Sunday, December 4, 2016

Health Insurance - Senator Rubio's Little Bag of Cyanide

Where Health Care Pickin's Are the Best
"Thar's sum big cash in them hills..."

It turns out that Florida is perhaps the sweetest opportunity to cash in big on health insurance money. It's hardly a secret that the environment is heavy laden with chances for the unscrupulous "harvesting" of the state's major reserve of Federal spending programs.

Of course, anyone who has been paying attention already knows that Florida's governor, Mark Scott, has "racked up" one of the largest health insurance frauds in recent history. The following POLITIFACT articles will bring visitors to the blog up to date on Governor Scott's record.

Rick Scott 'oversaw the largest Medicare 
fraud' in U.S. history, Florida Democratic Party says
By Amy Sherman on Monday, March 3rd, 2014 

[Visit the original article: here - POLITIFACT Links in original article remain enabled. A follow up story is  here]
First, Gov. Rick Scott scared the bejesus out of seniors with an online ad claiming that Medicare rate cuts would lead them to lose access to their doctors, hospitals and preventive care.

Then, the Florida Democratic Party fired back at Scott, issuing a press release that called Scott "the ultimate Medicare thief."

The Democrats were referring to Scott’s prior tenure as CEO of Columbia/HCA about a decade ago, when the hospital company was fined $1.7 billion for Medicare fraud.

"Rick Scott is saying Democrats are committing Medicare robbery, when in fact he's the ultimate Medicare thief. He lost the right to accuse Democrats of raiding Medicare when he oversaw the largest Medicare fraud in the nation's history. Rick Scott's company stole money that should have gone to health care for seniors," said Florida Democratic Party spokesman Joshua Karp in the Feb. 25 press release.

Separately, we have fact-checked Scott’s claim "we are seeing dramatic rate cuts" to Medicare that will affect people's choice of doctor, hospital and preventive care. We concluded that Scott had failed to say that the rate cut only applies to Medicare Advantage, and thus only affects a fraction of all Medicare beneficiaries. Also, it could be several months before we know the actual impact of the cut which could vary county by county. We rated Scott's claim Mostly False.

Here, we’ll fact-check the Democratic counter-attack that Scott "oversaw the largest Medicare fraud in the nation’s history."

Scott’s tenure at Columbia/HCA

During Scott’s 2010 race for governor, PolitiFact fact-checkedmultiple claims related to his tenure at Columbia/HCA. Now, we’ll recap some of our earlier discussion of the investigation and fine.

Scott started what was first Columbia in 1987, purchasing two El Paso, Texas, hospitals. Over the next decade he would add hundreds of hospitals, surgery centers and home health locations. In 1994, Scott’s Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies.

In 1997, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. The investigation focused on whether Columbia/HCA had committed Medicare and Medicaid fraud.

Scott resigned as CEO in July 1997, less than four months after the inquiry became public. Company executives said had Scott remained CEO, the entire chain could have been in jeopardy.

During his 2010 race, the Miami Herald reported that Scott had said he would have immediately stopped his company from committing fraud -- if only "somebody told me something was wrong." But there were such warnings in the company’s annual public reports to stockholders -- which Scott had to sign as president and CEO.

Scott wanted to fight the accusations, but the corporate board of the publicly traded company wanted to settle.

In December 2000, the U.S. Justice Department announced that Columbia/HCA agreed to pay $840 million in criminal fines, civil damages and penalties.

Among the revelations from the 2000 settlement:

• Columbia billed Medicare, Medicaid, and other federal programs for tests that were not necessary or had not been ordered by physicians;

• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals;

• The company illegally claimed non-reimbursable marketing and advertising costs as community education;

• Columbia billed the government for home health care visits for patients who did not qualify to receive them.

The government settled a second series of similar claims with Columbia/HCA in 2002 for an additional $881 million. The total for the two fines was $1.7 billion.

On Scott’s 2010 campaign website, he admitted to the $1.7 billion fine, though the link is no longer on the site.

What type of record was that fine?

The fine clearly set a record, though the Justice Department (and media reports at the time) were not always consistent in their terminology, sometimes describing it as the "largest government fraud settlement in U.S. History" and other times more specifically as the "largest health care fraud case in U.S. History."

A Justice Department spokeswoman said that officials refer to Columbia/HCA as "largest health care fraud" rather than the more narrow term "Medicare fraud" because it involved defrauding other government programs such as Medicaid rather than Medicare exclusively. The Justice Department described in detail the various ways the company defrauded Medicare and other government health programs here.

Here’s a key point, though: While the Columbia/HCA settlement was a record at the time for health care fraud, it has since been surpassed. In cases related to the improper promotion of certain drugs, Johnson & Johnson agreed to a a $2.2 billion settlement in 2013, Pfizer settled for $2.3 billion in 2009, and GlaxoSmithKlinesettled for $3 billion in 2012.

"HCA was the record health care fraud at the time. It’s now Glaxo," Justice Department spokeswoman Linda Mansour told PolitiFact in an email.

That said, these cases were a little different. While the Justice Department’s case against Columbia/HCA repeatedly mentions overbilling and defrauding Medicare and Medicaid specifically, the three newer cases focused on the marketing of drugs, with Medicare, Medicaid and other federal programs caught up in the impropriety, rather than being the specific targets of the fraud.

Because the Justice Department press releases explaining the settlements don’t explicitly break down how much of the misconduct in those more recent cases defrauded Medicare explicitly, it’s difficult to make comparisons.

The Pfizer case includes violations relating to mis-branding and kickbacks, "so there may be a distinction to be made for that reason when thinking about whether it all should be classified under the very general category of ‘Medicare fraud,’ " said Asha Scielzo, who practices health care law at the firm Pillsbury Winthrop Shaw Pittman.

The Columbia/HCA case "still is the largest fraud settlement for a hospital corporation in U.S. history," since all the others involved pharmaceutical firms, added Zack Buck, a health care law professor at Mercer. "So I guess, the quote (by the Florida Democratic Party) is a little loose."

The Scott campaign did not respond to an inquiry for this fact-check. However in 2010, Scott told the Tampa Bay Times, "There's no question that mistakes were made and as CEO, I have to accept responsibility for those mistakes. I was focused on lowering costs and making the hospitals more efficient. I could have had more internal and external controls. I learned hard lessons, and I've taken that lesson and it's helped me become a better business person and a better leader."


Our ruling

The Florida Democratic Party said Scott "oversaw the largest Medicare fraud in the nation’s history."

The Columbia/HCA settlement has since been surpassed in dollar value, though the bigger cases involved Medicare somewhat less directly. Because the Democratic Party could have been a bit more specific in its wording -- by saying that Scott oversaw the largest Medicare fraud at the time -- we rate the claim Mostly True.

US Elders "Wintering" in Sunny Florida
The old folks totally love Medicare fraud.
Gutting Social Security is also apparently one of their favorites.
Everything's easier after it's been soaked in FOX right wing lies.

Florida is full of senior citizens who receive and rely on Social Security and Medicare benefits. One might think that such a voting demographic would have swayed the state's leadership to be somewhat more generous with respect to these programs.

Not a problem. For Republicans an order coming down from the billionaire owners of the Party must be obeyed long before "confusing" the issue with the needs of a fully duped, voting public. These old Floridians seem quite comfortable in their role as fully propagandized, "true believers" and far less interested in any geriatric impulse for self-preservation.

The command of the day is not to provide for citizens. It is to provide for the campaign contributing oligarchs and corporatists who are "calling the tune."

Well, the Republican official policy remains the same. Absolute loyalty to Health Insurance corporate profits is not to be questioned. On again off again Florida GOP Senator, Marco Rubio, certainly rose to the occasion to perform his part of the hatchet job. 

Rubio's "Poison Pill"
Unhappily, little Marco's toxin infected far more territory than just Florida.
There simply must be adequate suffering to satisfy his corporate masters.

Little Marco

How Marco Rubio Is Quietly
Killing ObamaCare

By Marc A. Thiessen
December 14, 2015
[Visit the original article here_Washington_Post  Links remain enabled.]
    Sen. Marco Rubio (R-Fla) holds a town hall meeting last month at the Laconia VFW in N.H.                                                                                              Cheryl Senter, Associated Press

There’s a Cuban American first-term senator running for president who has done more than any Republican to stop Obamacare.
No, I’m not talking about Ted Cruz (R-Tex.).

I’m talking about Marco Rubio (R-Fla.).

The battle against Obamacare has been Cruz’s signature struggle. In 2013, Cruz took to the Senate floor and promised to speak out against Obamacare “until I am no longer able to stand.” To fill the time, he even read Dr. Seuss’s “Green Eggs and Ham.” His filibuster, and the government shutdown over Obamacare it sparked, launched Cruz into the political stratosphere — inspiring conservatives eager for a principled fighter who does not back down.

But while the shutdown may have helped boost Cruz into the top tier of Republican presidential contenders, it had zero impact on undermining Obamacare.

Rubio, by contrast, didn’t read Dr. Seuss on the Senate floor, but he has quietly pushed Obamacare into what may prove to be a death spiral.

When the Obama administration was crafting Obamacare, it came up with a crony capitalist solution to entice reluctant insurers to join the exchanges. Many insurers worried that there would not be enough healthy people paying in to cover the costs of sick people. So the administration created a “risk corridor” program to help prop up insurers who lost money in the first three years of the law. Profitable insurers would pay some of those profits into a pool to help insurers who lost money. If the amount insurers lost exceeded what the companies paid in, the government would step in and make up the difference.

Calling this “a taxpayer-funded bailout for insurance companies,” Rubio last year quietly inserted language into the omnibus government spending bill that barred the Department of Health and Human Services from dipping into general funds to pay failing insurers. “While the Obama administration can still administer the risk-corridor program, for one year at least, they won’t be able to use taxpayer funds to bail out insurance companies,” Rubio said.

His provision sparked little opposition at the time, but it has proved to be a poison pill that is killing Obamacare from within.

Last year, insurers lost $2.9 billion more than expected on Obamacare. But insurers had paid only $362 million into the program — leaving it more than $2.5 billion short. Thanks to Rubio’s provision, the administration was allowed to pay only 13 cents of every dollar insurers requested. Without the taxpayer bailouts, more than half of the Obamacare insurance cooperatives created under the law failed. One, Health Republic of Oregon, was expecting a $7.9 million bailout from the government. Instead, thanks to Rubio, it got only $995,000 — not a penny of it from the taxpayers. The Oregon co-op announced in October it was closing its doors. Soon, two other insurers — WinHealth Partners in Wyoming and Moda Health in Washington state — pulled out of the exchanges. And United Healthcare, one of the nation’s largest insurers, announced that it may leave the Obamacare exchanges in 2016. If that happens, and other insurers follow United’s lead, that could spell disaster for Obamacare.

The Hill newspaper called Rubio’s provision “the biggest blow in the GOP’s five-year war against Obamacare.” The New York Times declared in a front-page story, “For all the Republican talk about dismantling the Affordable Care Act, one Republican presidential hopeful has actually done something toward achieving that goal,” adding that Rubio’s provision has “tangled up the Obama administration, sent tremors through health insurance markets and rattled confidence in the durability of President Obama’s signature health law.”

Now that the Obama administration understands the grave threat Rubio’s provision poses to Obamacare, Democrats are pushing to block it from this year’s omnibus spending bill so that they can bail out the insurers. According to Politico, “HHS officials . . . maintained that insurers will eventually receive the requested payments during the next two years of the temporary program.”

The insurers are joining the fight. In talking points obtained by BuzzFeed, Blue Cross Blue Shield Association’s chief executive, Scott Serota, warned congressional Democrats that Rubio’s provision “will result in massive premium increases and could cause private insurers to become insolvent.” In other words, Rubio’s provision poses a mortal threat to Obamacare.

Rubio maintains that if it takes a taxpayer bailout of big business to save Obamacare, that alone proves the law is unsustainable. He is pushing to keep his bailout ban in the final bill. “Let’s be clear, the reason these health insurance companies are enduring a financial loss is that Obamacare is a disastrous law,” Rubio declared in a letter to House and Senate leaders. “It broke the promise to lower health insurance premiums . . . Now the very architects of this law are attempting to place taxpayers on the hook.”

He’s right — and now it’s up to GOP leaders to back him by refusing to agree to any omnibus spending bill that allows a taxpayer bailout for insurance companies that made a bad bet on Obamacare.

And Rubio deserves credit at Tuesday night’s Republican presidential debate as the only candidate on the stage who has done more than talk about killing Obamacare.

Who Signed Marco's Check?

Sick People: A FANTASTIC profit opportunity!
Don't ask about the health outcomes. [image WIKI]
[You can review Senator Rubio's campaign contributors here: Marco Rubio/OPENSECRETS]

Now that the banksters and lobbyists are completely in charge of everything, we can watch the wavering promises of the old ACA being patiently hacked to death to restore the corporate share of the country's $6 Trillion annual health care tab.

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