Health care proposal mandates coverage, drops public option

[Jiro]

Healthcare Timeline

 

[Jiro]

Bad Medicine and Out-of-Control Health-Care Fraud

Have you heard about the zombie doctors? No, it's not a horror movie, but they're scary all the same. Last year, a Senate report revealed that in the previous seven years, the federal Medicare program had paid as much as $92.8 million for about a half-million claims submitted in the names of doctors who were six feet under. The charges were for medical supplies, ranging from wheelchairs to prescription drugs. One pair of scam artists in Florida used the Medicare identification numbers of dead docs to bilk $1.3 million from the government—also known as we the taxpayers.

It's not like this was a hard crime to spot. More than 50,000 of the bogus claims involved doctors who had been deceased for at least ten years. Despite a warning from the Department of Health & Human Services (HHS) in 2001 about exactly this problem, tough safeguards were never put in place.
Here's another good one: the podiatrist who allegedly billed the government for treating people with no feet. Dr. David Quang Pham was indicted in St. Louis this past June for charging the government for nonexistent procedures that he backed up with phony notes (Pham has pleaded not guilty). As an unforgettable press release from the local U.S. Attorney's office put it, "Dr. Pham submitted reimbursement claims for treating the feet of patients whose feet had been amputated prior to the dates of service." And once again, it was the taxpayer who had to, er, foot the bill.

Unfortunately, the bigger issue here is no joke. Prosecutors across the country are scrambling to keep up with an epidemic of fraud and abuse?in our public health-care system. As President Obama seeks to reform health care, honest people can disagree about the best approach. But there's no disputing one important truth: Shocking amounts of money are stolen by crooked doctors and scammers, and that's driving up costs for all of us. The National Health Care Anti-Fraud Association estimates that more than $60 billion a year is lost to fraud—or 3 percent of federal health-care spending. Think of how all that money could improve, extend, or outright save lives.

Sadly, though, the shameless scammers are only getting more audacious. Take the case of Michael De Jesus Huarte. Huarte?and his co-conspirators set up 14 health-care clinics to treat illnesses like cancer and AIDS and billed the government for $70 million in Medicare and Medicaid reimbursements. But those clinics had no real patients. Working with seven associates, prosecutors alleged in June, Huarte paid people for their personal information, which he then entered into government forms. Two of his clinics, in greater New Orleans, were empty storefronts with handwritten business signs. Says acting U.S. Attorney for South Florida Jeffrey Sloman, the case has "taken health-care fraud to a new level. The breadth and scope of the scheme is different from what we've ever seen before."

Last year, Alex Acosta, then the U.S. Attorney for South Florida, had his agents inspect 1,581 medical equipment companies. "We had really tough standards," he says. "Are they open? Do they have a telephone? Four hundred and ninety-one of them failed." The companies, all told, had billed Medicare for $97 million. In another case, agents found that a "pharmacy" supposedly selling nebulizers for asthmatics was actually a broom closet. The "pharmacist" was an air-conditioning repairman, Acosta says.

But worse than con artists posing as medical professionals are the doctors who put their patients through unnecessary procedures for a little extra cash. In?Michigan, dermatologist Robert Stokes routinely removed minor skin blemishes he claimed were cancerous, terrifying his patients and jacking up his reimbursements from Medicare and Blue Cross of Michigan. Stokes is now serving a ten-and-a-half-year prison term. In Oregon, doctor Randall Smith billed insurers for a bogus procedure he performed on a patient to relieve her pelvic pain: massaging her "trigger points," which soon led to intercourse. That earned him just two months in prison. In September 2005, Pennsylvania dentist Alireza Asgari pleaded guilty to performing unnecessary root canals on his patients, including four on one woman who didn't need them.

The Justice Department and HHS have finally stepped up efforts to crack down on such abuse. Since last October, they've won 300 convictions and recovered nearly $1 billion. But most watchdogs agree that's just a start.?More funding and investigators are needed.

New laws and regulations are needed too. In January 2007, Medicare shut down 18 medical equipment suppliers in Florida after investigators discovered they were phony. But the companies were reinstated on appeal—only to be indicted several months later, after they had been paid another $5 million in taxpayer money. Loopholes that allow quick reinstatements—often after just a sworn statement from owners—must be closed.

With health-care reform at center stage, it's a perfect opportunity to take action. But the government has dropped the ball before. In the 16 years that his group has been around, says Dennis Jay, executive director of the Coalition Against Insurance Fraud, fraud prevention has gone from "abominably bad" to "very weak." He adds, "It still has a long, long way to go for taxpayers to feel comfortable that their dollars are being well spent." True change may take some time. But here's one small step Washington could take right away to restore some confidence:?Make sure that doctors collecting our dollars still have a pulse.

Do More

*
Blow the whistle. The feds have set up a website where you can report Medicare and Medicaid fraud: stopmedicarefraud.gov.
*
Show your support. A few U.S. senators are focusing on health-care fraud, including Republicans Mel Martinez of Florida and John Cornyn of Texas, who have proposed a Seniors and Taxpayers Obligation Protection (STOP) act to implement new fraud-prevention practices. Call Martinez at 202-224-3401 and Cornyn at 202-224-2934 and tell them to keep fighting.
*
Learn more. The National Health Care Anti-Fraud Association and the Coalition Against Insurance Fraud (check out its Hall of Shame) keep close tabs on fraud cases and what the authorities are doing about them.


Michael Crowley is a senior editor at the New Republic.

Outraged? Tell Michael Crowley about it.
Comments :
By Richard Lewis, 09/17/2009, 5:39 PM EDT

Just another example of scare tactics by a right wing conservative. Don't get me wrong, I'm not saying that we shouldn't do everything we can to stop fraud but how about writing an article about how the Health Insurance companies are bleeding this country dry. If we could all get our money back from their profits we could afford to fund National Heath Care for all. Talk about fraud, when they take your money and then deny you service that's the ultimate fraud. Get real would you!
By Christopher Gregory, 09/17/2009, 4:20 PM EDT

Ask yourself this question. If the federal government, in the form of the pitiful oversight by the SEC, let a crook like Madoff steal billions - what can we expect from government oversight of health care thieves?

 

[Jiro]

Really?

Can you please tell me which is cheaper - Paying for premium OR a few increase taxes for healthcare coverage?

Massachusetts mandated the residents to purchase health insurance. If I'm correct - the penalty for not having insurance in MA is about $900. You know what's funny? it's actually cheaper to pay the fee than to pay for the insurance. There are people who actually pay the penalty than spend more for the mandated coverage.

Messed up, huh? Of course I would like to see most of us to have health insurance but if we can't afford to purchase it... forcing us to get it and charging us fines for not getting it put us in a really tight spot. I don't see how mandating people to purchase health insurance is really doing anything to help the problem

so please, Liebling... do not fool yourself that a "few increase" tax is WOW CHEAP!!!! It's not just a "few bucks" more.

 

[jillio]

Systemic is an adjective meaning "affecting the body generally". When I talk about how something affects a system, it goes without saying that I'm talking about the whole, not the individual. Or at least it should.

Systemic is an adjective meaning affecting anything on a system wide level.

 

[jillio]

yea thank you for smacking me up after i had a narrow minded on something else. Now i see the clear picture that the job and familys service can get medicaid only if they make so low incomes. Thanks foxrac. :Oops: and thanks jillo too.

YW, Frisky!

 

[Foxrac]

If they are happy then is good for them but the problem is what they do if they are out of job?



Yes, I am with you on this.

My son went to dermatologist twice a week to have acne treatment on his forehead and back. We went there for skin cancer check-up.
My healthcare cover 100% .

If you lose job so you could qualify for medicaid but depends on income, along with unemployment benefit.

 

[Foxrac]

Many employees receive restricted coverage from their employers.

Many employers cannot afford to buy coverage due high premuime.

Yes, some employees are lucky to have generous healthcare coverage from their good employer BUT.... what employees do if they are on pension or out of work?... The generous healthcare, they received from their employers is not same as medicare when they are on pension.

And accord Obama´s speech last week, 14,000 people lost their healthcare coverage a day. I check Politifact on this... MOST TRUE.

Have you read Netrox´s link?


And other link


NCHC | Facts About Healthcare - Health Insurance Costs

My parent is middle class and my mother has excellent health insurance program, only pay around $200 per month for family so it's for premium insurance.

It's depends on job, they have great or bad benefits.

If you work at military service so your job will be stable and you would have great benefits under government.

 

[somedeafdudefromPNW]

and you too (but not me cuz I've already done my homework)

I feel sorry for you.

They have money.

Fidel Castro is not only one who went other country to have his surgery done.

Some politicians went other country to have their surgery done than trust their own country.

Some Americans went Cuba and Mexico to have their medical treatment, too. They are happy.

It´s not my responsible that you don´t want to see it.

Called "medical tourism." It happens. People go to Canada to bypass getting prescribed medicine. People go to China and India for organ transplants. People to go Israel for in-virto fertilization. People go to Mexico for plastic surgery.

However you're missing the big picture. While the media focuses on Americans travelling to other countries to get the above treatments: there are just as many people travelling to the United States to get in-patient treatments as there are Americans going out of the States.

Every country has its strengths and weaknesses, but a lot of that is based on how the healthcare is regulated:

1. In Cuba and Mexico, there is almost no regulation on plastic surgery.
2. In India and China, there is almost no regulation on the organ markets.
3. Canadian government helps offset the cost of medications.
4. American doctors give their patients individualistic attention.

However we are talking about foreigners, not domestic. So, why bring in medical tourism into the dabate in the FIRST place?

 

[Jiro]

Called "medical tourism." It happens. People go to Canada to bypass getting prescribed medicine. People go to China and India for organ transplants. People to go Israel for in-virto fertilization. People go to Mexico for plastic surgery.

However you're missing the big picture. While the media focuses on Americans travelling to other countries to get the above treatments: there are just as many people travelling to the United States to get in-patient treatments as there are Americans going out of the States.

Every country has its strengths and weaknesses, but a lot of that is based on how the healthcare is regulated:

1. In Cuba and Mexico, there is almost no regulation on plastic surgery.
2. In India and China, there is almost no regulation on the organ markets.
3. Canadian government helps offset the cost of medications.
4. American doctors give their patients individualistic attention.

However we are talking about foreigners, not domestic. So, why bring in medical tourism into the dabate in the FIRST place?

because as you said - every country has its strengths and weaknesses. Liebling's not seeing the strength in here.

 

[somedeafdudefromPNW]

because as you said - every country has its strengths and weaknesses. Liebling's not seeing the strength in here.

I just don't understand why Liebling chose to use medical tourism in the debate without knowing why people travel. The health reform is just to address the domestic affairs of Americans.

Someone who is travelling to another country to take advantage of a country's healthcare system is not a sign that something is wrong. It just... easier to bypass your own country's regulations by going to another country.

The medical tourism debate still doesn't address the uninsured or the rocketing premiums.

 

[Liebling:-)))]

Souggy, excuse me... I know what I am saying but unfortunlately you misinterpreted my post because Jiro twist my posts.

Jiro,

No, it´s not just Sicko... Many Americans seek to Cuba illegal to have their surgery done before Michael Moore made his document "Sicko" in 2007.

Michael Moore have the reason to document healthcare system because 9/11 volunteers were being denied by US government and other people were also denied by their own insurance company to have their surgery done... Michael Moore took them to Cuba to have their medical treatment. It shows that Cuba healthcare system do not deny them.

Bragging? Huh? I only share the positive of people´s own experiences to have their treatment at other country. I´m sorry that you don´t like it.

Educate yourself, Jiro...

Souggy, you really don´t know what you are talking about.

I never say anything about medical tourism in first place. I would suggest you to re-read Jiro´s post more carefully. He is the one who brought up over Cuba healthcare system... etc.

Don´t you know that 80% Canadians don´t want to have US healthcare system? I posted that link at other thread last month.

Some Canadians positive their country´s healthcare. check from my post # 96 before canadians posts came to rebutt American ADer´s negative post over Canada´s healthcare system.

http://www.alldeaf.com/topic-debates/56937-universal-health-care-4.html

http://www.alldeaf.com/war-political-news/46824-us-isnt-ready-free-medical-like-canada.html

Don´t you know that many Americans went Canada to have their surgery, medical treatment done?

 

[Liebling:-)))]

because as you said - every country has its strengths and weaknesses. Liebling's not seeing the strength in here.

No, I only remind you that Fidel is not only one who decide to have their surgery done at other country than his own country because you started to bring up over Fidel Castro and Cuba healthcare system.

Americans went other country to have their surgery/medical treatment done. They went Europe countries to have their surgery/medical treatment done than their own country. It´s their decision and money. If Fidel choose to have his surgery done then is his decision the same as Canadians choose to go US to have their surgery done is their decision.

 

[Jiro]

No, I only remind you that Fidel is not only one who decide to have their surgery done at other country than his own country because you started to bring up over Fidel Castro and Cuba healthcare system.

Americans went other country to have their surgery/medical treatment done. They went Europe countries to have their surgery/medical treatment done than their own country. It´s their decision and money. If Fidel choose to have his surgery done then is his decision the same as Canadians choose to go US to have their surgery done is their decision.

if the leader of his OWN country doesn't even trust his OWN COUNTRY'S surgeon and hospital for his health, that is BAD! VERY bad! Bill Clinton, Dick Cheney, and just about every Presidents have their surgeries done in America by American doctors at American hospitals, not Canada or Cuba or Mexico or Germany or UK. the American citizens have SAME access to healthcare that the American Presidents received but the Cuban citizens do not. They do not get their surgery done by Spanish top surgeon that Fidel Castro had and the Cubans do not have same access to healthcare as Castro.

Do you understand the implication of Fidel's action or not?

 

[Jiro]

Souggy, excuse me... I know what I am saying but unfortunlately you misinterpreted my post because Jiro twist my posts.

Jiro,

No, it´s not just Sicko... Many Americans seek to Cuba illegal to have their surgery done before Michael Sicko made his document "Sicko" in 2007.

Michael Moore have the reason to document healthcare system because 911 volunteers were being denied by US government and other people were also denied by their own insurance company to have their surgery done... Michael Moore took them to Cuba to have their medical treatment. It shows that Cuba healthcare system do not deny them.

Bragging? Huh? I only share the positive of people´s own experiences to have their treatment at other country. I´m sorry that you don´t like it.

Educate yourself, Jiro...

Souggy, you really don´t know what you are talking about.

I never say anything about medical tourism in first place. I would suggest you to re-read Jiro´s post more carefully. He is the one who brought up over Cuba healthcare system... etc.

Don´t you know that 80% Canadians don´t want to have US healthcare system? I posted that link at other thread.

Some Canadians positive their country´s healthcare. check my post 96 before canadians posts came.

http://www.alldeaf.com/topic-debates/56937-universal-health-care-4.html

http://www.alldeaf.com/war-political-news/46824-us-isnt-ready-free-medical-like-canada.html

Don´t you know that many Americans went Canada to have their surgery, medical treatment done?

You just proved my point in post #16 - "It is evident that you're never going to understand our reasons anyway."

Your post is unsubstantiated, baseless, and misleading.

 

[Liebling:-)))]

You just proved my point in post #16 - "It is evident that you're never going to understand our reasons anyway."

Your post is unsubstantiated, baseless, and misleading.

Okay,

You can say what you want..

I can see from your post that you are misinformed by your own country...

I feel sorry for you...

 

[somedeafdudefromPNW]

Don´t you know that 80% Canadians don´t want to have US healthcare system? I posted that link at other thread. Some Canadians positive their country´s healthcare.

I don't want the U.S. health-care system either. However like I said-- I can understand why Americans are resistant to it. We went through the same thing forty years ago! We had the same reaction to the healthcare reform in the 1960s until 1980s. I even explained why Canadians finally accepted the reform as part of their lifestyle.

I just don't like seeing my health-care system being compared to another country because they have no understanding how they work-- even the British don't really understand it. Like I said-- I like the Canadian health-care system when I don't have a lot of money put aside. I may get frustrated with the wait-time, but it's a nice safety net for me. If I have to pay $54 a month so I won't have to worry about finding a job with insurance... that's awesome.

Souggy, excuse me... I know what I am saying but unfortunlately you misinterpreted my post because Jiro twist my posts.

He didn't twist it, you just failed to shut down his points by NOT saying that medical tourism shouldn't be part of the debate. I realize that Jiro was the one that brought up Fidel Castro, but really instead of counter-arguing about medical tourism (aka Americans going to Cuba and Mexico), you should had shut down that it's irrelevant to the domestic affairs since he was going into international waters (so to speak) of the debate.

Don´t you know that many Americans went Canada to have their surgery, medical treatment done?

Yes, and I know why. Still got nothing to do with the reform.

 

[Jiro]

Doctors’ Group Opposes Public Insurance Plan

WASHINGTON — As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.

The opposition, which comes as Mr. Obama prepares to address the powerful doctors’ group on Monday in Chicago, could be a major hurdle for advocates of a public insurance plan. The A.M.A., with about 250,000 members, is America’s largest physician organization.

While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.

In the presidential campaign last year and in a letter to Congress last week, Mr. Obama called for a new “public health insurance option,” which he said would compete with private insurers and keep them honest.

Speaker Nancy Pelosi of California said Wednesday that she supported that goal. “A bill will not come out of the House without a public option,” she said Wednesday on MSNBC.

But in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

While not the political behemoth it once was, the association probably has more influence than any other group in the health care industry. Lawmakers seek its opinion and support whenever possible. It has repeatedly persuaded Congress to cancel or postpone cuts in Medicare payments to doctors, though it has not secured a “permanent fix.”

If the doctors are too aggressive in fighting the public plan, they risk alienating Democrats whose support they need for legislation to increase their Medicare fees.

The group has historically had a strong lobbying operation, supplemented by generous campaign donations. Since the 2000 election cycle, its political action committee has contributed $9.8 million to Congressional candidates, according to data from the Federal Election Commission and the Center for Responsive Politics. Republicans got more than Democrats in the four election cycles before 2008, when 56 percent went to Democrats.

Robert Gibbs, the White House press secretary, said that in his address to the group next week, Mr. Obama would “outline the case for health care reform and make clear why we can’t afford to wait another year, or another administration, to bring down costs that are crushing families, businesses and government.”

Mr. Gibbs did not say whether Mr. Obama would discuss a public insurance plan, the most contentious issue in the debate.

The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals. In recent years, some doctors have become so fed up with the administrative hassles of private insurance that they are looking for alternatives.

Until now, stakeholders in the health care industry have generally muted their criticism of Democratic proposals. But as details of the legislation have emerged, the criticism has become more pointed.

America’s Health Insurance Plans, a lobby for insurers, said Tuesday that the government plan proposed by some Senate Democrats could “dismantle employer-based coverage and significantly increase costs for those who remain in private coverage.”

Under a proposal favored by many Democrats, doctors who take Medicare patients would also have to participate in the new public plan. Democrats say that requirement is needed to make sure the public plan can go into business right away with a large network of doctors.

The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”

“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”

In an interview, Dr. Nancy H. Nielsen, president of the American Medical Association, said she was delighted by Mr. Obama’s plan to address the doctors.

“Health care reform is as important to us as it is to him,” Dr. Nielsen said. “We will be engaged in discussions in a constructive way. But we absolutely oppose government control of health care decisions or mandatory physician participation in any insurance plan.”

Mr. Obama’s trip recalls a speech to the A.M.A. in Chicago on June 13, 1993, by Hillary Rodham Clinton. She proposed “a new bargain” in which the White House would limit malpractice lawsuits and free doctors from onerous rules if doctors supported her effort to overhaul the health care system.

The association agrees with Mr. Obama on some points. It says that individuals and families who can afford coverage should be required to obtain it.

Like Mr. Obama, the association wants Congress to cut payments to private Medicare Advantage plans. The White House says Medicare pays the private plans 14 percent more than it would cost the government to care for the same people in traditional Medicare.

 

[Jiro]

Okay,

You can say what you want..

I can see from your post that you are misinformed by your own country...

I feel sorry for you...

I'm sorry but your post carries no credibility because your posts clearly showed a lack of critical thinking and blatant avoidance.

1. You have repeatedly avoided my simple question in post #16 and #18 - "Do you agree that there are more than 1 solution for this health care problem?"
2. You have not proved your accusation against me that I insulted Americans as lazy for not having healthcare coverage.
3. You have clearly demonstrated your BLIND OBEDIENCE WITHOUT QUESTION in post #19 as you admitted that Obama's healthcare reform is the ONLY SOLUTION
4. You failed to acknowledge that what works for others does not mean it will work in USA
5. I doubt you understand any of counter arguments to Obama's healthcare reform

 

[Liebling:-)))]

I just don't like seeing my health-care system being compared to another country because they have no understanding how they work

If you don´t like then tell US media that, not us. They are the one who attack other country´s healthcare system. I repeated that every country´s healthcare system is not perfect.

-- even the British don't really understand it.

They did not attack US healthcare system in first place. It´s US media who started it that´s why British have the right to rebutt US media´s misleading article over UK healthcare system. I can see that UK are not only one who rebutt US Media´s misleading article over NHS healthcare. We are well aware that NHS system is not perfect as the same as other countries as well.

Like I said-- I like the Canadian health-care system when I don't have a lot of money put aside. I may get frustrated with the wait-time, but it's a nice safety net for me. If I have to pay $54 a month so I won't have to worry about finding a job with insurance... that's awesome.

True.

I know how you feeling about waiting time. I have similar experience when I was in UK. I have my own experience... 2 years waiting list once in my life is tonsil removal... and waiting time most up to between one and two hours... It doesn´t bother me really because I read any magazines or knit... I alway bring magazines or knit when I go to doctor.

He didn't twist it, you just failed to shut down his points by NOT saying that medical tourism shouldn't be part of the debate. I realize that Jiro was the one that brought up Fidel Castro, but really instead of counter-arguing about medical tourism (aka Americans going to Cuba and Mexico), you should had shut down that it's irrelevant to the domestic affairs since he was going into international waters (so to speak) of the debate.

I would suggest you to re-read more carefully... Yes I am well aware that medical tourism doesn´t relate this thread here... Jiro is the one who started it over Cuba healthcare issues. I am one who remind him. It´s not my responsible that you don´t want to see it.

 

[Liebling:-)))]

I'm sorry but your post carries no credibility because your posts clearly showed a lack of critical thinking and blatant avoidance.

1. You have repeatedly avoided my simple question in post #16 and #18 - "Do you agree that there are more than 1 solution for this health care problem?"
2. You have not proved your accusation against me that I insulted Americans as lazy for not having healthcare coverage.
3. You have clearly demonstrated your BLIND OBEDIENCE WITHOUT QUESTION in post #19 as you admitted that Obama's healthcare reform is the ONLY SOLUTION
4. You failed to acknowledge that what works for others does not mean it will work in USA
5. I doubt you understand any of counter arguments to Obama's healthcare reform

I did answered your questions about solution, etc... I don´t know why you overlook my answers to your questions...

I entitle to my POV as different as you over healthcare issue. I am sorry if you don´t like my POV. Please accept that I have different knowledge as you that what I know. I would not post if I don´t know or I have no reason to make up anything.

Yes, you insult American over lazy at other thread a few months ago... I have no reason to make up... I did not forget what I saw and told you off for your disrespectful behavior and insult for label Americans as lazy etc. in other thread.