Tuesday, April 15, 2014

CA Hospitals Overbilled Medicare By $367 Million

CA Hospitals Overbilled Medicare By $367 Million

Auditors miffed about claims hiatus in SGR patch bill

California's hospitals received nearly $367 million in Medicare overpayments in 2012, primarily for inpatient services, the San Francisco Business Times reported.

The overpayments in California were part of $2.4 billion in alleged mispayments involving hospitals from two years ago, according to data supplied by the Centers for Medicare & Medicaid Services (CMS).

Overall, CMS believes the hospitals received $2.3 billion in overpayments and about $109 million in underpayments. California, which had the nation's highest total of excess payments, represents about 10 percent of the U.S. population but about 15 percent of the overpayments. Its total was more than double that of New York and nearly triple that of Florida.

Although the numbers reported by recovery audit contractors are large, theBusiness Times noted that the 18-month hiatus on claims audits that was included in the recent patch to the sustainable growth rate (SGR) formula complicates ongoing follow-up. Congress lumped in the auditing hiatus, along with a delay in the implementation of ICD-10, in its annual SGR patch bill when a permanent fix to SGR collapsed over objections to the insertion in legislation of a delay for the individual mandate to purchase health insurance. However, CMS did expand the overall authority of auditors to deny claims.

Nevertheless, the hiatus also has the auditor community riled up--and conflicted.
"Our members vehemently oppose this oversight holiday," said Becky Reeves, a spokeswoman for the American Coalition for Healthcare Claims Integrity (ACHCI), which represents recovery audit contractors, Medicare audit contracts and zone program integrity contractors. However, individual auditing organizations can't comment on the hiatus due to contracts they signed with CMS to provide services, according to the Business Times.

The hiatus could potentially keep ongoing waste in the Medicare program from going unchecked, the ACHCI suggested in a statement.

However, David Sayen, California's regional CMS administrator, told the Business Times that the hiatus is a sign that the agency's auditing program actually works.

To learn more:
- read the 
San Francisco Business Times article
- here's the CMS 
report (.pdf)
- check out the ACHCI 

Related Articles:
House approves temporary SGR fix
CMS expands contractors' claims denial authority
Medicare RACs recoup $2.4B in overpayments in nine months
Congress demands RAC reform
OIG blasts Medicare, RACs for weak oversight
CMS to suspend RAC requests

Thank You FierceHealthFinance and Mr Shrinkman.

$367 Million seems a bit low to us, . . . but, . . . . oh well, . . . those numbers Must be right if they came from CMS.

also from Mr Shrinkman back in 2012:

Medicare Fraud Detection System Disappoints

"A computer initiative to stop fraudulent Medicare billing at the point of claims submission has so far been a disappointment, reported the Associated Press.
To date, the $77 million computer system, which went online in mid-2011, had prevented exactly one bad claim by late last year. That totaled $7,591."

Polish Prosecutors Hit GlaxoSmithKline With 3rd Round Of Bribery Charges

fiercepharma has;
Polish Prosecutors Hit GlaxoSmithKline With 3rd Round of Bribery Charges
April 14, 2014 | By 

GlaxoSmithKline ($GSK) has now hit a trifecta in bribery investigations: First China, then Iraq, and now Poland. According to the BBC, a former GSK sales rep says the company was trading cash for prescriptions in the country in a wink-wink sort of way, by disguising the script incentives as speaking fees.

And it's not just allegations from an unnamed whistleblower. This rep is identified by name, and public prosecutors in Poland say there's evidence that the payments amounted to bribery. One doctor has already admitted guilt. Glaxo says it has "disciplined" one employee and launched its own investigation.

According to the former rep, Jarek Wisniewski, the pay-for-prescriptions approach was "a simple equation."

"We pay doctors, they give us prescriptions," Wisniewski told the BBC. "We don't pay doctors, we don't see prescriptions for our drugs."

But Glaxo couldn't outright trade payments for prescriptions, Wisniewski said. "So we prepare an agreement for them to give a talk to patients, we pay £100, but we expect more than 100 prescriptions for this drug," he said (as quoted by the BBC), adding, "It's a bribe."

Krzysztof Kopania, a spokesman for the prosecutor in Lodz, Poland, told the news program Panorama that doctors in more than a dozen health centers apparently accepted cash from GSK--in the form of speaking fees for educational programs--and no such programs followed. "[I]t was a camouflaged form of a bribe," Kopania said. "In return for the financial gains the doctors would favor the product proposed by the pharmaceutical company and they prescribed that medicine."

In China, Glaxo is accused of paying almost $490 million in bribes to doctors, funneling the payments through travel agencies. More than a dozen company employees were detained in China in connection with the corruption probe; Glaxo recently replaced its local chief, but maintains that its top executives in the U.K. had no knowledge of the shenanigans. In Iraq, the company faces allegations that it hired government doctors and other healthcare professionals as sales reps, even as they continued to work for the government.

In Poland, Glaxo says, the improper payments appear to be the work of one person. In a statement to the BBC, the drugmaker said its own investigation "found evidence of inappropriate communication in contravention of GSK policy by a single employee. The employee concerned was reprimanded and disciplined as a result."
Apart from that rep's handiwork, the educational program was legit, the company says. Doctors were paid to speak about diagnosis and treatment of respiratory disease--including use of its lung drug Seretide, sold as Advair in the U.S. Respiratory specialists received payments "appropriate to the scope of work" and to their individual expertise, the company said.

The Polish probe is the latest blow to CEO Andrew Witty's attempts to clean up Glaxo's image. The company has overhauled its sales incentives in the U.S. already, and is rolling out the new compensation system worldwide. GSK also says it will phase out speaking fees for doctors, with plans to hire staff physicians to keep drug education in-house.

Not soon enough, at least in Poland. As prosecutors continue their probe, GSK says its investigation continues, and it's "cooperating fully" with Poland's anticorruption authorities.

Meanwhile, the company may face repercussions in the U.S. and the U.K., where local laws are designed to punish companies for corrupt practices overseas. Investors aren't likely to respond positively to the news, either, Panmure Gordon analyst Savyas Neophytou told Reuters: "In isolation, the events in Poland are trivial but evidence is building up of sharp practices in many areas of GSK's organization which will impact sentiment significantly."

- see the BBC news
- get 
more from Reuters

Special Reports: Top 10 Drugmakers in Emerging Markets - GSK | The top 10 pharma companies by 2013 revenue - GlaxoSmithKline

Related Articles:
If Glaxo's CEO wants to be Mr. Clean, he needs to pick up a broom
GlaxoSmithKline confronts new bribery charges, this time in Iraq
British penalties for China bribery may be on the way for GSK
China probes of Glaxo, Sanofi, others put big chill on key growth market
GlaxoSmithKline exec admits 'breaches,' promises price cuts in China

Thank You Fierce Pharma and Ms. Staton.

Monday, April 14, 2014

George Will: Left Has A "Kind Of Tourette's Syndrome" In Constantly Blaming Race

Left Has A "Kind Of Tourette's Syndrome" In Constantly Blaming Race
The race card is all the liberals have.

Eric Holder’s suggestion earlier this week that he and President Obama receive more criticism due to their race is just the latest example of the “intellectual poverty” among Democrats, according to George Will.
“Liberalism has a kind of Tourette’s syndrome these days — it’s just constantly saying the word ‘racism’ and ‘racist,’” he said on Fox News Sunday.
With Democrats facing the unpopularity of Obamacare, a troubled foreign-policy, and an “unprecedentedly bad” economic recovery, the party had started to employ this strategy in to top-gear ahead of the fall midterms. In fact, earlier in the day, Democratic Congressional Campaign Committee chairman Steve Israel (D., N.Y.) told CNN that a “significant extent” of Republicans were “animated by racism.”
But Will expects the public will see through Democrats’ strategy. “It’s so inappropriate — the constant invocation of this — that it is, I think, becoming a national mirth,” he said.

Thank You Mr. Will, NRO, and Dapandico.


"Looks like it's going to rain." 

"That's Racist!"

Mental Health Central San Francisco: Transgender Traitror Bradley Manning To Lead Gay Pride Parade (from Inside Prison?)

San Fran Libs To Give "Proper Honor" To American Traitor Bradley Manning,  Will Be Grand Marshall At Gay Pride Parade

[Ed; Hell of a Mentally Healthy' thing to be Proud of. S/he's doing 35 years in Leavenworth as a Traitor.]

Which will be tough to do considering he . . . errr . . . she is locked up in Fort Leavenworth.
Via Hot Air:
So there’s a name you haven’t heard in a while, eh? Bradley Manning is still cooling his heels at Fort Leavenworth, serving a 35 year sentence for violating his oath and releasing the nation’s classified documents. But his organization of supporters (now renamed The Chelsea Manning Support Network) remains busy on his behalf. In one of their latest, breaking news announcements, we find that the San Francisco gay pride parade organizers are going to correct a “mishandling” of administrative details from last year and provide a “proper honor” in 2014 by naming him an Honorary Grand Marshal:
Today, the nation’s largest Lesbian Gay Bisexual Transgender Pride Celebration Committee announced on its website that WikiLeaks whistle-blower Chelsea Manning has been chosen to represent the event as a 2014 Honorary Grand Marshal.
Manning thanked the San Francisco Pride Committee from Fort Leavenworth military prison, declaring, “As a trans* woman, I appreciate the Pride movement’s significant role in bringing together diverse communities and elevating the public profile of the fight for queer rights. I have always enjoyed attending Pride celebrations given the opportunity, and I’m deeply honored to receive this title.” Manning explained that she prefers “Trans*” (with an asterisk) to denote not only transgender men and women, but also those who identify outside of a gender binary.

Thank You Hot Air and Zip. 

Report: Obama Has Sought To Raise Taxes 442 Times

Report: Obama Has Sought To Raise Taxes 442 Times

Then again, this is Barack Obama we’re talking about.
April 15 is a hard day for many, as their annual federal tax bill comes due. But it could have been worse.
According to a new report, President Obama has sought 442 tax increases since taking office, though most have died because of congressional opposition.
Having included 93 new taxes in his fiscal 2015 budget, the anti-tax Americans for Tax Reform reviewed his proposals since his 2009 Inauguration to determine just how tax friendly the president has been. Their conclusion: He’s very friendly.
“History tells us what Obama was able to do. This list reminds us of what Obama wanted to do,” said Grover Norquist, president of Americans for Tax Reform.
The group’s list of 442 tax proposals notes that he did sign 20 tax increases into Obamacare and a tobacco tax approved soon after he entered office. For the Obamacare taxes, the net tax hike over the next decade is at least $1 trillion, said the group.

Thank You Wash Examiner and Zip. 

SEIU Workers Demand San Francisco Raise Minimum Wage For CITY Workers To $21 An Hour

SEIU Workers Demand San Francisco Raise Minimum Wage To $21 An Hour

Only $21 an hour?

Via SF Gate:
From fighting Google buses to protesting Ellis Act evictions, San Francisco’s 9,475-member Service Employees International Union local has been leading the campaign for a more livable city. Now it’s putting its members’ own economic agenda front and center at City Hall.
The SEIU’s proposed new contract with the city includes calls for:
– A 15 percent raise over the next three years.
 A $21-an-hour minimum wage for all city workers.
– Fully paid health coverage for single workers, 98 percent paid coverage for couples and 85 percent coverage for families.
– A free clinic just for city workers to go along with the health coverage.
– A free $50,000 life insurance policy for SEIU workers. Seven other city unions already have free life insurance.
The union has dropped its call for a $76-a-month commuter subsidy and premium pay while off on paid holidays.
The city is countering with a 2.5 percent raise over two years, and no clinic, no free life insurance and a health care package of 93 percent coverage for singles and couples and 83 percent for families.
“This is about income equality,” said Larry Bradshaw, vice president of SEIU Local 1021. He noted that when times were lean, workers took cuts. Now with the economy on the upswing, he said, they deserve their share.

Thank You SF Gate, and Zip. 

'Mental Health'. This is what it Does when you allow it to take over.

And we're Still inundated with hand wringing and stern warnings from Every Corner that unless we buy even More of it the entire country will go straight to hell. 

How Nice - SEIU, AFSCME 'Leaders' Honored by CPUSA

Saturday, April 12, 2014

WH Press Sec Jay Carney Has Soviet Propaganda Posters Decorating His Home (No Surprise There)

WH Press Sec Jay Carney Has Soviet Propaganda Posters Decorating His Home

Check the pictures on the wall in the back.
Washingtonian MOM magazine’s spring issue has a profile of White House Press Secretary Jay Carney’s wife, ABC News contributor Claire Shipman, that features a picture taken inside their home. In the background of the photo, you can see two framed Soviet-era propaganda posters.
One of Carney’s posters is a version of this iconic design by artist Dmitry Moor with a soldier pointing his finger alongside text that says “Have YOU Enlisted?” in Russian.
The other poster features a female factory worker. According to this eBay seller, who is offering one for $1,660, the poster was printed on June 26, 1941, days after Russia began fighting the Axis powers in World War II. It encourages women take jobs vacated by men who have gone to fight. The woman in the poster is switching out a tag with a man’s name to one with hers and the text says: “Women! Learn production, replace workers who went to the front! The stronger the hinterland – the stronger the front!”
Carney and Shipman have a lot of history with Russia. They met in Moscow in the 1990s while he was writing for Time and she worked for CNN. Carney did not respond to a request for comment from Business Insider Friday.

And if you Don't Believe in them, they have Doctors and Pills to make sure that whatever is Left of you Will at least Sit Down, Shut Up, and Drool.

"I Just Can't Quit You!" Man Tries To Cancel His ObamaCare Coverage, But Finds They Don't Want To Let Him Go

"I Just Can't Quit You!" Man Tries To Cancel His ObamaCare Coverage, But Finds They Don't Want To Let Him Go

Obamacare numbers includes people who didn’t actually pay and people who want out, but hey, success!
I never wanted to be a pawn in President Obama’s absurd and irresponsible attempt to mandate, regulate and complicate the American health care system. Unfortunately, there wasn’t much of a choice.
I was a casualty of Mr. Obama’s Big Lie. You know the one: “If you like your health care plan, you can keep your health care plan.” By the time my plan vanished, the only individual health insurance plans available had been captured by the tentacles of Obamacare.
Signing up for insurance under Obamacare was harder than making sense of Donald Trump’s hair. It took more than 20 attempts over four days just to get on the “Health Insurance Marketplace” website and shop for insurance. The plan I found most similar to my canceled plan cost nearly $1,000 more a year, and my deductible increased from about $2,000 to more than $5,000. So I was forced to pay almost twice as much for a whole lot less insurance.
It’s surprising there’s not a link to buy a solid-gold eight-track player on the Healthcare.gov site — everything else for sale in Mr. Obama’s marketplace is also ridiculously overpriced and pretty much useless.
Signing up for Obamacare was a tremendous hassle. But even that experience was a joy compared with what I went through to cancel my coverage.

Thank You Wash Times and Nickarama.

From the people Buying You, on money which doesn't belong to them and the people it Does belong to Don't Have, the suppression of Thought and Mood crimes.