/PRNewswire/ -- The National Inflation Association today released the following statement to its http://inflation.us/ members:
"It is becoming increasingly likely that health care will be the straw that causes the U.S. Dollar to collapse. There is no doubt about it that health care costs are out-of-control in America. Unfortunately, most Americans are calling for the government to do something about astronomical health care costs, when the government is actually the cause of the crisis and will only make it much worse.
Medicare costs have increased from $3 billion in 1966 to an estimated $408 billion in 2009. This equals a compound annual growth rate of 12% and proves that inflation gravitates towards parts of the economy where government is involved in the most. Health care now accounts for 17% of the U.S. GDP, and by 2017 it is estimated that one out of every $5 spent in this country will be on health care.
Isn't it amazing that the one area of medical care that is going down in price is plastic surgery and other cosmetic procedures, because it is the area where the government is involved in the least? Free market forces dictate plastic surgery prices, because health insurance typically does not cover it.
Today we have a system where tax free health benefits from employers force Americans into expensive health insurance plans that encourage individuals to claim every small doctor's visit. This creates abuse of the system with Americans going to the emergency room for unnecessary reasons, knowing they will only have to pay a $10 co-pay.
If Americans were able to take home the cost of their health insurance plans, in the form of higher wages, they would then be able to purchase cheaper health insurance plans on their own that cover only bad accidents and major emergencies. If they wanted to see the doctor for something minor, they could pay for it out of pocket. With less people abusing the system, waits would be shorter and doctors would be encouraged to charge the least. Today, with doctors getting paid by a handful of third-party corporations, they are encouraged to charge the most.
Government intervention into health care has ruined the industry for doctors too. The government has made the industry less efficient by creating too many licenses and regulations. Doctors now spend half of their time filling out excessive paperwork while worrying about malpractice lawsuits. If somebody has a small bruise on their arm, instead of telling the patient to use ice, doctors now run multiple tests and fill out dozens of forms to comply with regulations and prevent themselves from being sued.
Obama's plan of socialized health care will wipe out the private sector and create less competition. No private health insurance companies will be able to compete with the government, which will be able to operate at a loss continuously. With any remaining efficiencies of the free market eliminated, costs will go up for all Americans in the form of much higher inflation, and the quality of health care will go down.
If we want the U.S. to remain the country where millions of people travel to for top quality medical care, we need to allow the free market to work for itself. Free market principles are the only way to drive costs down while improving the quality of health care."
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Tuesday, July 7, 2009
NIA Says Health Care Will Cause U.S. Dollar Collapse
Thursday, June 25, 2009
Legislators Say Federal Health Reform Efforts Trample States’ Rights
(BUSINESS WIRE)--Federal efforts to establish a Medicare-modeled “public plan” and a national health insurance exchange would trample states’ rights and lead Americans down the road to single-payer health care, said the American Legislative Exchange Council (ALEC), a nonpartisan organization of 1,800 state legislators nationwide.
ALEC’s lawmakers approved the Resolution on Preserving States’ Rights Regarding Federal Health Insurance Exchanges and a Public Plan, which deems the public plan anti-competitive and calls the proposed national health insurance exchange a “federal takeover” of the states’ role in regulating health insurance.
“The government will never compete unless it can change the rules to win,” says Iowa Representative Linda Upmeyer, minority whip, family nurse practitioner, and chair of ALEC’s Health and Human Services Task Force. “It’s an unlevel playing field when a public plan can shift costs to our state’s private insurers because of low doctor and hospital reimbursement rates, and then raid the federal Treasury for unlimited subsidies,” she added.
“The real goal of national health insurance exchange isn’t competition—it’s a federal power grab that flies in the face of the Tenth Amendment,” says Wisconsin Representative Leah Vukmir, ranking member of the House Committee on Health and Health Care Reform, pediatric nurse practitioner, and ALEC member. “Legislators don’t want a bloated federal health insurance bureaucracy that duplicates the regulatory functions currently performed by states. And our constituents don’t want the feds to run health care like a public utility,” she added.
“The public plan and national health insurance exchange will squeeze out private insurance and put us on the road to single-payer health care,” said Georgia Senator Judson Hill, member of the Senate Health and Human Services Committee and ALEC member. “Political pressure to keep premiums low and benefits high will result in millions dropping their private coverage and getting on the federal health care dole. Having the public plan now will mean socialized medicine later,” he added.
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Wednesday, March 4, 2009
Free Seminars Offered to Georgia Seniors with Diabetes and Other Chronic Illnesses
/PRNewswire/ -- A series of free seminars designed to help Georgia Medicare beneficiaries with chronic illness maintain a healthy lifestyle and learn about Medicare Advantage Special Needs Plans designed for their unique needs will be offered during March at various locations throughout the state.
Care Improvement Plus, the state's largest Medicare Advantage Special Needs Plan for beneficiaries with diabetes and other chronic conditions, is hosting the sessions, which will include tips on proper nutrition and fitness, a free farmers market, and information on its 2009 plan offerings.
"Medicare beneficiaries in Georgia experience higher rates of chronic illnesses such as diabetes and heart failure, which can lead to serious complications if not properly managed," says Lisa Nelson, national director of community outreach for Care Improvement Plus. "Our goal is not only to educate beneficiaries on our plan benefits and services, but to present them with a sense of the unique support and education that our special needs plan seeks to provide."
Call toll free, 1-866-766-8698 (TTY: 1-866-766-8695) for more information or to register to attend one of the following seminars in your area:
March seminars:
March 18th, 10:00 AM March 20th, 11:00 AM March 20th, 10:30 AM
Hampton Inn North Lake Marriott Hotel March 23rd, 10:30 AM
3400 Northlake Pkwy. 1045 Stevens Creek Rd. Columbus Government
Atlanta, GA 30345 Augusta, GA 30907 Annex Bldg.
420 Tenth St.
Columbus, GA 31901
March 16th, 11:00 AM March 25th, 10:00 AM March 24th, 11:00 AM
Country Inn & Suites Life Enrichment Center DeKalb Extension Office
1312 Old Covington Hwy. 1340 McConnell Dr. 4380 Memorial Dr.
Conyers, GA 30012 Decatur, GA 30033 Decatur, GA 30033
March 17th, 11:00 AM March 27th, 11:00 AM March 26th, 11:00 AM
Holiday Inn Coweta County Fairgrounds Mullberry Inn
441 Park West Dr. Conf. Center 601 East Bay St.
Grovetown, GA 30813 Golden Creek Room Savannah, GA 31401
575 Pine Rd.
Newnan, GA 30263
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Tuesday, December 9, 2008
Consumers and Employers Paying Almost $90 Billion Due to Under-Payments to Hospitals and Physicians by Medicare and Medicaid
/PRNewswire-USNewswire/ -- Low Medicare and Medicaid reimbursements to hospitals and physicians lead to significantly higher health insurance costs for consumers and employers, according to a study released today by Milliman Inc. The report found that annual health care spending for an average family of four is $1,788 higher than it would be if Medicare, Medicaid and private employers paid hospitals and physicians similar rates, with total provider reimbursement unchanged.
The continued underpayment of providers by public programs has devastating consequences for families and employers that are struggling to afford health care coverage. These underpayments create a payment gap to hospitals and physicians that privately insured employers and consumers must close through a "cost shift" or "hidden tax."
The Milliman study measures the cost shift as the difference between actual payment rates and average payment rates for Medicare, Medicaid and private payers; total payment to hospitals and physicians is held constant. The study does not assess appropriate levels of payment, but rather the disparities among current payment rates.
The study found that cost shifting:
-- Adds an estimated $1,512, or 10.6 percent, to the average premium for
a family of four
-- Of this amount, employers pay approximately $1,115 and the employee
share is $397
-- Families pay an additional $276 more in coinsurance and deductibles
due to the cost-shift
"As businesses struggle to cut costs to match sagging revenues, employee health benefits are increasingly at risk," said Rich Umbdenstock, president and CEO of the American Hospital Association. "The faltering economy makes fair payment by Medicare and Medicaid more important than ever."
In 2006, the hospital cost shift from Medicare was $34.8 billion and $16.2 billion for Medicaid. In 2007, the physician cost shift was $14.1 billion for Medicare and $23.7 billion for Medicaid. Taken together, the estimated annual cost shift is $88.8 billion.
Overall, the cost shift represents 15 percent of the current amount spent by commercial payers on hospitals and physicians. Stated differently, if there were no cost shift, hospital and physician costs for privately insured patients would be 15 percent lower.
Health plans have taken many actions to keep coverage affordable, but are challenged by the growing cost of the subsidy that their customers provide to public programs. In 2006, Premera Blue Cross, which provides coverage for 1.7 million consumers in Washington, Alaska, Oregon and Arizona, commissioned a local cost-shift study, the first of its kind, to examine how deficient payments by Medicare and Medicaid are affecting employers and hospitals in their area. Their work laid the foundation for the national cost shift study which examines the additional cost burden passed on to all employers and consumers nationwide.
"This new study shows that cost-shifting is driving up the costs of health care for all consumers," said Scott P. Serota, President and CEO of the Blue Cross and Blue Shield Association. "As our nation embarks on comprehensive healthcare reform -- and we collectively strive to extend coverage to all, improve quality of care and keep healthcare affordable for future generations -- cost-shifting is one of the areas where we should focus our attention."
"This study quantifies the 'hidden tax' that cost-shifting imposes on families and employers across the nation," said Karen Ignagni, President and CEO of America's Health Insurance Plans. "As Congress and the new administration focus on health care reform, they should confront this issue."
Also hospitals and physicians in some areas may not be able to offset low public payments with higher commercial payments creating additional financial pressures. In addition to this hidden tax, the privately insured also must bear the costs associated with bad debt and charity care provided to individuals without insurance, which is not separately quantified in this report.
"As we consider approaches to expand coverage nationally, we need to keep in mind the disparity among Medicare, Medicaid, and commercial provider payment rates, and the pressure that this disparity places on hospitals, physicians, and commercial payers," said John Pickering, Principal and Consulting Actuary at Milliman, Inc., who co-authored the report with Will Fox, also a Principal and Consulting Actuary at Milliman, Inc.
Milliman is an independent consulting firm that was engaged by AHIP, AHA, BCBSA and Premera Blue Cross to develop a best estimate of the cost shift in the United States. Hospital findings are based on analysis of the 2006 AHA Survey data. The survey includes data on the 4,927 short-term, community hospitals in the U.S. The data represent each hospital's fiscal year 2006 results. The physician findings are based on 2007 fee schedule levels for Medicare, Medicaid and commercial payers.
The American Hospital Association (AHA) is a not-for-profit association of health care provider organizations and individuals that are committed to health improvement in their communities. The AHA is the national advocate for its members, which include almost 5,000 hospitals, health care systems, networks, and other providers of care. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the Web site at www.aha.org.
America's Health Insurance Plans (AHIP) is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. AHIP provides a unified voice for the community of health insurance plans. A major policy goal for our members is to expand access to high quality, affordable coverage to all Americans. We have developed innovative proposed solutions to promote universal coverage, raise the bar on quality, and make health care services more affordable. For more information, visit the Web site at www.ahip.org.
The Blue Cross Blue Shield Association (BCBSA) is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 102 million individuals - nearly one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit www.BCBS.com.
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Wednesday, November 12, 2008
Medicare Today Launches National Medicare Prescription Drug Enrollment Awareness Campaign
PRNewswire-USNewswire/ -- Health care leaders today announced a national campaign to raise awareness about the 2009 Medicare prescription drug coverage open enrollment period, which runs from November 15 to December 31, 2008.
The campaign is designed to encourage seniors to sign up for prescription drug plans under Medicare's Part D program if they have not already done so, and to remind those seniors who are already enrolled in the program to review their current plan and compare it with other available plans.
"It is extremely important for beneficiaries, especially those with limited income, to take advantage of the choice, convenience and cost savings that Medicare's prescription drug plans offer them," said Mary R. Grealy, president of the Healthcare Leadership Council, a coalition of the nation's leading health care companies and organizations. "This national campaign will help make sure seniors are aware that now is the time to enroll in a plan or review their current Medicare drug plan."
The campaign will include television advertising, media coverage and grassroots outreach activities and will highlight the high satisfaction rates among beneficiaries currently enrolled in Part D plans.
Heading into its fourth year, seniors continue to give the program high marks, with 90 percent reporting that they were satisfied with their plan, up 12 points since the beginning of the program, according to a survey released today by Medicare Today, a project of the Healthcare Leadership Council and conducted in September by KRC Research.
"This survey is yet more evidence that the Medicare prescription drug benefit provides seniors with the flexibility they need to choose a plan that's right for them," said former U.S. Senator and Medicare Today Co-Chairman John Breaux.
According to the survey, in addition to high satisfaction rates, beneficiaries report that they're saving money under Medicare Part D prescription drug plans, which have been available to beneficiaries since 2006. Prior to the addition of Part D coverage, millions of Medicare beneficiaries had coverage for hospital and doctor expenses, but not prescription drug expenses. Most seniors agree that their plan is delivering what it said it would when they signed up, and nearly eight in 10 seniors say they are better off now than before the program. Eighty-six percent say their co-payments are affordable, 85 percent say their monthly premiums are affordable, 91 percent say their plan offers a good value, and 71 percent say they've lowered their prescription drug spending.
"During these tough economic times, I'm pleased that the program can provide savings for seniors and that they have the ability to choose the plan that best suits their needs," said former U.S. Senator and Medicare Today Co-Chairman Trent Lott.
"Having access to your medicines is a critical part of healthy aging for all seniors and the Medicare Part D benefit makes that possible," said Dr. Jane L. Delgado, President and CEO of the National Alliance for Hispanic Health (the Alliance). "It is critical that before the deadline of December 31, 2008 all seniors who do not yet have prescription drug coverage sign up for Medicare Part D for their health and their family's piece of mind."
The Alliance announced the availability of help with understanding Medicare benefits through the Alliance's 1-866-SU-FAMILIA (1-866-783-2645) National Hispanic Family Health Helpline. Callers get free reliable and confidential health information in Spanish and English. Bilingual health promotion advisors can also refer callers to a local health care provider in their community and callers can get a free bilingual guide to diabetes and their Medicare benefits.
Current and potential beneficiaries can speak with a Medicare counselor for information about the benefit by calling 1-800-MEDICARE (1-800-633-4227). To prepare for a discussion with a counselor, beneficiaries should have on hand a list of the prescription drugs they take, including the dosage and frequency, and a preferred pharmacy.
The Medicare Prescription Drug Plan Finder and Medicare Options Compare are two new tools available on www.medicare.gov to assist current beneficiaries and those eligible in process of choosing a plan or comparing a current plan to another option. These tools provide detailed information on all the available plans and the means to compare them based on cost, coverage, service area, and quality.
The Social Security Administration can also provide assistance for those who may qualify financially for extra help with the cost of prescription drugs. Medicare beneficiaries interested in applying for extra help or those who have previously applied and want to check their status can call 1-800-772-1213 to contact their local Social Security office.
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Thursday, November 6, 2008
Columbus Medicare Diabetes Screening Project Cited as Model for State by Lt. Governor Casey Cagle
PRNewswire/ -- Lt. Governor Casey Cagle today applauded the design and implementation of the Medicare Diabetes Screening Project (MDSP) in Columbus, citing it as a model for other cities in Georgia and around the country. He made his remarks at the Columbus Summit, a meeting hosted by the Columbus Research Foundation and the Columbus Medicare Diabetes Screening Project, designed to enlist other Georgia cities to adopt the innovative outreach effort in Columbus that has created a model for promoting diabetes screening for adults aged 65 and older.
"There is no greater health challenge in Georgia than the fight against diabetes," said Lt. Gov. Cagle. "The Columbus Medicare Diabetes Screening Project has developed an effective and powerful model for encouraging senior citizens to get screened and to work with their health care providers to prevent or better manage their diabetes. This model should be adopted by other Georgia cities to help our seniors win the fight against diabetes."
Since July 2007, leaders of the Columbus MDSP have conducted a variety of activities to increase awareness of the benefits Medicare offers to adults age 65 and older for free screening for diabetes. These leaders shared their strategies and accomplishments today with their counterparts from Albany, Augusta, Gainesville, Macon and Savannah, who had been invited to participate in this statewide launch of the MDSP.
Medicare beneficiaries at risk for diabetes are eligible for free, annual diabetes screenings from their health care provider. Although as many as 60% of Medicare beneficiaries are at risk for diabetes and should be screened, less than 10% of beneficiaries nationally used the free diabetes screening benefit in 2006, according to the most recently available data. In Georgia, just 6.8% of beneficiaries were screened in 2006.
The MDSP in Columbus has engaged citizens through a variety of awareness-raising and informational activities, including an event at the Columbus Civic Center, distribution of information in church newsletters, displays at shopping centers and health fairs, risk assessments at local fire stations, and advertisements on television and radio.
"A diverse group of public and private city leaders came together, worked hard, and delivered the message of free Medicare diabetes screening to the senior citizens of Columbus and health care providers," said Columbus Mayor Jim Wetherington, as he welcomed the assembled crowd. "Our work in Columbus can serve as a model for how you might implement the Project in your communities."
The Mayor was followed by Dr. William Rowley, the Chief Operating Officer and a Senior Futurist at the Institute for Alternative Futures, who made a compelling case for the potentially devastating impact of diabetes on America and Georgia in the coming decades, and why we need programs such as the Medicare Diabetes Screening Project to help stem the relentless tide of this disease.
Steven Leichter, MD, FACP, FACE, Medical Director of the Columbus Research Foundation, then explained the details of the benefits Medicare offers for diabetes screening, and why their use is vital to helping identify older adults with undiagnosed diabetes or pre-diabetes. "It's critical that we get more of our seniors to use their free Medicare screening benefits," said Dr. Leichter, "so that we can help find those who have diabetes or pre-diabetes but don't know it. Screening and diagnosis is the essential first step to prevent diabetes for those at risk or to better manage diabetes for those who may already have the disease."
After watching a new video about the Columbus MDSP, participants at the Columbus Summit witnessed a lively panel discussion that included the perspectives of four local Columbus leaders who have worked with MDSP: Renee Adamson, Region 3 President, Georgia Pharmacy Association; the Rev. Dr. Johnny Flakes, 4th Street Missionary Baptist Church; Mike Gaymon, President, Columbus Chamber of Commerce; and Jeff Meyer, Chief of the Columbus Department of Fire and Emergency Services.
Later in the forum the assembled community leaders from Albany, Augusta, Gainesville, Macon and Savannah joined with their counterparts from Columbus in small group work sessions, where they asked questions, brainstormed ideas for activities, and planned how they might implement the MDSP in their communities. At the end of the day, Lt. Governor Cagle gave the charge to participants to take what they had learned and work to promote diabetes screening for Medicare-aged residents of their own cities.
The Medicare Diabetes Screening Project in Columbus is a community-based effort to reach and motivate the estimated 12,000 seniors who have undiagnosed diabetes or pre-diabetes to see their doctors and take advantage of the free diabetes screening benefits offered by Medicare. Locally in Columbus, efforts have been led by the Columbus Research Foundation. On a national basis, the MDSP is co-chaired by the American Diabetes Association, the Healthcare Leadership Council, and Novo Nordisk Inc., and includes more than 20 organizations representing patients, health care providers, older adults, businesses and government. It is the first and only program designed to increase awareness and promote use of the largely unused, free screening benefits that Medicare offers for diabetes and pre-diabetes. Information is available at www.screenfordiabetes.org.
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Thursday, October 9, 2008
Only the First of Many Future Bailouts
PRNewswire-USNewswire/ -- For those who think the U.S. Treasury's bailout of the banking industry is bad, here's some news for you -- this mortgage bailout is only the first, and the smallest, of a series of bailouts that are going to be necessary in the future, warns the Institute for Policy Innovation (IPI). And taxpayers who have made responsible financial decisions are going to be on the hook for those as well.
Americans are rightly concerned not only about the cost of the bailout, but of the precedent of letting actors in the market make enormous profits while having the risk backstopped by taxpayers. And taxpayers are disturbed by the fact that elected officials were repeatedly warned about these risks and problems, but did nothing.
The bailout will affect regulatory policy, tax policy and the funds available for any number of other programs, to say nothing of affecting our ability to deal with any future crisis that might arise.
Medicare and Social Security are both going broke, and everyone knows it. The combined unfunded obligations of Medicare Part A and Social Security are in the neighborhood of $48 trillion -- 48 trillion dollars that the federal government has promised to retirees but has no way to pay -- and knows it has no way to pay.
But it's worse than that -- taking into account the three major components of Medicare, its unfunded liability alone is $85 trillion. Combined with Social Security, that results in about $100 trillion in promises the federal government has made that it has no plan to fulfill.
Medicare went into deficit this year -- 2008. That means that this year Medicare began paying out more than the program takes in. And Social Security will go into deficit in 2017 -- less than nine years from now.
As far as bailouts go, you ain't seen nuthin' yet.
It's time for voters and taxpayers to start holding elected officials accountable for heeding the warnings they are given and solving problems BEFORE gigantic taxpayer bailouts are required. Any fool can go to Washington, collect campaign contributions and stand in front of the TV cameras. But we can't afford that luxury anymore.
Voters must hold the next Congress and the next President accountable to take action to prevent the need for a massive taxpayer bailout of Social Security and Medicare. That's the bad news. The good news is that, in the weeks before an election, we all get to choose who makes those decisions.
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Monday, September 22, 2008
Care Improvement Plus Partners with Atlanta Regional Commission to Provide Preventive Services to Area Seniors
PRNewswire/ -- Care Improvement Plus, Georgia's largest state-wide Medicare Special Needs Plan for beneficiaries with chronic health conditions, today announced that it will be collaborating with the Atlanta Regional Commission's Sickness Prevention Achieved through Regional Collaboration (SPARC) coalition to organize 13 health fairs this fall across DeKalb and Fulton counties to improve community-wide delivery of disease prevention services among older adults.
"Over 60 percent of older adults in our community do not get the routine care they need to maintain their health," said Jennie Deese, community outreach director for Care Improvement Plus. "The mission of the SPARC program is well-aligned with that of Care Improvement Plus -- to improve the health of area seniors by providing access to valuable preventive services. We are honored to be a part of this program."
Originally launched as a pilot program in the Atlanta region in 2006, SPARC, which is administered by the Atlanta Regional Commission Area Agency on Aging, encourages the use of community resources and locations to improve access to routine preventive care.
The coalition is finalizing plans to host 13 senior health fairs between October and December at various locations throughout DeKalb and Fulton counties. Fairs will include health related activities such as flu and pneumonia vaccinations, bone density screenings, blood pressure and blood glucose testing, podiatry assessments, medication reviews, and nutritional information including free produce selections.
Current dates and locations for SPARC health fairs include:
Fulton County
October 1 October 7
Adamsville Recreation Jefferson Place
3404 Delmar Ln., NW 1135 Jefferson St.
Atlanta, Ga. Atlanta, Ga.
10:00-12:00 10:00-12:00
October 14 October 21
North Fulton Community Charities Norman Berry Village
11270 Elkins Rd. 2840 Norman Berry Dr.
Roswell, Ga. East Point, Ga.
10:00-12:00 10:00-12:00
DeKalb County
September 16 September 23
Lithonia Senior Center Lou Walker Senior Center
2484 Bruce St. 2538 Panola Rd.
Lithonia, Ga. Lithonia, Ga.
9:30-1:30 9:30-1:30
October 2 October 7
North Dekalb Senior Center Ashford Parkside Senior Residence
2248 Johnson Ferry Rd. 3522 Blair Circle
Atlanta, Ga. Decatur, Ga.
9:30-1:30 9:30-1:30
October 8 October 23
Dekalb Atlanta Senior Center Life Enrichment Services
25 Warren St. 1340 McConnell Dr.
Atlanta, Ga. Decatur, Ga.
9:30-1:30 11:00-1:30
October 24 November 14
Clairmont Oaks Austin Drive Senior Campus
441 Clairemont Ave. 1989 Austin Dr.
Decatur, Ga. Decatur, Ga.
9:30-1:30 10:00-2:00
November 18
Beulah Baptist Church
2340 Clifton Springs Rd.
Decatur, GA 30034
9:30 a.m. - 1:30 p.m.
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Monday, August 11, 2008
Medical Supply Executive Imprisoned for Defrauding Medicare
ANGELA D. ISLEY, 44, of Atlanta, Georgia, was sentenced today by United States District Judge Charles A. Pannell, Jr. to serve more than 5 years in prison on charges of health care fraud, mail fraud, and money laundering. ISLEY was convicted of these charges on April 28, 2008, following a two week jury trial.
United States Attorney David E. Nahmias said, “The defendant submitted false claims to Medicare with a total value of more than $600,000, resulting in a loss to Medicare of $219,000. She also used her position at Orthoscript, Inc. to steal more than $360,000 from that company. Every dollar the defendant stole from the Medicare program was a dollar taken from the elderly and disabled Americans who depend on Medicare for their health care needs, and from the taxpayers who fund the program. The prison sentence imposed today reinforces the message that health care fraud is a serious crime with serious penalties.”
OIG Special Agent in Charge Melody Jackson said, “Today's action sends a message to those who corruptly take advantage of the Medicare system. The Office of Inspector General, Atlanta Regional Office will continue to work aggressively to eliminate this type of corruption in our health care system.”
ISLEY was sentenced to five years, ten months in federal prison to be followed by three years of supervised release, and ordered to pay restitution in the amount of $703,814. Judge Pannell said from the bench at today’s hearing that, partly because of extra costs incurred by the government retrieving hundreds of documents demanded by ISLEY during discovery that he is also ordering her to pay a fine of $125,000.
According to United States Attorney Nahmias and the information presented in court: Between January 2001 and December 2003, ISLEY knowingly assigned incorrect “product codes” to certain wrist braces and walking boots in Orthoscript Incorporated’s inventory in order to generate higher reimbursements from Medicare. ISLEY instructed company employees, often over their objections, to file claims with Medicare listing fraudulent product codes which are to be specifically used for custom-fabricated wrist braces, when all Orthoscript actually supplied were cheaper, prefabricated, off-the-shelf items. As a result of the health care fraud scheme, ISLEY caused Orthoscript to fraudulently bill the Medicare program for more than $600,000.
ISLEY's responsibilities at Orthoscript also included handling and accounting for ordinary business expenses, such as writing checks to vendors. Between April 2001 and April 2004, ISLEY wrote Orthoscript company checks to pay her and her partner's personal Capital One credit card bills, and used her sole control over Orthoscript's books to cause these payments, totaling more than $360,000, to be falsely recorded as legitimate business expenses. Orthoscript's officers and shareholders never authorized ISLEY to obtain reimbursement for these personal expenses.
A defendant in a related case, ARCH NELSON, 46, of Alpharetta, Georgia, who was a partner in Orthoscript, was sentenced late this afternoon to 5 years of probation, and ordered to perform 250 hours of community service, on a charge of misprision of felony, in knowing about and not reporting ISLEY’s crimes. NELSON had pleaded guilty to the charge in October 2006 and testified against ISLEY at her trial.
This case was investigated by Special Agents of the Department of Health and Human Services Office of Inspector General and the Federal Bureau of Investigation.
Assistant United States Attorneys Glenn D. Baker and John Horn prosecuted the case.
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Sunday, July 6, 2008
Proposed Congressional Legislation Would Cut $143 Million from the Medicare Advantage Program in Georgia
PRNewswire- -- Georgia seniors enrolled in Medicare Advantage face significant funding cuts under legislation being considered in Congress, according to new data released by America's Health Insurance Plans.
As Congress considers ways to halt the impending cut to physician payments in Medicare, many are looking at the Medicare Advantage program to pay for the fix. Legislation currently being considered (H.R. 6331) would cut $143 million from the Medicare Advantage program in Georgia alone over a five year period and severely cut back the areas where Medicare private fee-for-service plans can operate, adversely impacting 42,000 Georgia seniors enrolled in these plans.
"Congress should fix the physician payment cut without forcing seniors to pay for it," said Karen Ignagni, President and CEO of AHIP. "Seniors enrolled in Medicare Advantage could face limited choices, reduced benefits, and higher out-of-pocket costs if these cuts became law."
More than 135,000 Medicare beneficiaries in Georgia currently rely on Medicare Advantage to meet their health care needs. These plans offer additional benefits and services that are not available in traditional Medicare, including reduced out-of-pocket costs; $0-premium comprehensive drug coverage; vision, hearing, and dental coverage; wellness programs; and disease management and care coordination programs. Medicare Advantage enrollees save an average of $90 per month -- through improved benefits and lower out-of-pocket costs -- compared to what they would pay in traditional Medicare.
Friday, June 13, 2008
Chambliss Urges Bipartisan Medicare Solution for Doctors and Seniors
U.S. Senator Saxby Chambliss, R-Ga., today (June 12, 2008) took to the Senate floor to urge a bipartisan Medicare solution for doctors and seniors and expressed his opposition to S. 3101, a Medicare bill introduced by Sen. Max Baucus, D- Montana, he says would negatively impact Georgia seniors. A procedural vote to begin debate on the bill received 54 votes, short of the necessary 60 votes required under Senate rules. Chambliss is supporting an alternative measure, the “Preserving Access to Medicare Act of 2008,” introduced by Sen. Charles Grassley, R-Iowa, that would replace the scheduled physicians fee cut with a 1.1 percent increase but does not make drastic cuts to the Medicare Advantage program. Senate Democrats would not allow the Grassley legislation to be considered.
“While I am supportive of ensuring doctors receive adequate Medicare reimbursements so they can cover costs, I cannot support Senator Baucus’ legislation, which will expand entitlement programs and ultimately take money away from reimbursing doctors as we move on down the road. Now is not the time to expand entitlement spending when it is already out of control and unsustainable. This Medicare bill would drastically cut Medicare Advantage plans. Medicare Advantage saves beneficiaries an average of $86 per month compared to premiums in traditional fee-for-service Medicare, and 138,000 Georgians benefit from this program. Additionally, the president has threatened to veto the legislation and realistically we do not have enough time before the July1 deadline—even if this legislation had overwhelming support, which it does not—for this legislation to pass both houses, receive a veto from the president, and return for a veto override.
“While we need a more permanent solution so doctors don’t have to worry about having to lay off employees or denying Medicare patients altogether, it is important that we work in a bipartisan manner to reach a temporary solution for doctors’ reimbursements in the meantime. Doctors and seniors deserve a serious and responsible effort that addresses the impending fee cut without playing politics and creating a major expansion of entitlement spending. It is my hope that Congress will work toward a bipartisan agreement that will provide doctors with the relief they need before July 1.”
On December 18, 2007, Chambliss voted in favor of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-183). This legislation replaced the scheduled 10 percent fee cut with a 0.5 percent increase through June 30, 2008.
