Jim sent this in:

On Sunday night, the popular news show 60 Minutes aired a disturbing segment on corruption within government health care programs that already exist — Medicare and Medicaid. The importance of this newsworthy event is that finally a major news organization was asking the right questions regarding the current epidemic of fraud and abuse within the government health care bureaucracy which is a preview of what can be expected once the federal government takes control of Americans’ overall health care.

With the Obama Administration and Democrat leaders in both houses of the US Congress desperately pushing a major overhaul — many say government takeover — of US health care, a report obtained by the National Association of Chiefs of Police’s Fraud & White Collar Crime Committee sheds light on the fraud and corruption already existing in government medical programs. And one can only imagine the amount of corruption that will occur with total government control of the medicine,

On April 22, 2009, Government Accountability Office officials testified before an ad-hoc Congressional subcommittee at a hearing entitled, “Eliminating Waste and Fraud in Medicare and Medicaid.”

In a subsequent letter responding to a May 29, 2009 request for responses to questions for the record related to the April 22, 2009, testimony, the GAO responded to the following questions:  What do you see as the biggest challenge for Centers for Medicare/Medicaid Services (CMS) to provide an estimate for improper payments under Medicare Part D? Has GAO identified any problems with the current process for reviewing and paying Medicare claims that would make the program more vulnerable to fraudulent claims?  Is there any reason the US federal agency which administers Medicare, Medicaid, and the Children’s Health Insurance Program cannot include penalties in its Medicare Administrative Contractor contracts for paying improper or fraudulent claims that they are aware of?

With total outlays of about $46 billion in fiscal year 2008, Medicare Part D is the last significant part of Medicare for which the department has yet to develop an estimate of improper payments. In developing its estimate, it will be important for CMS to determine where the vulnerabilities and risks exist in the Medicare Part D structure and operations that could impact CMS’s ability to effectively detect, measure, and ultimately reduce improper payments.

In HHS’s fiscal year 2008 AFR, the department reported that it had calculated payment error rates for two components of Medicare Part D but also that its measurement was not fully implemented. Also, it will be important to consider Health and Human Services’ Office of Inspector General identified concerns about CMS’s implementation of internal controls to ensure payment accuracy as well as inadequate analysis of claims data.  

The GAO investigation identified several weaknesses with the current process for reviewing Medicare claims. Limitations in the number of medical reviews conducted leave the home health benefit — within the Medicare program — vulnerable to improper payments, including payments resulting from fraud and abuse.

In previous studies, the GAO reported in February 2009 that in fiscal year 2007, only 0.5 percent of the more than 8.7 million home health agency (HHA) claims processed were subjected to prepayment review by Medicare’s contractors.

The contractors focused primarily on claims submitted by HHAs whose billing patterns differed from their peers on measures such as cost per episode. Of those claims that were reviewed, over 40 percent were denied in whole or in part. There are also weaknesses with respect to selecting claims to review in Medicare Fee-for-Service.

In addition to the weaknesses with the current Medicare claims review process, analysts found that failure to effectively screen health providers before granting them billing privileges also increases the program’s vulnerability to fraudulent claims.

Consistent with the Social Security Act and applicable federal procurement regulations, CMS may include provisions in Medicare Administrative Contractor (MAC) contracts to:  prescribe the costs incurred by MACs in processing and paying Medicare claims that CMS may reimburse;  provide incentives or disincentives related to payment accuracy; and hold MACs and their employees liable for improper or fraudulent claims payments under limited circumstances.

Otherwise, neither the Social Security Act nor applicable federal procurement regulations expressly provides for CMS to reduce amounts owed to MACs under their contracts or to assess charges against MACs for improper or fraudulent claims payments.

Opponents of the plan currently considered by the US Congress — commonly known as ObamaCare — believe that if the US government succeeds in taking control of the health care industry, losses due to fraud and abuse will drastically increase.

Jim sent this in:

Last week, millions of Americans watched President Barack Obama continue to sell his national health care plan on news shows, talk shows and even the David Letterman Show.  Reporters during televised question and answer portions of Obama’s performances attempted to appear unbiased, but their tone and demeanor is a marked difference from the attack approach they use on conservative politicians. And not one reporter asked about the potential for fraud and corruption in such a huge financial endeavor as providing health care for Americans.

When President Obama stated that cutting Medicare and Medicaid fraud and waste would help to fund what’s become known as ObamaCare, that statement begged the questions: “Mr. President, why hasn’t the US government already cracked down on fraud and abuse in programs that are being looted by thieves and liars? Why wait, Mr. President?”

With the Obama Administration and Democrat leaders in both houses of the US Congress desperately pushing a major overhaul — many say government takeover — of US health care, a report obtained by the National Association of Chiefs of Police’s Fraud & White Collar Crime Committee sheds light on the fraud and corruption already existing in government medical programs. And one can only imagine the amount of corruption that will occur with total government control of the medicine,

On April 22, 2009, Government Accountability Office officials testified before an ad-hoc Congressional subcommittee at a hearing entitled, “Eliminating Waste and Fraud in Medicare and Medicaid.”

In a subsequent letter responding to a May 29, 2009 request for responses to questions for the record related to the April 22, 2009, testimony, the GAO responded to the following questions:  What do you see as the biggest challenge for Centers for Medicare/Medicaid Services (CMS) to provide an estimate for improper payments under Medicare Part D? Has GAO identified any problems with the current process for reviewing and paying Medicare claims that would make the program more vulnerable to fraudulent claims?  Is there any reason the US federal agency which administers Medicare, Medicaid, and the Children’s Health Insurance Program cannot include penalties in its Medicare Administrative Contractor contracts for paying improper or fraudulent claims that they are aware of?

With total outlays of about $46 billion in fiscal year 2008, Medicare Part D is the last significant part of Medicare for which the department has yet to develop an estimate of improper payments. In developing its estimate, it will be important for CMS to determine where the vulnerabilities and risks exist in the Medicare Part D structure and operations that could impact CMS’s ability to effectively detect, measure, and ultimately reduce improper payments.

In HHS’s fiscal year 2008 AFR, the department reported that it had calculated payment error rates for two components of Medicare Part D but also that its measurement was not fully implemented. Also, it will be important to consider Health and Human Services’ Office of Inspector General identified concerns about CMS’s implementation of internal controls to ensure payment accuracy as well as inadequate analysis of claims data.  

The GAO investigation identified several weaknesses with the current process for reviewing Medicare claims. Limitations in the number of medical reviews conducted leave the home health benefit — within the Medicare program — vulnerable to improper payments, including payments resulting from fraud and abuse.

In previous studies, the GAO reported in February 2009 that in fiscal year 2007, only 0.5 percent of the more than 8.7 million home health agency (HHA) claims processed were subjected to prepayment review by Medicare’s contractors.

The contractors focused primarily on claims submitted by HHAs whose billing patterns differed from their peers on measures such as cost per episode. Of those claims that were reviewed, over 40 percent were denied in whole or in part. There are also weaknesses with respect to selecting claims to review in Medicare Fee-for-Service.

In addition to the weaknesses with the current Medicare claims review process, analysts found that failure to effectively screen health providers before granting them billing privileges also increases the program’s vulnerability to fraudulent claims.

Consistent with the Social Security Act and applicable federal procurement regulations, CMS may include provisions in Medicare Administrative Contractor (MAC) contracts to:  prescribe the costs incurred by MACs in processing and paying Medicare claims that CMS may reimburse;  provide incentives or disincentives related to payment accuracy; and hold MACs and their employees liable for improper or fraudulent claims payments under limited circumstances.

Otherwise, neither the Social Security Act nor applicable federal procurement regulations expressly provides for CMS to reduce amounts owed to MACs under their contracts or to assess charges against MACs for improper or fraudulent claims payments.

Opponents of the plan currently considered by the US Congress — commonly known as ObamaCare — believe that if the US government succeeds in taking control of the health care industry, losses due to fraud and abuse will drastically increase.

The lobbyists up in Washington continue to do what they do best – buying influence in a myriad of ways – donations to politicians’ campaigns, secret meetings and in the rare instance – bribes.  Nonetheless, their presence is felt, yet they may possibly have a challenge on their hands as President Obama marches ahead in his quest to craft health care into his vision. 

What Obama has in mind is to squeeze Medicare and Medicaid spending in order to help create a 10-year, $634 billion – that’s billion with a B – fund best described as a down payment on his quest of providing health insurance to everyone.  He intends to use $316 billion in savings from these entitlement programs; some of the savings would come in the form of scaling back payments to private insurance plans that serve older Americans.

The Republicans are opposed to the plan, as they very well should be.  Folks, what Obama has in mind is very simple – this so-called “health care reform” is just another fancy name for health coverage that is all the rage in Canada and most of Europe.  And it is called “universal health care”.  And I, for one, do not want to pay for it.  Do you?

The state of Georgia got its first installment of its federal stimulus money on Wednesday in the form of $340 million for Medicaid relief.  But Governor Sonny Perdue, fresh from a D.C. meeting of the nation’s governors, handed over his wish list to his state agency heads Wednesday afternoon.

Georgia is eligible to receive anywhere between $6-15 billion in federal stimulus money, and here’s what you can expect the state to get and what for:

• $340 million for state Medicaid relief.
• Over $1 billion for roads, bridges and other transportation improvements – infrastructure, if you will.
• $750 million for education.
• $980 million for energy improvements to public buildings.

The list gets bigger, but that’s what I have access to.  But Perdue is reluctant to accept $220 million in federal money because it could require the state of Georgia to raise unemployment taxes in the future.  Folks, you can add Perdue to the growing list of Republicans who approved the stimulus package as he said he wasn’t philosophically opposed to it; he further added that he wants to make sure the money is spent wisely.  He also told agency heads that if they get stimulus funds to make sure the money goes towards approved projects only.

The state of California, like the vast majority of states, is getting a chunk of the federal stimulus money.  They also got their budget signed Friday.  so what does all of this mean to Californians?  Lots.  Officials in the state have said that they will act quickly to secure federal money for road projects that have been delayed by Caltrans and for schools – preventing some layoffs and program cuts.

In April, the state will incorporate a 1-cent increase in the state sales tax and the vehicle license fee increase in May; presumably by that time, 2.4 unemployed California residents will be receiving higher unemployment benefits while 2 million residents will be eligible for more food stamp assistance.

The Feds also have allocated $11 billion to help Californians keep health coverage under Medicaid – also known here in California as Medi-Cal – which benefits the state budget.  In addition, 12 million state taxpayers will be eligible for $400 tax credit ($800 for couples) while 4 million middle-income taxpayers will not be subject to the alternative  minimum tax – which was designed to ensure that wealthy individuals pay some taxes.

You can expect the 0.25% increase in the state personal income taxes to be reduced as federal stimulus money flows into the state.  What effects – good and bad – can the state realize as a result of the federal money coming in?  If what comes from Governor Schwarzenegger’s office is any help to you, California should benefit.  The stimulus bill is expected – like anything else, this is more a projection – to possibly give an $80 billion boost to the state in tax relief, expenditures and “investment”.

The governor’s staff also estimates that the state is eligible for $45 billion in spending for education, health care, infrastructure and increased benefits.  Speaking of infrastructure, $5 billion is the impact expected to be felt as spending will be limited to roads, bridges and mass transit.  Caltrans has 6 months to allocate one-half of the money and one year to allocate all of it, otherwise, the money not spent if forfeited – presumably to other states.

A rough estimate out there is that about $609 million will go to the urban areas of the state for infrastructure, with about $108 million going to the San Jose and San Francisco-Oakland metropolitan areas.  Now let’s go to the inside skinny on school spending.

The state budget, in its current state, provides for $8.4 billion in cuts for schools and community colleges – which means probable layoffs and reduced class sizes.  Under the stimulus plan, California is expected to receive roughly $4.8 billion, designed to be used for schools and other services – along with $1.5 billion for poorer school districts and $1.2 billion for special education; the governor also will have $1 billion set aside for what is described as a “flexible block grant” that he can spend on education.

What would the impact be after the federal money starts flowing into the state?  Really tough to say right now, but I suspect there may be indicators later on this year.  Personally, I was never in favor of the federal stimulus package from Day 1; however, we’re stuck with it, for better or for worse.  One thing is for certain – President Obama’s presidency is riding on this f

The so-called economic stimulus bill, crafted by the firm of Pelosi, Reid and Frank, is getting closer to a signature by President Obama as the House today passed the final version of the $787 billion economic stimulus plan, which was designed to provide a boost to the U.S. economy.  To no one’s surprise, the bill passed along party lines, with the vote count being 246-183 with no Republicans voting for the bill; believe it or not, 3 Republicans went redcoat and supported the bill – Susan Collins and Olympia Snowe of Maine and Arlen Specter of Pennsylvania.

The measure in and of itself is 1,071 pages and 8 inches thick and was posted at a congessional website on Thursday, giving legislators little time to read the entire bill.  Want to bet that the Democrats didn’t exactly rush to their PC’s to comb through the bill?  The plan includes roughly $281 billion in tax cuts along with $308 billion in outlays that are funded by the appropriations committees and about $198 billion in benefit programs, such as unemployment assistance, one-time $250 payments to millions of people currently receiving Social Security benefits and extra money to states to help with the Medicaid health program for the poor and disabled.

Add to the bill Obama’s “Making Work Pay” tax cut; it went from a $500 break for most workers to $400, with couples receiving $800 instead of $1,000.  And of course, plenty of pork – of which had been previously posted here at The Temple.  It still bugs me to no end that none of us got the chance to see the bill in its entirety so we can see for ourselves where our money is going.  This is just about the closest thing to public thievery that is out there right now.