Posts

Obamacare’s Dishonor System

Photo Credit: National Review Perhaps you’ve heard the radio or TV commercials sponsored by the Department of Health and Human Services urging seniors to report instances of Medicare fraud. There’s a number to call, along with cheerful suggestions.

The intent here seems benign enough — saving taxpayer money by catching the dishonest. One might even be tempted to praise it, were it not for what the Obama administration is doing with the other hand — issuing an engraved invitation to commit fraud when signing up for the health-care exchanges.

Obamacare is proving too unwieldy even for the greediest of big-government centralizers in the Obama administration. With only months to go before their Frankenstein was set to get its jolt of electricity in January 2014, they’ve announced a series of delays. The employer mandate, whereby businesses with 50 or more employees must certify that they are providing insurance that meets government requirements, will be delayed by a year.

When you design a Rube Goldberg health-care system with a thousand moving parts — subsidies, mandates, exchanges, reporting requirements, sliding scales, and varying eligibility for Medicaid, expanded Medicaid, and so forth — it doesn’t take much to bring the whole contraption to a halt. By delaying the employer mandate, the Obama administration undercut its own complex system for calculating people’s eligibility for health exchanges. In theory, it was supposed to be based on family income, family size, the lack of employer-provided insurance, eligibility for other government programs, and more. (For further edification, consult the 600-page rule HHS issued on July 5.)

Read more from this story HERE.

Planned Parenthood Abortion Business Has Engaged in $12.5 Million in Medicaid Fraud

Photo Credit: LifeNewsThe good people at Alliance Defending Freedom have forwarded me the settlement agreement between Planned Parenthood Gulf Coast and the United States of America, the Texas Attorney General, and whistleblower Karen Reynolds, for charges that PPGC committed Medicaid fraud between 2003-2009. The settlement was signed by all parties on July 24 and 25.

As I wrote yesterday, PPGC has agreed to pay $4.3 million. According to the settlement, the money will be divied three ways:

$2,552,169 – United States
$1,247,000 – Karen Reynolds (bounty)
$500,831 – State of Texas

In addition, PPGC must pay Reynolds’ attorney fees. Reynolds was represented by the American Center for Law and Justice.

ADF attorney Casey Mattox was kind enough to walk me through the settlement agreement. Following are the high points, including a few bombshells.

Read more from this story HERE.

The Obamacare Train Wreck Continues: Now, the HHS Fraud Prevention Mandate Thrown Out (+videos)

Photo Credit: ThinkstockHHS gives up on Obamacare’s anti-fraud measures

By Philip Klein. One of the biggest administrative hurdles facing Obamacare was the ambitious plan to verify the income and insurance status of applicants for federal health coverage subsidies. In theory, on Oct. 1 of this year, a prospective beneficiary of Obamacare was supposed to be able to visit a website like Orbitz, enter basic information, and wait as multiple state and federal government databases communicated with one another to confirm in real time the applicant’s income level, and then display the level of subsidy to which the applicant was entitled, if any. It was a level of technological sophistication unlike anything ever attempted by the government. Now, with less than three months to go before Obamacare’s health insurance exchanges are set to begin enrolling applicants, Obama’s Department of Health and Human Services is throwing up its hands. Just as it did with the employer mandate, the administration has announced it would delay the implementation of these anti-fraud procedures due to the administrative difficulty.

In a regulation released Friday and flagged by Washington Post reporters Sarah Kliff and Sandhya Somashekhar, the administration will now rely on self-reported data. You read that correctly. A man who earns $50,000 per year and gets insurance through his employer could log on to the new government website and say he earns $20,000 and gets no insurance through his employer, and the government would not even attempt to confirm that the information is accurate before forking over generous taxpayer subsidies. It’s a recipe for rampant fraud, which is already widespread in Medicare and Medicaid.

Read more from this story HERE.

_______________________________________________________________________

Photo Credit: Washington Examiner Obamacare was simply bad legislating

By Timothy P. Carney. President Obama’s signature legislative achievement was simply a bad bit of legislating. The administration’s decision to postpone the employer health insurance mandate is just the latest evidence that this law was poorly built.

An analogy: You may think Frank Lloyd Wright’s buildings are beautiful or ugly. But that’s a matter of taste, and it’s a different question from whether they are built soundly.

Analogously, you may share Obama’s views of government or reject it, but that’s a separate issue from whether this law was well made. With Obamacare, the architects used nails where screws were needed, and the angles aren’t quite right. This structure can’t bear its own weight.

The employer mandate was always a bad idea, and not only from the perspective of economic liberty. Liberal health-care wonks knew that the employer-based health-insurance system was a big part of our problem. If people get their insurance from work, then they lose their insurance when they switch jobs, exacerbating the problem that insurers typically don’t cover preexisting conditions. Also, when the HR director is doing the insurance shopping for all employees, insurers don’t face real competitive pressure.

Read more from this story HERE.

_______________________________________________________________________

Photo Credit: TownhallWhat the Employer Mandate Delay Says About Obamacare’s Dysfunction

By Kevin Glass. The Obama Administration’s decision to delay implementation of one of Obamacare’s big regulations – the employer mandate – led to some progressives actually cheering. “Delaying Obamacare’s employer mandate is the right thing to do. Frankly, eliminating it — or at least utterly overhauling it — is probably the right thing to do,” wrote the Washington Post’s Ezra Klein. “In my view, the Administration should have gone further than delaying the employer mandate. They should have also proposed a bill to remove it entirely,” writes economist Austin Frakt. Talking Points Memo’s Brian Beutler writes, “I think you can make a decent case that the administration is actually doubling down on the most crucial and politically high-valence part of the law.”

These have come along with typical blame-Republicans condemnations. If the employer mandate is so bad, why wouldn’t Congressional Republicans just team up with Democrats to repeal it entirely, for example?

These critics are largely missing the point.

President Obama promised perfection when it came to the Affordable Care Act. More insurance coverage, better health outcomes, cheaper premiums, and you can keep your health care plan. That last one was particularly key when it came to selling the whole package. “If you like your health care plan, you can keep it” was repeated time and again in the President’s PR campaign for the health legislation. Read more from this story HERE.

Feds Charge 89 People, Including Doctors, Nurses, with Millions in Medicare Fraud

Photo Credit: J. Scott Applewhite / APIn a major crackdown on healthcare fraud across the country, 89 people, including 14 doctors and nurses, were charged for their roles in various Medicare scams that bilked taxpayers of some $223 million through bogus charges, federal officials said Tuesday.

Some people allegedly posed as doctors and wrote bogus prescriptions for drugs and psychotherapy therapy and then billed the government $12 million.

Others are accused of bribing Medicare patients for their ID numbers, then using those numbers to bill $20 million in home health care never performed or not medically necessary.

The lead suspect in that case used the money to buy luxury cars, including two Lamborghinis and a Ferrari, officials said.

About 400 federal agents were involved in Tuesday’s arrests, raiding businesses, seizing documents and charging suspects in Miami, Los Angeles, Houston, New York City, Detroit, Chicago, Tampa, Fla., and Baton Rouge, La.

Read more from this story HERE.

Surprise! Audit Uncovers Rampant Fraud in Fed Program

photo credit: yomanimus

A federal audit of one part of the Medicaid system has uncovered hundreds of millions of dollars in suspected fraud, including payments to caregivers to provide home-care services to the disabled even when they are hospitalized or in nursing homes.

“It would seem inconceivable – even for today’s bloated government – if it wasn’t laid out in a report … by the offending agency’s inspector general,” noted Judicial Watch, which reported on the systemic failure.

Judicial Watch said the issue centers on personal care services provided by the federal and state-funded health insurance Medicaid, which have been provided to the disabled since the Supreme Court ruled in the 1990s that such care is a civil right.

“The idea is to allow the sick, disabled and those with chronic or temporary conditions [to] stay home and, in turn, avoid sticking Uncle Sam with a hefty hospitalization bill,” Judicial Watch said.

“Instead, Medicaid’s personal care services program is rife with corruption that was first exposed more than five years ago and continues to be documented annually by the agency’s watchdog. The budget has ballooned to more than $12 billion a year, just to send what amounts to a nanny to provide supportive ‘nonmedical services’ like meal preparation, housework, help with bathing and getting dressed, transportation and even money management.”

Read more from this story HERE.

Planned Parenthood Hit With Massive Fraud Suit, Alleging Medicaid Overbilling, Substandard Medical Practices

A former Planned Parenthood abortion clinic manager has filed a lawsuit against the nation’s biggest abortion business accusing it of engaging in massive fraudulent activities. The lawsuit follows a new investigation of Planned Parenthood in Illinois and Planned Parenthood abortion companies in other states having been found to have engaged in overbilling and Medicaid fraud.

Planned Parenthood clinic director Sue Thayer filed the lawsuit against the abortion giant’s Iowa affiliate accusing it of submitting “repeated false, fraudulent, and/or ineligible claims for reimbursements” to Medicaid and failing to meet acceptable standards of medical practice. Alliance Defending Freedom (formerly the Alliance Defense Fund) filed the suit for Thayer in March 2011, but it only became public yesterday.

“Americans deserve to know if their hard-earned tax money is being funneled to groups that are misusing it,” said Senior Counsel Michael Norton, a former United States Attorney who is handling the lawsuit for ADF. “People may hold different views about abortion, but everyone can agree that Planned Parenthood should play by the same rules as everyone else. It certainly isn’t entitled to any public funds, especially if it is defrauding Medicaid and the American taxpayer.”

Alliance Defending Freedom attorneys filed the suit under a federal law that allows “whistleblowers” with inside information to expose fraudulent billing by government contractors. By law, such cases may not be made public until a court unseals them. In March, a federal court unsealed a similar Alliance Defending Freedom lawsuit against a Texas Planned Parenthood affiliate.

“During my last years working at Planned Parenthood, it became increasingly clear to me that not all of their policies and protocols were completely legal and ethical. After much thought, I contacted the Alliance Defending Freedom,” Thayer said about the lawsuit. “I believe that it is an important piece in the nationwide effort to shed light on the darkness and deception surrounding America’s largest abortion provider – Planned Parenthood.”

Read more from this story HERE.

Photo credit: stevendamron