to pass state-based single-payer laws. The Oregon bill, co-sponsored by six other Democrats, would make a number of sweeping changes to the healthcare system.

• It creates a state health plan with no co-pays, deductibles or cost sharing.
• It bars commercial insurers from competing with the state plan, aside from offering additional coverage.
• It eliminates provider panels and says the plan must accept any qualified provider.
• Providers must too accept what the health plan pays, barring them from billing patients for the remainder.
• It expands certificate of need for hospitals and managed care plans.
• It leaves out the question of funding except to say costs will be based on an individual’s ability to pay.

Dembrow said he hopes Friday’s hearing starts a discussion that could see some of the ideas adopted by the Oregon Health Authority in applying for federal waivers or strengthening a proposal for a state-based public option.

“A lot of people are on board with the notion of trying to create the biggest pool as possible,” Dembrow said. “We just want to go a step further and take the insurance companies out of it and move to a self-insurance of this pool and try and dissociate coverage from employment.”

If the bill were to become reality, Dembrow envisions an exodus of employees from commercial insurers to government employees or government contract employees. Exactly how many people it would require or how much it would cost is unknown.

Rep. Bill Kennemer (R-Oregon City), who sits on the House Health Care Committee, said he’s not prepared to move the bill. “It’s a dramatic change from what we're doing,” he said. “When you're making social change, it's tough to do dramatic change well.”

Supporters would like to at least see the legislature authorize a study to compare the costs of a single-payer system in the state with other options, as other states have done, said Peter Shapiro with Portland Jobs with Justice, who helped write the bill. 

“It will certainly keep single payer in play as something to discuss and be taken seriously,” Shapiro said. “It also might create a better environment for something to fall short of that but advance the cause.”

Portland Jobs With Justice, Physicians for a National Health Program chapters in Corvallis and Portland, Mad as Hell Doctors and Healthcare for All Oregon formed the Oregon Single Payer Campaign to advocate for the bill. 

Oregon March 11, 2011 Single Payer Health Care Leaflet

Medicaid chief: Single payer may be better than ‘devil-may-be’ market

A senior Patrick administration health care official said Friday that a single payer system may work more effectively and efficiently than Massachusetts’s existing insurance market, a high-profile endorsement that raised eyebrows at a legislative hearing.
“I like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better,” said Terry Dougherty, director of MassHealth – the state-run Medicaid plan that insures nearly 1.3 million Massachusetts residents – when lawmakers asked for his “personal view” on a single payer system.
Dougherty’s comment, made during a budget hearing at the Boston Public Library, prompted his boss, Secretary of Health and Human Services JudyAnn Bigby, to interject: “That’s his personal opinion.”

After his remarks, Dougherty told the News Service that he’s learned to appreciate “elements of single payer” during his 30 years in health care.Dougherty noted that MassHealth, by far the largest program in state government, spends just 1.5 percent of its $10-billion-a-year budget on administrative costs – compared to about 9.5 percent by the private market, according to studies by the state Division of Health Care Finance and Policy. That figure won plaudits from several lawmakers on the panel, including some who have supported implementing a statewide single payer system.
“It’s got to be better than this devil-may-be marketplace,” he said. “We don’t build big buildings. We don’t have high salaries. We don’t have a lot of marketing, which makes, to some extent, some of the things that we do easier and less costly than some things that happen in the marketplace. Overall, my point is, we have individuals who work in state government in MassHealth ... who are just as smart, just as tactile, just as creative as people who work in the private sector, but they work for a lot less money.”
A single payer system would replace the state’s patchwork of nonprofit and private insurers with a single, public insurer through which all health care dollars would flow to hospitals, doctors and other health care providers. Supporters say it would eliminate administrative waste and ensure that all residents receive adequate coverage.
But while supporters point to single payer models used by other countries and tout the idea as a cost saver, critics warn the system would result in government bureaucrats deciding what services to cover and how to pay for them, would reduce the quality of care and would disrupt relationships between doctors and patients.
Hundreds of thousands of Massachusetts residents have endorsed the approach. In fact voters in 14 House districts –including five that backed Scott Brown for U.S. Senate – voted overwhelmingly last year to support a non-binding ballot question that asked, “Shall the state representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?”
A similar question passed in 10 other House districts in 2008.
Although last session 50 members of the Legislature supported a single payer model, the issue has lacked support from the upper echelons of the Legislature and the Patrick administration.
A single payer plan would scrap Massachusetts’s landmark health care system, which relies on the private insurance marketplace, and that backers have credited with helping insure about 98 percent of the population. Backers of the existing structure, while acknowledging that health care costs have continued to climb, note that the state has covered about 430,000 residents since the inception of health care reform in 2006. Individuals are required to purchase health insurance, and low-income residents without access to health care through their employers may obtain partially or fully-subsidized care through the state’s Connector Authority, an exchange that pairs consumers with private plans, or through MassHealth.
This session, only 32 members signed on to the single payer proposal, although the sponsors include several high-ranking lawmakers: Rep. Stephen Kulik, vice chair of the Ways and Means Committee; Rep. Martha Walz, assistant vice chair of the Ways and Means Committee; Reps. Ellen Story and Byron Rushing, members of Speaker Robert DeLeo’s upper leadership team; and eight House committee chairs. The bill’s lead sponsors are Rep. Jason Lewis (D-Winchester) and Sen. James Eldridge (D-Acton). Last session’s lead sponsor, Rep. Matthew Patrick (D-Falmouth) was ousted at the polls by Republican David Vieira.
Benjamin Day, executive director of Mass Care, a single payer advocacy group, noted that only six of the lawmakers in the 14 House districts whose voters endorsed single payer health care signed onto the bill. He asserted that many members of state government’s health care hierarchy support single payer health care but keep it to themselves.
“Everyone is making political considerations, tactical considerations,” he said.
Day said supporters of a single payer system are eyeing Vermont, which recently elected a Democratic governor who ran on a platform that included a single payer system.

“If Vermont passes it, that will be such an incredible boon,” he said.
Day noted that Vermont has hired key players in Massachusetts’ own landmark health reform efforts, including Jonathan Gruber, a member of the Massachusetts Connector Authority board and Anya Rader Wallack, a health care consultant who previously headed the Massachusetts Medicaid Policy Institute.
Proposals to advance a single payer system have fallen in and out of favor for decades. Before he became Senate president in 2003, Robert Travaglini was the lead sponsor of a proposal to create a task force charged with recommending ways to implement single payer health care in Massachusetts, although he later endorsed the current system, which Gov. Mitt Romney signed into law in 2006.

Twenty People Indicted in Florida for Health Care Fraud Scheme Involving Approximately $200 Million in Medicare Billing

Twenty People Indicted in Florida for Health Care Fraud Scheme Involving Approximately $200 Million in Medicare Billing

Related Action Charges Four Other Defendants with Additional Offenses

WASHINGTON – Twenty individuals, including three doctors, were charged today in the Southern District of Florida for various health care fraud, kickback and money laundering charges related to their alleged participation in a fraud scheme involving approximately $200 million in Medicare billing for purported mental health services, announced the Departments of Justice and Health and Human Services (HHS).
The 38-count indictment unsealed today in U.S. District Court in the Southern District of Florida alleges that the defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc.  According to court documents, the defendants participated in a scheme to defraud Medicare by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided at all.  The indictment alleges that various defendants paid kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities (ALFs), in exchange for delivering patients to ATC facilities.  Various defendants are charged with participating in an extensive and complicated money laundering scheme related to the cash for kickback payments.  Sixteen defendants were arrested this morning in the Southern District of Florida and are expected to appear in U.S. District Court in Miami later today.   Arrests are expected to continue in the coming days.  
ATC’s and Medlink’s owners and managers, Lawrence S. Duran, Marianella Valera, Judith Negron and Margarita Acevedo, were originally indicted along with the corporate entities, ATC and Medlink, in October 2010.  A superseding 38-count indictment unsealed today in the Southern District of Florida charges them with additional offenses.

“As today’s charges reflect, defrauding the Medicare system was not an aberration at ATC, but instead part and parcel of its business operations,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division.  “The alleged scheme was brazen in scope, and carried out by the company’s owners, doctors, marketers and others.  By exploiting positions of trust, these defendants masked their fraudulent operation as a legitimate mental health business.  These charges are evidence that we will pursue Medicare cheats no matter their position.”

“Community mental health centers are an essential element of the nation’s health care system and serve vulnerable populations,” said Daniel R. Levinson, HHS Inspector General.  “Today’s arrests by OIG agents and our law enforcement partners show that we will not tolerate criminals who pay kickbacks for referrals of Medicare business or who bill for services that were either medically unnecessary or never provided.”

“Community Mental Health Centers can no longer use phantom medical care as a front to bilk Medicare for unnecessary or nonexistent medical services,” said FBI Special Agent in Charge John V. Gillies of the Miami Field Office.   “The FBI and our law enforcement partners will investigate and criminally prosecute such fraud to the fullest extent of the law.”

U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida stated, “Health care fraud has evolved from DME fraud, to infusion fraud, to home health care fraud, and now, as this case shows, to community mental health treatment fraud.  Worse yet, health care fraud has come to permeate every level of the health care industry, from the owners and managers of dirty clinics, to complicit doctors, program directors, therapists, marketers, and patient recruiters.  Today’s prosecution confirms that we are well-equipped and primed to fight the changing face of Medicare fraud in the Southern District of Florida, and that we will prosecute every link in the fraud chain.” 

According to court documents, ATC, headquartered in Miami, operated purported partial hospitalization programs (PHPs) in seven different locations throughout Florida, from Homestead to Orlando.  A PHP is a form of intensive treatment for mental illness.  Court documents allege that Duran and Valera orchestrated the fraud, kickback and money laundering schemes.  Negron assisted Duran and Valera in operating the schemes.  Acevedo operated the kickback scheme.        
According to court documents, doctors Mark Willner, Alan Gumer and Alberta Ayala were medical directors for ATC, and Vanja Abreu (Ph.D.), Nancy Merced-Sola and Lydia Ward (Ph.D.) served as program directors who managed ATC facilities.  Nichole Eckert was a therapist at ATC.  Court documents allege that Duran, Negron and Valera, along with the program directors and Eckert, regularly altered and instructed others to alter patient charts and notes from therapy sessions at ATC in order to make it appear that the patients being treated qualified for PHP treatments, when, in fact, they did not.  According to the indictment, Willner, Gumer and Ayala then signed the false patient charts authorizing unnecessary treatment or continued treatment for patients who were not eligible for PHP treatment, without examining the patients or the charts.  Duran and Valera also allegedly instructed employees and doctors at ATC, including Willner, Gumer and Ayala, to alter diagnoses and medication types and levels to falsely make it appear that the patients qualified for PHP treatments.
According to court documents, Valera, Willner, Gumer and Ayala manipulated the length of patients’ stays in order to maximize the number of days Medicare would pay for the PHP services.  According to a civil complaint filed in the Southern District of Florida, ATC routinely admitted patients to the PHP program who suffered from Alzheimer’s and severe dementia and therefore were not eligible for the PHP program because their mental capacity did not allow them to benefit from group therapy.
The indictment also alleges that Sandra Jimenez, Hilario Morris and Joseph Valdes were marketers for ATC and participated in the kickback operation.  These marketers, along with Duran, Valera, Negron and Acevedo, allegedly paid kickbacks to patient brokers and owners and operators of ALFs and halfway houses in exchange for delivering patients from their facilities to ATC.  The indictment alleges that defendants Mathis Moore, Nelson Fernandez, Leyanes Placeres, James Edwards, Frank Criado and Curtis Gates were patient brokers and, in exchange for kickbacks, provided patients to ATC every month from ALFs and halfway houses with which they had relationships.  The indictment alleges that the kickback payments totaled millions of dollars.
The indictments allege that the kickback scheme was supported by a money laundering scheme whereby individuals received checks in their own names or in the names of shell corporations they created, cashed the checks and returned the cash to Duran and Valera, which Duran and Valera then used to pay the kickbacks.  Defendants Adriana Mejia, Pedro Sosa, Yoisel Cancio and an unnamed coconspirator, along with Moore, Fernandez, Placeres, Edwards, Criado and Gates, allegedly participated with Duran, Valera, Negron and Acevedo in the charged money laundering conspiracy.  According to the indictment, Mejia, Sosa and Cancio received monthly, bi-weekly and weekly payments from Medlink despite the fact that they had no job functions at Medlink or ATC, other than laundering money.  The indictments also charge that Duran, Valera, Negron, Mejia, Sosa and Cancio engaged in transactions designed to conceal proceeds of unlawful activity and structured their transactions to avoid reporting requirements that require banks to report certain transactions.  According to the indictments, these defendants together laundered millions of dollars over several years.
The alleged scheme also involved a company called American Sleep Institute (ASI), which purportedly provided sleep study services.  The defendants paid additional kickbacks for some patients to also visit ASI.  Court documents allege that Willner, Gumer and Ayala furthered the health care fraud conspiracy by referring patients to ASI.
In a separate action in October 2010, a civil complaint for injunctive relief was filed in U.S. District Court in the Southern District of Florida and a preliminary injunction was obtained to freeze the assets of Duran, Valera, Negron, Acevedo, ATC and Medlink as well as ASI and D&V Development Inc., as participants in the health care fraud.  Civil court documents allege that D&V Development was owned and operated by Valera and Duran and was established in an effort to divert funds received by ATC and ASI.
An indictment is merely a charge and defendants are presumed innocent until proven guilty.
Today’s actions were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Wifredo A. Ferrer for the Southern District of Florida; Special Agent in Charge John V. Gillies of the FBI’s Miami Field Office; and Daniel R. Levinson, Inspector General of HHS.
The criminal cases are being prosecuted by Trial Attorneys Jennifer L. Saulino, Maria Gonzalez Calvet and Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.  The related civil action is being prosecuted by Vanessa I. Reed and Carolyn B. Tapie of the Civil Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of Florida. The cases are being investigated by the FBI and HHS Office of Inspector General (OIG). The cases were brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.
Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for approximately $2.1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:www.stopmedicarefraud.gov .

Conyers: Constitutional Text and History Proves the Validity of Health Care’s Minimum Coverage Requirement

Contact: Nicole Triplett (202) 226-5543                                                                                                  

Wednesday, February 16, 2011

Conyers:  Constitutional Text and History Proves the Validity of Health Care’s Minimum Coverage Requirement

Minimum Coverage is Necessary to Eliminate Insurance Discrimination Against Those With Pre-Existing Conditions and Make Health Care Affordable and Available for All

(Washington)—Today, at the House Judiciary Full Committee’s Hearing on the “Constitutionality of the Individual Mandate,” Ranking Member John Conyers, Jr. (D-Mich.) and his Democratic colleagues stressed how the Affordable Healthcare Act’s foundations are constitutionally sound, invoking the Constitution’s plain language, past Supreme Court cases, and the establishment of federal programs, such as Medicare and Social Security. 

Mr. Conyers and other Judiciary Democrats emphasized the critical importance for the minimum coverage requirement to be coupled with efforts to prevent insurance companies from terminating coverage for people with pre-existing conditions.  They argued that, without the individual mandate, citizens would pay higher taxes and experience double-digit premium increases.

Below is an excerpt of Mr. Conyers’ hearing remarks:

Indeed, the position that my Republican colleagues are taking is curious.  After all, they were for the individual mandate long before they were against it. 

Senators Orrin Hatch and Charles Grassley, along with 18 of their Republican colleagues included the idea of an individual mandate in their “Health Equity and Access Reform Today Act of 1993,” their counter to President Clinton’s plan. 

Former Massachusetts Governor Mitt Romney featured an individual mandate as part of his successful health care reform law, where it helped reduce insurance premiums by 40 percent while the national average has increased 14 percent.

Given its demonstrated success, and the need to solve our national health care crisis, one would hope that my Republican colleagues would continue to embrace the idea.  But instead, they’ve gone on attack, now claiming that the individual mandate is unconstitutional. 

Were they wrong then, or are they wrong now? 

I believe that they are wrong now – Congress has the clear power under Article I, Section 8, Clause 3 of the Constitution, which gives us authority to regulate commerce between the states.  That power is augmented by Article I, Section 8, Clause 18, which grants us discretion to choose the “Necessary and Proper” means of achieving our legitimate regulatory goals.  I’d like to explain briefly why our authority here is beyond question and their counter arguments should not carry the day.

First, their core argument, that this regulates “inactivity,” requires us to accept a complete fiction.  We all participate in the health care market.  No one can credibly claim that they will never get ill or injured and, in this country, we promise emergency care for all who need it.  We should be proud of that, but we also must find a better way to pay for it.  The cost of uncompensated care was $43 billion in 2008 alone, and those costs are shifted to other Americans who pay higher taxes and increased fees for medical care and insurance premiums. The individual mandate recognizes the reality that we are all “active” in the health care market and regulates how and when we pay for our health care.  Doing so is well within Congress’s power.

Second, while some of my colleagues may score political points by making this “inactivity” argument, it is – as President Ronald Reagan’s Solicitor General Charles Fried explained to our Senate colleagues – “in any event irrelevant” as a matter of law. 

Solicitor General Fried is not a partisan supporter of the Affordable Care Act, but he is a staunch defender of our Constitution. In his view, the individual mandate is fully constitutional because Congress unquestionably has the power to regulate the interstate health and insurance markets and discretion to choose the “Necessary and Proper” means of doing so.  He testified on this before our Senate colleagues and I would like to seek unanimous consent to enter his statement into the record today.  

Finally, we have been hearing that this is all about individual liberty, the right to be let alone.  But is it really?  For example, states can, and do, require citizens to purchase car insurance.  And, in Massachusetts, legislation signed by former Governor Romney obligates that state’s residents to purchase health insurance.  Many other laws impose affirmative obligations on our citizenry:  we must pay taxes, send our children to schools and vaccinate them, contribute to Medicare and Social Security, to name just a few. Surely some citizens would like to avoid these requirements as well.  But, aside from religious objectors, who also are excused here, they have no constitutionally recognized right to do so.  The liberty interests at stake do not change simply because it is the federal, rather than the state, government that is imposing the requirement.  While we can debate whether the Congress has the power to impose this requirement – something I believe we clearly do – we should not scare Americans into believing that how we resolve that question says anything about their individual liberty.

I look forward to hearing from our witnesses today, and hope that they can shed additional light on the points that I have made.

###

Single Payer Health Care Fraud Prevention Powerpoint and Speaker Notes

Single Payer Health Care Fraud Prevention Powerpoint and Speaker Notes

Single Payer Health Care Fraud Prevention Powerpoint.  This is the next phase in implementation of the National Health Care Act introduced by Congressman John Conyers.
A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse Powerpoint
A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse: Speaker Notes

States Cry Foul With Health Care Mandate

States Cry Foul With Health Care Mandate

Ever wanted to know why there was so much opposition to the health care reform?  Well here it is.

It's called fraud.  Yes, contained within health care reform is also regulation.  Here is a great little rant from the State of Florida.  Why are they ranting?  It is because they are not compliant.

Florida is so bad, the U.S. Department of Justice teamed up with the U.S. Department of Health and Human Resources to establish the Health Care Fraud Enforcement Task Force (H.E.A.T.)  The worst part of the levels of health care fraud in these states that are crying the unconstitutional foul is that the levels of Medicaid fraud, once the federal moritoria on the suspension of the rules are lifted, will make Medicare pail in comparison to the ugly beast called Medicaid fraud.

U.S. DHHS OIG and DOJ Health Care Fraud Prevention Enforcement Team
The lack of Medicaid and Medicare regulation in the states will substantially cut the federal funding to their programs.  In essence, coming into federally funded, mandated compliance to end Medicaid and Medicare fraud will kill jobs because these fraud scheme, racketeering operations will be shut down.Department of Justice and Department of Health and Human Services response to Senator Grassley's inquiry on...

Single Payer Health Insurance Pilot Program A Success

Single Payer Health Insurance Pilot Program A Success

This is the look of the future of health insurance.  This is it.  This is a single payer program.

Congressman John Conyers, Jr. has been promoting a Single Payer Program for health care for everyone to be eligible with his United States National Health Care Act, HR 676.  This program deals with a single payer source, not specifically a "single individual" paying into the program with tax dollars.

The single payer is a financial term referring to a single funding source.  When there is a single funding source, in the instance of the CHIRPA Medicaid programs for children and families, the ability exists to provide transparency, accountability and oversight through its counter program, and that is the single audit.

In the United States, the Single Audit, also known as the OMB A-133 audit, is a rigorous, organization-wide auditor examination of an entity that expends $500,000 or more of Federal assistance (commonly known as Federal funds, Federal grants, or Federal awards) received for its operations.^[1][2][3] Usually performed annually,^[4] the Single Audit’s objective is to provide assurance to the US federal government as to the management and use of such funds by recipients such as states, cities, universities, and non-profit organizations. The audit is typically performed by an independent certified public accountant (CPA) and encompasses both financial and compliance components. The Single Audits must be submitted to the Federal Audit Clearinghouse along with a data collection form, Form SF-SAC.

OMB Circular A-133 Compliance Supplement 2009

The Single Audit ensures there is efficiency in the delivery of services, there is continuous quality improvement of programs and services, and enforces mandatory compliance with the terms of funding source, reducing fraud, waste and abuse.

With the Electronic Health Records  incentive programs, it is only with a click of the button that these single payer programs can be reviewed through auditing programs.

Even more so, there are other codified mechanisms to ensure accountability of single payer programs such as the Sarbanes-Oxley Act.

When there are such oversight mechanisms in place, there is always an improvement in program goals.  The goals of any program is to provide care for the health of society.  Through the investment in the best interests of the child, the national society profits when the program produces a future taxpaying citizen.  The child becomes a health adult.  A healthy adult becomes part of a healthy nation.  A healthy nation lessens the drain on its economical resources.

The Medicare model of the single payer will eventually be adopted.  When it does, there will already be a plan for implementation as its pilot program is dealing with children and families.

Two Year Anniversary of Children’s Health Insurance Law Sees Millions of Newly Insured Children, Families

Two years after President Obama signed the Children’s Health Insurance Program Reauthorization Act, HHS Secretary Kathleen Sebelius today announced that more than two million more children were served by Medicaid or the Children’s Health Insurance Program (CHIP) at some point over the past year.

Together, the two programs serve more than 42 million children who would otherwise not have access to regular medical care.

“The increase in the number of children served by these two vital programs is especially significant in the face of the recent economic downturn states are experiencing,” said Secretary Sebelius. “Even in times of hardship, states have demonstrated their commitment to the health of children by continuing efforts to identify and enroll them in coverage.”

To continue to advance coverage for children, Secretary Sebelius today also announced $40 million in new grants to states, community-based organizations, school systems and others to support their outreach and enrollment activities.  The grants will help states further modernize and streamline their administrative systems, as well as create and implement school-based outreach strategies and approaches for identifying children who have historically been hard to reach.

Today’s grant announcement builds on $206 million in enrollment bonuses earned by 15 states last year that increased enrollment above specific target levels.  The bonus funds help states cover the cost of enrolling additional children in Medicaid.

“As we mark the second anniversary of one of President Obama’s first actions as President, we can be confident that CHIPRA has proven to be a tremendous success,” said Sebelius. “Now we must build on our accomplishments. Today, I am again calling on leaders across the country – from federal, state and local officials to private sector leaders – to join our effort to insure more children. We all have a stake in America’s children and together, we will ensure millions more children get the care they need.”

States were able to increase enrollment in the two programs in part because of boosts in federal support provided by the American Recovery and Reinvestment Act (ARRA).  ARRA temporarily increased federal matching funds for state Medicaid programs during the recession.

While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level in more than two decades, an estimated five million uninsured children are thought to be eligible for one of these programs, yet not covered.

The Secretary’s Challenge: Connecting Kids to Coverage, launched last year, will continue support efforts to reach more children by providing leaders with critical information and support as they work to insure more children in their communities and by closely monitoring progress. 

“States’ continued progress toward enrolling all eligible children in coverage is a significant step in cushioning the recession’s impact on access to health insurance,” said Cindy Mann, director, Center for Medicaid, State and Survey and Certification Operations, within the Centers for Medicare & Medicaid Services (CMS). “As families lose employment or have their hours cut back they may lose the health coverage benefit that came with that job.  If not for these two programs, millions more children would go without critical health care services.”

In its second annual report on CHIP and Medicaid enrollment, CMS notes that:

• More than 2 million children gained Medicaid or CHIP coverage during federal fiscal year 2010 (October 1, 2009 – September 30, 2010). In total, Medicaid and CHIP served more than 42 million children last year. This steady increase in enrollment is evidence of the important role that Medicaid and CHIP play for children, especially during economic downturns.  The uninsured rate for children continues to decline at a time with the rate for adults is climbing.  The increase in children’s enrollment demonstrates that Medicaid and CHIP are serving the purpose for which they were created – providing high quality health coverage for lower-income families.
• Thirteen states implemented eligibility expansions in 2010 and many others simplified their enrollment and renewal procedures.  Forty-six states and the District of Columbia now cover children with incomes up to 200 percent of the federal poverty level (FPL) in Medicaid and CHIP; with 24 of those states and the District of Columbia covering children with incomes up to 250 percent of the FPL.  Twenty-one states now offer coverage to lawfully residing immigrant children and/or pregnant women, enabling states to receive federal funding for this coverage.
•  CHIPRA Performance Bonuses have encouraged states to adopt and augment simplification measures in Medicaid and CHIP. Fifteen states qualified for a total of $206 million in performance bonuses for FY 2010; this is a significant increase over 2009 where 10 states received bonuses totaling $75 million. These bonuses provide additional federal financial support each year to states that successfully boost enrollment above target levels among previously eligible but uninsured children in Medicaid.  To qualify, a state not only has to enroll more children, but must also have implemented program features that are designed to promote enrollment of eligible children. 
• States are increasing their use of technology to facilitate children’s enrollment and retention.  Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications.  Six states have received approval to enroll children through the “Express Lane Eligibility” option created by CHIPRA.  Express lane eligibility allows states to use data gathered for other programs such as housing assistance or food stamps to determine Medicaid or CHIP eligibility. And 33 states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.
• Outreach and enrollment grants have advanced coverage and led to public-private partnerships throughout the country to enroll more children. Sixty-eight grantees across 41 States and the District of Columbia are working diligently to facilitate children’s enrollment in health coverage 

Children's Health Insurance Program Reauthorization Act (CHIPRA) 2010 Annual Report

The American Health Care System

Congressman John Conyers, Jr. explains the National Health Care Act, HR 676, providing health care for all.

The people who will really decide whether health-care reform succeeds or fails

By Ezra Klein

The New Yorker isn't allowing Atul Gawande's latest article out from behind the paywall, but you can read the abstract here. The basic point is well worth keeping in mind amid all the arguments over the Affordable Care Act: Health-care costs -- and thus our paychecks, and the federal budget -- won't be decided by how we deliver and structure health-care insurance. They'll be decided by how we deliver and structure health care. And though national policy has a role in that, it's not always a huge role, and it's not usually a controversial one.

Gawande relates a series of stories showing innovation in the toughest corners of the care-delivery system. The most inspiring is about Jeffrey Brenner, a Camden-based physician who began playing with his city's hospital claims data and making maps of where the money was being spent. It turned out that there were two city blocks, containing two particular buildings, where 900 people were responsible for "more than four thousand hospital visits and about two hundred million dollars in health-care bills" over the past seven years. So that's where he focused.

Insurers try to run from the costliest patients. They try to kick them out for having preexisting conditions, or they rescind their coverage, or they price coverage beyond their reach. That just makes them costlier, of course. Inconsistent access to medical care means more medical emergencies, and more medical emergencies mean higher medical costs. Brenner, by contrast, is lavishing them with attention. He's calling them daily. He's checking up on their medications, their lifestyles, their habits. He wants to open a doctor's office in their building. His patients averaged "sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after — a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after — a fifty-six-percent reduction."

We don't really know if his success can be replicated. But somebody'scan be. And that'll be where policy -- in particular, where Medicare -- comes in. The administration's vision sees things running something like this: A promising experiment or pilot program will come to the attention of the newly established Center for Medicare and Medicaid Innovation. The center will fund it on a larger scale and study it more intensely if. If it proves promising, the Independent Payment Advisory Board will force Medicare to implement it fairly quickly. And history shows that if something works in Medicare -- and, quite often, even if it doesn't -- it's soon adopted by private insurers.

That's if all goes well, of course. And all may not go well. But it's important to keep in mind that we know who costs the system money: Sick people. And we know what costs the system money: Their health care, particularly when it involves catastrophic or chronic conditions. So from a cost and quality perspective, this is where health-care reform will live and die: In doctor's offices, in community health centers, in operating rooms and in people's homes.

Insurers can play a role here, as can Medicare. But for the next few years, cost control is going to be less about setting national policy than about setting up the experiments that allow us to test what national policy should be. The Affordable Care Act's contribution to this is money, a center dedicated to bringing these experiments up to scale and a reform process that makes it easier to seed them in Medicare. But for all that to work, the component pieces need to remain in place, and some of the experiments actually need to pan out.

Photo credit: By Pat Sullivan/Associated Press