In a White House news conference, President Obama dismissed as "not logical" the suggestion that a public plan, which is intended to create more competition and therefore act as a brake on the rise of health insurance costs, would undermine the private insurance market. He argued that a government-run plan competing with private insurers would be an "important tool to discipline insurance companies" and scoffed at complaints that it could drive some out of business.
Two former CEOs of Atlanta-based Grady Memorial Hospital are battling in court. Pamela Stephenson replaced Otis Story as CEO in early 2008, and Stephenson was head of the Grady board that ousted him. Story felt slighted by the dismissal and, in a lawsuit filed against the board and Stephenson, accused her of engineering his dismissal so she could grab his job. In court papers filed June 15, Stephenson asserted that Story slandered her by telling others that she was a sexually available woman whom he could have slept with.
The Service Employees International Union alleges that the upstart National Union of Healthcare Workers is intimidating and misleading workers. As a result, the SEIU is urging federal officials to throw out petitions signed by tens of thousands of its own members who have asked to be represented by the rival upstart group. The SEIU has moved to block organizing elections at hospitals, clinics, and nursing homes throughout California.
The financial health of Pennsylvania's hospitals was declining even before the worst of the recession hit, according to a new report from the Pennsylvania Health Care Cost Containment Council. The report, which covered fiscal year 2007-08, found that both operating and total margins fell that year.
A majority of Americans see government action as critical to controlling runaway healthcare costs, but there is broad public anxiety about the potential impact of reform legislation and conflicting views about the types of fixes being proposed on Capitol Hill, according to a new poll. Most respondents are "very concerned" that healthcare reform would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy, the Washington Post-ABC News poll found.
South Florida's well-earned reputation as the Medicare fraud capital of the nation was reaffirmed this week with news that federal prosecutors have arrested eight people and charged them with attempting to bilk Medicare and Medicare Advantage with more than $100 million in fraudulent charges.
Even seasoned prosecutors were impressed by the size, scope, and complexity of the five-state criminal operation. "With new Medicare fraud cases being indicted in the Southern District of Florida every week, it is easy to become numb to otherwise egregious fraudulent conduct and staggering loss amounts," says acting US Attorney Jeffrey H. Sloman.
"This case is remarkable, not only in terms of the amounts stolen from Medicare, but also in terms of its sophistication and geographic breadth. These defendants attempted to steal approximately $100 million from the elderly, blind, and disabled by using multiple store-front clinics in five different states and then laundered their profits through local check cashing stores."
The defendants were identified as: Michel De Jesus Huarte, 38, Ramon Fonseca, 45,Vicente Gonzalez, 38, Alyd Dazza, 45, Monika Blacio, 41, Ricco Dazza, 41, Orlin Tamayo Quinonez, 35, and Juan Carralero, 56, all residents of Miami. They were indicted on June 18 on Medicare and other fraud-related charges. Another person involved, Madelin Machado, was indicted in January 2008, and remains a fugitive, the U.S. Attorney?s office said.
A 20-count indictment charges two separate Medicare fraud conspiracies. The first conspiracy charges that De Jesus Huarte and unindicted conspirators controlled and operated six sham medical clinics in Miami-Dade County that submitted at least $50.2 million in false claims to Medicare for infusion therapy, injection therapy, and other expensive medical treatments. Medicare paid Huarte and his conspirators at least $19.2 million. To conceal his involvement, De Jesus Huarte and his conspirators recruited sham owners for the clinics and paid them large sums of cash to sign the corporate records, bank records, and other business documents.
De Jesus Huarte and six coconspirators also reportedly ran eight sham infusion clinics in Florida, North Carolina, South Carolina, Georgia, and New Orleans that submitted at least $19.8 million in false claims to several private insurance companies that offer coverage through Medicare Advantage, and collected $4.6 million.
The indictment alleges that Huarte and Fonseca deposited fraud proceeds from their clinics at two Miami check cashing stores owned by Dazza and Blacio. They would reportedly accept Medicare Advantage insurance company checks between $30,000 and $80,000 from Huarte and Fonseca as often as three to four times per week and deposit them, wait for the checks to clear, and then deliver the cash to Huarte and/or Fonseca.
Federal prosecutors have long acknowledged that Miami and South Florida are a Medicare fraud hotbed.
In March 2007, the Department of Justice established a Medicare fraud strike force in Southern Florida that has filed about 100 indictments charging more than 170 people with fraud. However, there is also concern that the fraudsters are migrating to other parts of Florida and the country as investigations intensify in South Florida.
Last May, US Attorney Eric Holder said that during the first year of strike force operations in Miami, the federal government estimated that billing for durable medical equipment fell by $1.75 billion in claims and $334 million in payments.
Lawrenceville, GA-based Gwinnett Medical Center has submitted a filing with the state Department of Community Health addressing objections that may prevent the hospital from establishing an open-heart surgery program. The filing asks the department's commissioner to reinstate her initial decision in June 2008 to grant a certificate of need to allow the program. That decision was blocked when Piedmont Hospital, Emory University Hospital and Emory Crawford Long Hospital in Atlanta filed an appeal.
Overseers of Massachusetts' healthcare program made their first cuts as they trimmed $115 million, or 12%, from Commonwealth Care, which subsidizes premiums for needy residents and is the centerpiece of a 2006 law. The board of the Connector Authority made the cuts as officials confronted the state budget crisis and a surge in enrollment by the recently unemployed. The largest share of the savings will come from slowing enrollment.
The Census Bureau estimates that the number of uninsured amounts to 45.7 million people, but the agency might be overcounting by millions due to faulty assumptions, says Carl Bialik in this article for the Wall Street Journal. That 45.7 million figure also includes undocumented immigrants, even though they aren't likely to be covered under new laws, Bialik says. But that hasn't stopped both parties in Congress from using the flawed numbers liberally as they debate healthcare overhaul this summer, he adds.
As President Obama's effort to overhaul the healthcare system seems to hit one roadblock after another in Congress, he is counting on Senator Max Baucus to help him. More than anyone else, Baucus, the Montana Democrat and centrist chairman of the Senate Finance Committee, may have the best shot at getting his committee's measure passed into law.
