WHEN THE CITIZENS SAY WE WANT UNIVERSAL CARE FOR ALL AND LEAVE OUR MEDICARE AND MEDICAID ALONE AND POLITICIANS LOOK TO A PRIVATE NON-PROFIT FOR THE LEGISLATION AND POLICY....THIS IS WHAT YOU ALWAYS HEAR CALLED ' ALEC' ------ American Legislative Exchange Council. This is what we have in Maryland
I am using this one example not because Beilenson is the bad guy in health care issues. My point is that as people start forming all kinds of protests and demanding the health care they had and now don't .......we are starting a Universal Care for Maryland for example....you see one institution, in this case Hopkins which is very proud that Maryland health institutions are the most profitable in the nation with these private health system reforms.....already has a powerful hold not only on the organizational non-profits but on the politicians' ear. THIS NON-PROFIT RULES AND THESE NON-PROFIT STRUCTURES REMOVE ALL ABILITY OF COMMUNITIES TO FIGHT FOR AN ISSUE OR ENGAGE THEIR POLS.
As we saw with the advocates for the Homeless that saw their organization fail to address their goals, we see it with community development issues, education issues, etc....the entire public policy sphere. So, raise your hand if you think a Health Care for All coalition would have wanted a public/universal program in Maryland? Do you think a watered-down Medicaid that now looks like a public health monitoring system meets that? OF COURSE NOT AND YET THAT IS WHAT WE HAVE AND HOPKINS HAD THESE POLICIES WELL-FORMULATED FOR A DECADE OR MORE.....WHAT WE GOT WAS HOPKINS' GOAL.
It really does matter that we not have these parallel quasi-governmental organizations filling our community needs. It is not democracy. It always moves policy away from people-friendly to corporate-friendly legislation. This is why we now have such wealth inequity and corporate rule......WE ALL FAILED TO NOTICE THESE FEW DECADES AS THIS STRUCTURE WAS TAKING SHAPE AND IT WAS THE FINANCIAL CRASH AND THE IMPOVERISHMENT OF NOT ONLY PEOPLE BUT GOVERNMENT COFFERS THAT ALLOWED THESE 1% TO COME OUT OF THE SHADOWS.
We can easily reverse this if we work around what this private non-profit puts into place. We run and vote for labor and justice to replace incumbent pols that are working with this crew and remove the legislation that allows all these non-profits such access to money and power.
VOTE YOUR INCUMBENT OUT OF OFFICE!!!
You can bet that what came out of these public meetings was not what the members of this coalition wanted. We wouldn't be forming a new Health Care for All right now if it was! THE HEALTH CARE FOR ALL BELOW IS JUST AN ALEC-STYLE BUSINESS POLICY-MAKING GROUP.
History The Founder of the Initiative is Peter Beilenson, MD, MPH, and the President is Vincent DeMarco, MA, JD. The Maryland Citizens’ Health Initiative Education Fund (“MCHI”) is a 501(c)(3) non-profit advocacy organization that was created in 1999 with a mission to educate all Marylanders about sound ways to achieve quality, affordable health care for all.
In order to create a comprehensive, economically sound health care for all plan, MCHI organized the state’s largest coalition and solicited input from coalition members and thousands of Maryland citizens in town hall meetings. National experts at the Johns Hopkins University Bloomberg School of Public Health and the University of Maryland Law School then worked to incorporate this community input into MCHI’s Health Care for All! Plan. In 2002, MCHI released its first plan and conducted a statewide campaign to educate people about how the plan would guarantee health care security for all Marylanders. A revised version of the plan was released in 2008 by the same set of experts that created the original following another round of public stakeholder meetings. The updated plan includes similar components as the Patient Protection and Affordable Care Act (2010) and is being used to guide analysis and planning for state and local implementation of the federal health reform law.
Over 1,200 faith, labor, business, health, and community organizations have joined the Health Care for All! Coalition to support enactment of MCHI’s plan. This is the largest coalition ever created in Maryland and certainly one of the largest health care consumer coalitions in the country.
The Coalition successfully advocated for a number of laws that will increase access to care and prescription drugs. In addition, MCHI continues to work with key state leaders to educate members of our broad coalition about how they can access health care programs now in existence. In the years ahead, MCHI will continue to educate and activate its powerful coalition to increase health care access in Maryland.
______________________________________________________
IF YOU TALK WITH ANY SOCIAL WORKER IN MARYLAND....ESPECIALLY BALTIMORE.... WHO CARRIES A MEDICAL CASE LOAD OF POOR WITH HEALTH/ MENTAL HEALTH ISSUES THEY WILL TELL YOU THEY HAVE CASELOADS IN THE HUNDREDS NOT THE 60-80 THAT IS RECOMMENDED. THAT IS BECAUSE MARYLAND DELIBERATELY UNDERFUNDS FOR SOCIAL WORK.
IT DOESN'T TAKE A ROCKET SCIENTIST TO FIGURE THAT THE STATE IS RECORDING THESE HUNDREDS OF CASES AND PROVIDING SERVICES THAT ARE AT BEST TOUCHING BASE WITH THESE PATIENTS, NOT PROVIDING CARE. FOR MENTAL HEALTH IT IS OFTEN SIMPLY HANDING THESE PATIENTS THEIR MEDS.
Johns Hopkins Medicine and the Health Care Debate
This article originally appeared in the pages of the Johns Hopkins Gazette, an official publication of the Johns Hopkins University. It may be found at the web address. http://gazette.jhu.edu/2009/11/02/jhm-and-the-health-care-debate/. For more information on the Healthcare Innovation Zones described above, please visit
How would you refocus the debate?
Miller: The president says the current system is broken. Well, the current system is broken because of the way the dollars are allocated for the delivery of health care. Namely, it is still a fee-for-service business. You are not going to really fix the system until you take a look at a different way to pay for the health care that you deliver.
Peterson: There is no incentive for a doctor to necessarily spend a lot of time and attention keeping patients well because that doctor is getting paid in the fee-for-service model. We believe there is something to be said for looking at a model that would give incentives for the providers of health care to keep people well as long as possible and be thoughtful for what they do when they introduce the patient into the health care delivery system.
Do such models exist?
Peterson: We have experience with two major programs where we have responsibility for whole populations. For example, we co-sponsor a Medicaid managed care organization called Priority Partners. Within that context, we receive from the state’s Department of Health and Mental Hygiene a monthly payment for each member that is enrolled. There are upwards of 150,000 individuals in the program. Along with that payment is the expectation that we will take care of all their health care needs. That has caused us to think about what we should be doing on behalf of those patients, and what we think is in our own best financial interests as well. It has caused us to pay more attention to prevention and to think about where are the most appropriate places to care for the patient when they need access to service.
Like what Dr. Miller is saying, you should have more incentive alignment between payer and provider. This population model causes us to think about how to do it more cost-effectively, but also how to do what is right medically and what is in the best interest of the patient.
[Editor’s note: The other major program that Johns Hopkins manages is the Maryland division of the Department of Defense’s Uniformed Services Family Health Plan, a health care program serving active-duty dependents, retirees, their families, survivors and certain former spouses worldwide.]
Is reform happening too fast or too slow?
Miller: Number one, you are dealing with one-sixth of the U.S. economy. We don’t think you can turn this thing upside down overnight. When we got into this managed care business, we had to learn. It’s an incremental learning curve. We think that anything that has to happen should be [in] incremental changes, not great big gulps, so to speak.
Peterson: We lost money for the first several years when we took on these managed care responsibilities. And as we learned to manage them, over time we did much better.
Something else to consider: In the past year, Maryland has changed the eligibility requirements for medical assistance, and so, many more people came into the system. We have taken about 30,000 more people. What happens when they first enroll is that they start to consume services. These folks seek out care because they never had access to a primary care doctor before. In a microcosm, it sort of gives you a taste of what could happen if the federal government extends in a big way coverage to large numbers of people.
The point is, we think that based on what we’ve seen, and what the state of Massachusetts has seen, it would be very wise for the federal government to introduce this in some reasonable increments. It is imperative that you balance the ability to ratchet up the capacity of the supply side with the demand you are creating.
This seems to all go back to the point that you want to share what has worked, and what hasn’t.
Miller: If we can identify the 5 [percent] to 10 percent of people who are really sick, because a lot of people are really healthy, and put measures in place to help those who are sick, that is where you can get some real value. We now have the largest primary health care network in Maryland. We have built that over time. If you go back to President Obama’s premise that we need to flatten the cost curve, we think we have experience here—that others can perhaps learn from what we have learned the hard way.
We also think that what we do in the Baltimore region is going to be different from what we do in Seattle or Chicago or San Diego. So there have to be areas of the country where there are experiments of how best to manage populations. For example, we deal with a lot of inner city poor people. In Iowa, you are dealing with more rural populations. Maybe you invest in telemedicine out there because you are dealing with such long distances.
____________________________________________________
Now, here we have Health Care for All with Beilenson at the lead back in 1999 and if you look at spending in Maryland of $6 billion, WHERE ARE THE RESULTS? You can ask any underserved resident and they will tell you that Hopkins does not care for them and in fact they will say that all their health care comes from 'research studies' that target the poor.
It is a conflict of interest at the least and I feel there is fraud in how issues are captured. How is this important to the middle-class? You do not keep going to the same player in any business when the policies fail to meet objectives and when the goal is profit. You can bet that the next project Beilenson develops.....in this case the Health Co-Op Insurance for those just above the poverty line will not be about quality care, it will protect health industry from lost profits from this cohort.
Life expectancy low, but growing in city
Women in many parts of country are dying youngerJune 15, 2011|By Noam N. Levey, Tribune Newspapers
Women in large swaths of America are dying younger than they were a generation ago, reversing nearly a century of progress in public health and underscoring the rising toll of smoking and record obesity.
Nationwide, life expectancy for American men and women has risen over the past two decades, and some U.S. communities still boast life expectancies as long as any in the world, according to newly released data. But over the past decade, the nation has experienced a widening gap between the most and least healthy places to live. In some parts of the United States, men and women are dying younger on average than their counterparts in nations such as Syria, Panama and Vietnam.
Baltimore remains among the areas with the lowest life expectancies, though improvements accelerated at twice the national average during the most recent decade studied.
Overall, America is falling further behind other industrialized nations, many of which have also made greater strides cutting child mortality and reducing preventable deaths.
In 737 U.S. counties, life expectancies for women actually declined between 1997 and 2007. For life expectancy to decline in a developed nation is rare. Setbacks on this scale have not been seen in the U.S. since the Spanish influenza epidemic of 1918, according to demographers.
"There are just lots of places where things are getting worse," said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, which conducted the research. "We're not keeping up."
The widening gulf between the healthiest and least healthy populations is partly due to wealth. But part of the gap appears to be attributable to cultural norms and differences in public health efforts, the researchers found.
Communities with large immigrant populations — Southern California, for example — fared considerably better than average despite relatively high poverty rates. The worst-performing counties were clustered primarily in Appalachia, the deep South and the lower Midwest. In those places, women died as much as a year younger in 2007 than women did a decade earlier. Life expectancy for women slipped 21/2 years in Madison County, Miss., which recorded the biggest regression.
A key finding of the data is that "inequality appears to be growing in the U.S.," said Eileen Crimmins, a gerontologist at the University of Southern California who also co-chaired the 2011 National Academies panel on life expectancies. "We are different than other countries." Researchers found substantially fewer geographic disparities in Great Britain, Canada and Japan, for example.
In general, men and women die youngest in poor, mostly rural parts of the South and in struggling urban centers like Philadelphia and St. Louis. In Baltimore, men on average live only 66.7 years.
By contrast, Americans in affluent counties near Washington, the San Francisco Bay Area and elsewhere have among the longest life expectancies in the world, outpacing even international leaders such as Japan and Switzerland.
The state and Baltimore's health officials have long recognized that those in the wealthier suburbs live longer and so do those in wealthier city neighborhoods.
For example, average life expectancy in Hollins Market is 20 years shorter than in wealthier Roland Park.
Dr. Oxiris Barbot, city health commissioner, said it amounts to a lot of "preventable death."
The city has adopted programs over the years to address the disparities, and Barbot recently unveiled a new program called Healthy Baltimore 2015 that seeks to involve most neighborhood, hospitals, businesses and faith organizations in the city. It sets specific goals for reducing the prevalence of Baltimore's most pervasive killers, such as HIV infection, heart disease and smoking.
"The fact that Baltimore City and cities like it continue to have shorter life expectancies than other areas draws attention to the fact that what we do in addressing the public health challenges has to go beyond the traditional health models," Barbot said. "We need to address the social determinants of health and adopt a health-in-all-policies approach."
That approach has already helped the statistics, said Frances B. Phillips, a deputy secretary of the state Department of Health and Mental Hygiene. The University of Washington report showed a jump in life expectancy of 4.1 years for men in Baltimore and 2.2 years for women in the decade ending in 2007 — about twice the national average. I WOULD LIKE TO POINT OUT THAT IT WAS FRANCES PHILLIPS WHO LOOKED AT ME AND TOLD ME THERE WAS NO HEALTH FRAUD IN THE SYSTEM.......I WOULD DOUBT HER STATISTICS!!!
Since then, Phillips said, the state's own data show that life expectancy for men and women in the state increased to 72.9 years in 2008-2009 from 72.4 years in 2006-2008.
She said the city and state have to continue focusing on access to health care, but also social and environmental factors, particularly in less affluent neighborhoods.
For now, she said, "Your ZIP code represents so many influences and opportunities you have to stay healthy or not."
__________________________________________________
Below you see health fraud legislation that was announced with great fanfare. Only it doesn't do anything. Not allowing compensatory damages? Not guaranteeing a lawyer's fee be paid in the settlement?
THESE ARE THE SAME LAWS ON RECORD THAT GIVE US THESE PARKING TICKET FINES WALL STREET RECEIVED FOR MASSIVE CRIME.
So in 2010 the Maryland Assembly acts as though it is getting tough on fraud especially now that the number of people falling into Medicaid is about to skyrocket....and it does nothing. I also want to say that the idea that there is only 5-10% of fraud in Medicaid is RIDICULOUS!!!!! All watchdogs and government accountability place entitlement fraud at 1/3 to 1/2 of all spending. Even doctors tell you that.
Maryland Senate passes watered-down state False Health Claims Act
Posted on March 24, 2010 by Richard Renner
The Maryland Senate yesterday passed a state version of the False Claims Act (FCA) by a vote of 37 in favor and 8 against. Before passing this bill, however, the Senate watered it down with an amendment. The Maryland False Health Claims Act of 2010, SB 279, as amended, no longer allows the state (or a whistleblower acting on behalf of the state) to obtain compensatory damages. The amendment also requires a court to dismiss the action if the State of Maryland declines to intervene. The Senate's amendment also waters down the provision for attorney fees. It now provides that attorney's fees and costs "may" be allowed by the court, and that the court must consider the amount of penalties and damages recovered. This last provision is contrary to prevailing law that calls on courts to award attorney fees based on market rates, without regard to any proportionality to the amount of recovery. The Senate's bill also allows courts to reduce the amount of the whistleblower's recovery if the court finds that the whistleblower participated in the violation. A more enlightened view would have barred recovery only if the person caused the violation through actions other than following orders of a superior. Also, I mentioned before that Maryland could gain even more if this bill covered all frauds, and not just those arising in medical care programs. Perhaps the Maryland House will consider these shortcomings when its Judiciary and Appropriations committee conducts the bill at its first hearing on April 1. The Senate bill does include an anti-retaliation provision, Section 2-607, that would allow employees to sue if they suffer retaliation for participating in a lawsuit, objecting to a violation, or refusing to participate in a violation. According to a Baltimore Sun article, the state administration estimates that between 5 and 10 percent of the state's $6 billion in annual medical spending is lost in fraudulent claims. The article quotes a spokesperson for the hospital association as saying that the amendment would cost the state the extra 10% it would receive from federal false claims lawsuits in the state. This refers to the Grassley Amendment to the federal FCA which increases a state's share if the state's law meets certain minimum requirements. Apparently, making hospital administrators happy is more important to Maryland's Senators than protecting taxpayer dollars.
_______________________________________________
HERE YOU HAVE THE HYPE AROUND LAWS THAT MAKE IT SOUND AS THOUGH THESE POLS ARE GETTING TOUGH ON FRAUD. AS YOU SEE EACH TIME THE THOUGHT GOES OUT TOWARDS PROTECTING THE BUSINESS FROM THE PEOPLE AND AS YOU SEE BELOW YOU END WITH A BILL THAT ALLOWS ABSOLUTELY NOTHING.
WALL STREET IS ALLOWED OFF THE HOOK EACH TIME BECAUSE OF THE SINGLE WORD.......'INTENT'. IT DOESN'T MATTER HOW AIRTIGHT THE CASE IS, THE BURDEN OF PROVING 'INTENT' MEANS THE CASES NEVER COME AND THAT IS WHY THE MARYLAND HOSPITAL ASSOCIATION DIDN'T FIGHT THIS BILL.
OMALLEY AND BROWN PRETEND TO GET TOUGH ON CRIME AND THE FRAUD JUST KEEPS ON COMING BECAUSE THERE WILL BE NO LAWYER THAT TAKES A CASE UNDER THESE TERMS.
Bill could save state millions in Medicaid fraud
March 23, 2010|By Annie Linskey | annie.linskey@baltsun.com
The Maryland General Assembly is poised to get tough on fraud that officials say is sapping hundreds of millions of dollars from the state's health care program for the poor, a crackdown that comes as Maryland braces for an increase in Medicaid patients through the just-passed national health insurance overhaul.
State health and budget officials estimate that between 5 percent and 10 percent of Maryland's $6 billion in Medicaid spending is fraudulent, with companies seeking payment for wheelchairs never delivered and doctors filing claims for patients who never received treatment.
A measure working its way through the legislature would allow anyone with knowledge of false Medicaid claims to file a lawsuit and share a percentage of damages - a concept intended to encourage whistle-blowers. The initiative would allow the state to capture up to three times the amount of the deceptive billing as a civil penalty, and would allow Maryland to join larger multistate federal fraud cases.
"We don't bring nearly the volume [of fraud cases] that are out there because we don't have the right tools," said Lt. Gov. Anthony Brown, who has been pushing the measure on behalf of the O'Malley administration. "We have a little hammer and we have a field of nails out there. If we had a little bit bigger hammer we could get more accomplished with each stroke."
Brown and others say the initiative - similar to a federal program and provisions on the books in 23 other states and the District of Columbia - could yield $20 million yearly.
The need for greater fraud protection comes as the number of patients on Medicaid - a joint federal-state program that provides health care to the poor - is reaching new heights and is expected to grow.
Gov. Martin O'Malley supported broader eligibility requirements for the program, and that change, coupled with a down economy, pushed more people into the low-income health insurance program, adding roughly 160,000 people to the rolls since 2007.
The number of recipients is now 730,000. And another 300,000 could join the program after the health insurance reform plan approved by Congress becomes law. Maryland spends $6 billion yearly on Medicaid payments.
"If we are going to expand Medicaid, it is that much more important that we have the right tools in place," Brown said.
The anti-fraud measure, a top priority of O'Malley's, awaits final approval in the Senate, where it was defeated last year by a single vote. And the House Judiciary Committee has not yet voted on it. But, unlike in earlier attempts, this year's measure has the support of the Maryland Hospital Association, which had successfully fought previous versions out of concern that the bill would unleash an onslaught of meritless lawsuits.
"People see a big building with four walls and see deep pockets there," said Jim Reiter, a spokesman for the hospital association. But in a concession to the hospitals, which account for roughly one-third of state Medicaid claims, administration officials agreed this year to a provision requiring the state to sign off on false claims cases before they go forward.
The legislation requires the state to join fraud lawsuits; if not, judges would dismiss them. "The state does not enter into frivolous lawsuits," said Sen. Brian E. Frosh, a Montgomery County Democrat and chair of the Judicial Proceedings Committee.
The compromise jeopardizes one of the potential revenue-generating aspects of the state bill, and will likely make Maryland ineligible for an enhanced proportion of damages from federal cases enjoyed by 14 states with the toughest whistle-blower provisions.
"That is the trade-off we made," said state health secretary John M. Colmers. "It was a way of trying to listen to the concerns of the hospitals."
Without the compromise, Maryland could have received 60 percent of any damages from a federal fraud case instead of the current 50-50 split.
Hospitals were also nervous that the legislation would make them liable for honest billing mistakes, and insisted on a provision requiring the plaintiffs prove intent. "Hopefully, it will prevent fraud instead of making us a target to go after," Reiter said.
The bill faces stiff opposition from the Maryland Chamber of Commerce, which believes it could drive up the cost of health care. Additionally, doctors worry that the measure doesn't include enough protection from unintentional billing errors.
"Billing in a doctor's office is very complex and the doctors are not typically involved," said Gene Ransom, CEO of MedChi, the state's medical society.
He opposes allowing individuals to sue to recover false billings, saying "we should not create an atmosphere where people are bounty hunting for doctors."
But advocates of the plan say the nation's health care system relies on trust, so it is critical that those with information about false claims come forward.
I am using this one example not because Beilenson is the bad guy in health care issues. My point is that as people start forming all kinds of protests and demanding the health care they had and now don't .......we are starting a Universal Care for Maryland for example....you see one institution, in this case Hopkins which is very proud that Maryland health institutions are the most profitable in the nation with these private health system reforms.....already has a powerful hold not only on the organizational non-profits but on the politicians' ear. THIS NON-PROFIT RULES AND THESE NON-PROFIT STRUCTURES REMOVE ALL ABILITY OF COMMUNITIES TO FIGHT FOR AN ISSUE OR ENGAGE THEIR POLS.
As we saw with the advocates for the Homeless that saw their organization fail to address their goals, we see it with community development issues, education issues, etc....the entire public policy sphere. So, raise your hand if you think a Health Care for All coalition would have wanted a public/universal program in Maryland? Do you think a watered-down Medicaid that now looks like a public health monitoring system meets that? OF COURSE NOT AND YET THAT IS WHAT WE HAVE AND HOPKINS HAD THESE POLICIES WELL-FORMULATED FOR A DECADE OR MORE.....WHAT WE GOT WAS HOPKINS' GOAL.
It really does matter that we not have these parallel quasi-governmental organizations filling our community needs. It is not democracy. It always moves policy away from people-friendly to corporate-friendly legislation. This is why we now have such wealth inequity and corporate rule......WE ALL FAILED TO NOTICE THESE FEW DECADES AS THIS STRUCTURE WAS TAKING SHAPE AND IT WAS THE FINANCIAL CRASH AND THE IMPOVERISHMENT OF NOT ONLY PEOPLE BUT GOVERNMENT COFFERS THAT ALLOWED THESE 1% TO COME OUT OF THE SHADOWS.
We can easily reverse this if we work around what this private non-profit puts into place. We run and vote for labor and justice to replace incumbent pols that are working with this crew and remove the legislation that allows all these non-profits such access to money and power.
VOTE YOUR INCUMBENT OUT OF OFFICE!!!
You can bet that what came out of these public meetings was not what the members of this coalition wanted. We wouldn't be forming a new Health Care for All right now if it was! THE HEALTH CARE FOR ALL BELOW IS JUST AN ALEC-STYLE BUSINESS POLICY-MAKING GROUP.
History The Founder of the Initiative is Peter Beilenson, MD, MPH, and the President is Vincent DeMarco, MA, JD. The Maryland Citizens’ Health Initiative Education Fund (“MCHI”) is a 501(c)(3) non-profit advocacy organization that was created in 1999 with a mission to educate all Marylanders about sound ways to achieve quality, affordable health care for all.
In order to create a comprehensive, economically sound health care for all plan, MCHI organized the state’s largest coalition and solicited input from coalition members and thousands of Maryland citizens in town hall meetings. National experts at the Johns Hopkins University Bloomberg School of Public Health and the University of Maryland Law School then worked to incorporate this community input into MCHI’s Health Care for All! Plan. In 2002, MCHI released its first plan and conducted a statewide campaign to educate people about how the plan would guarantee health care security for all Marylanders. A revised version of the plan was released in 2008 by the same set of experts that created the original following another round of public stakeholder meetings. The updated plan includes similar components as the Patient Protection and Affordable Care Act (2010) and is being used to guide analysis and planning for state and local implementation of the federal health reform law.
Over 1,200 faith, labor, business, health, and community organizations have joined the Health Care for All! Coalition to support enactment of MCHI’s plan. This is the largest coalition ever created in Maryland and certainly one of the largest health care consumer coalitions in the country.
The Coalition successfully advocated for a number of laws that will increase access to care and prescription drugs. In addition, MCHI continues to work with key state leaders to educate members of our broad coalition about how they can access health care programs now in existence. In the years ahead, MCHI will continue to educate and activate its powerful coalition to increase health care access in Maryland.
______________________________________________________
IF YOU TALK WITH ANY SOCIAL WORKER IN MARYLAND....ESPECIALLY BALTIMORE.... WHO CARRIES A MEDICAL CASE LOAD OF POOR WITH HEALTH/ MENTAL HEALTH ISSUES THEY WILL TELL YOU THEY HAVE CASELOADS IN THE HUNDREDS NOT THE 60-80 THAT IS RECOMMENDED. THAT IS BECAUSE MARYLAND DELIBERATELY UNDERFUNDS FOR SOCIAL WORK.
IT DOESN'T TAKE A ROCKET SCIENTIST TO FIGURE THAT THE STATE IS RECORDING THESE HUNDREDS OF CASES AND PROVIDING SERVICES THAT ARE AT BEST TOUCHING BASE WITH THESE PATIENTS, NOT PROVIDING CARE. FOR MENTAL HEALTH IT IS OFTEN SIMPLY HANDING THESE PATIENTS THEIR MEDS.
Johns Hopkins Medicine and the Health Care Debate
This article originally appeared in the pages of the Johns Hopkins Gazette, an official publication of the Johns Hopkins University. It may be found at the web address. http://gazette.jhu.edu/2009/11/02/jhm-and-the-health-care-debate/. For more information on the Healthcare Innovation Zones described above, please visit
How would you refocus the debate?
Miller: The president says the current system is broken. Well, the current system is broken because of the way the dollars are allocated for the delivery of health care. Namely, it is still a fee-for-service business. You are not going to really fix the system until you take a look at a different way to pay for the health care that you deliver.
Peterson: There is no incentive for a doctor to necessarily spend a lot of time and attention keeping patients well because that doctor is getting paid in the fee-for-service model. We believe there is something to be said for looking at a model that would give incentives for the providers of health care to keep people well as long as possible and be thoughtful for what they do when they introduce the patient into the health care delivery system.
Do such models exist?
Peterson: We have experience with two major programs where we have responsibility for whole populations. For example, we co-sponsor a Medicaid managed care organization called Priority Partners. Within that context, we receive from the state’s Department of Health and Mental Hygiene a monthly payment for each member that is enrolled. There are upwards of 150,000 individuals in the program. Along with that payment is the expectation that we will take care of all their health care needs. That has caused us to think about what we should be doing on behalf of those patients, and what we think is in our own best financial interests as well. It has caused us to pay more attention to prevention and to think about where are the most appropriate places to care for the patient when they need access to service.
Like what Dr. Miller is saying, you should have more incentive alignment between payer and provider. This population model causes us to think about how to do it more cost-effectively, but also how to do what is right medically and what is in the best interest of the patient.
[Editor’s note: The other major program that Johns Hopkins manages is the Maryland division of the Department of Defense’s Uniformed Services Family Health Plan, a health care program serving active-duty dependents, retirees, their families, survivors and certain former spouses worldwide.]
Is reform happening too fast or too slow?
Miller: Number one, you are dealing with one-sixth of the U.S. economy. We don’t think you can turn this thing upside down overnight. When we got into this managed care business, we had to learn. It’s an incremental learning curve. We think that anything that has to happen should be [in] incremental changes, not great big gulps, so to speak.
Peterson: We lost money for the first several years when we took on these managed care responsibilities. And as we learned to manage them, over time we did much better.
Something else to consider: In the past year, Maryland has changed the eligibility requirements for medical assistance, and so, many more people came into the system. We have taken about 30,000 more people. What happens when they first enroll is that they start to consume services. These folks seek out care because they never had access to a primary care doctor before. In a microcosm, it sort of gives you a taste of what could happen if the federal government extends in a big way coverage to large numbers of people.
The point is, we think that based on what we’ve seen, and what the state of Massachusetts has seen, it would be very wise for the federal government to introduce this in some reasonable increments. It is imperative that you balance the ability to ratchet up the capacity of the supply side with the demand you are creating.
This seems to all go back to the point that you want to share what has worked, and what hasn’t.
Miller: If we can identify the 5 [percent] to 10 percent of people who are really sick, because a lot of people are really healthy, and put measures in place to help those who are sick, that is where you can get some real value. We now have the largest primary health care network in Maryland. We have built that over time. If you go back to President Obama’s premise that we need to flatten the cost curve, we think we have experience here—that others can perhaps learn from what we have learned the hard way.
We also think that what we do in the Baltimore region is going to be different from what we do in Seattle or Chicago or San Diego. So there have to be areas of the country where there are experiments of how best to manage populations. For example, we deal with a lot of inner city poor people. In Iowa, you are dealing with more rural populations. Maybe you invest in telemedicine out there because you are dealing with such long distances.
____________________________________________________
Now, here we have Health Care for All with Beilenson at the lead back in 1999 and if you look at spending in Maryland of $6 billion, WHERE ARE THE RESULTS? You can ask any underserved resident and they will tell you that Hopkins does not care for them and in fact they will say that all their health care comes from 'research studies' that target the poor.
It is a conflict of interest at the least and I feel there is fraud in how issues are captured. How is this important to the middle-class? You do not keep going to the same player in any business when the policies fail to meet objectives and when the goal is profit. You can bet that the next project Beilenson develops.....in this case the Health Co-Op Insurance for those just above the poverty line will not be about quality care, it will protect health industry from lost profits from this cohort.
Life expectancy low, but growing in city
Women in many parts of country are dying youngerJune 15, 2011|By Noam N. Levey, Tribune Newspapers
Women in large swaths of America are dying younger than they were a generation ago, reversing nearly a century of progress in public health and underscoring the rising toll of smoking and record obesity.
Nationwide, life expectancy for American men and women has risen over the past two decades, and some U.S. communities still boast life expectancies as long as any in the world, according to newly released data. But over the past decade, the nation has experienced a widening gap between the most and least healthy places to live. In some parts of the United States, men and women are dying younger on average than their counterparts in nations such as Syria, Panama and Vietnam.
Baltimore remains among the areas with the lowest life expectancies, though improvements accelerated at twice the national average during the most recent decade studied.
Overall, America is falling further behind other industrialized nations, many of which have also made greater strides cutting child mortality and reducing preventable deaths.
In 737 U.S. counties, life expectancies for women actually declined between 1997 and 2007. For life expectancy to decline in a developed nation is rare. Setbacks on this scale have not been seen in the U.S. since the Spanish influenza epidemic of 1918, according to demographers.
"There are just lots of places where things are getting worse," said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, which conducted the research. "We're not keeping up."
The widening gulf between the healthiest and least healthy populations is partly due to wealth. But part of the gap appears to be attributable to cultural norms and differences in public health efforts, the researchers found.
Communities with large immigrant populations — Southern California, for example — fared considerably better than average despite relatively high poverty rates. The worst-performing counties were clustered primarily in Appalachia, the deep South and the lower Midwest. In those places, women died as much as a year younger in 2007 than women did a decade earlier. Life expectancy for women slipped 21/2 years in Madison County, Miss., which recorded the biggest regression.
A key finding of the data is that "inequality appears to be growing in the U.S.," said Eileen Crimmins, a gerontologist at the University of Southern California who also co-chaired the 2011 National Academies panel on life expectancies. "We are different than other countries." Researchers found substantially fewer geographic disparities in Great Britain, Canada and Japan, for example.
In general, men and women die youngest in poor, mostly rural parts of the South and in struggling urban centers like Philadelphia and St. Louis. In Baltimore, men on average live only 66.7 years.
By contrast, Americans in affluent counties near Washington, the San Francisco Bay Area and elsewhere have among the longest life expectancies in the world, outpacing even international leaders such as Japan and Switzerland.
The state and Baltimore's health officials have long recognized that those in the wealthier suburbs live longer and so do those in wealthier city neighborhoods.
For example, average life expectancy in Hollins Market is 20 years shorter than in wealthier Roland Park.
Dr. Oxiris Barbot, city health commissioner, said it amounts to a lot of "preventable death."
The city has adopted programs over the years to address the disparities, and Barbot recently unveiled a new program called Healthy Baltimore 2015 that seeks to involve most neighborhood, hospitals, businesses and faith organizations in the city. It sets specific goals for reducing the prevalence of Baltimore's most pervasive killers, such as HIV infection, heart disease and smoking.
"The fact that Baltimore City and cities like it continue to have shorter life expectancies than other areas draws attention to the fact that what we do in addressing the public health challenges has to go beyond the traditional health models," Barbot said. "We need to address the social determinants of health and adopt a health-in-all-policies approach."
That approach has already helped the statistics, said Frances B. Phillips, a deputy secretary of the state Department of Health and Mental Hygiene. The University of Washington report showed a jump in life expectancy of 4.1 years for men in Baltimore and 2.2 years for women in the decade ending in 2007 — about twice the national average. I WOULD LIKE TO POINT OUT THAT IT WAS FRANCES PHILLIPS WHO LOOKED AT ME AND TOLD ME THERE WAS NO HEALTH FRAUD IN THE SYSTEM.......I WOULD DOUBT HER STATISTICS!!!
Since then, Phillips said, the state's own data show that life expectancy for men and women in the state increased to 72.9 years in 2008-2009 from 72.4 years in 2006-2008.
She said the city and state have to continue focusing on access to health care, but also social and environmental factors, particularly in less affluent neighborhoods.
For now, she said, "Your ZIP code represents so many influences and opportunities you have to stay healthy or not."
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Below you see health fraud legislation that was announced with great fanfare. Only it doesn't do anything. Not allowing compensatory damages? Not guaranteeing a lawyer's fee be paid in the settlement?
THESE ARE THE SAME LAWS ON RECORD THAT GIVE US THESE PARKING TICKET FINES WALL STREET RECEIVED FOR MASSIVE CRIME.
So in 2010 the Maryland Assembly acts as though it is getting tough on fraud especially now that the number of people falling into Medicaid is about to skyrocket....and it does nothing. I also want to say that the idea that there is only 5-10% of fraud in Medicaid is RIDICULOUS!!!!! All watchdogs and government accountability place entitlement fraud at 1/3 to 1/2 of all spending. Even doctors tell you that.
Maryland Senate passes watered-down state False Health Claims Act
Posted on March 24, 2010 by Richard Renner
The Maryland Senate yesterday passed a state version of the False Claims Act (FCA) by a vote of 37 in favor and 8 against. Before passing this bill, however, the Senate watered it down with an amendment. The Maryland False Health Claims Act of 2010, SB 279, as amended, no longer allows the state (or a whistleblower acting on behalf of the state) to obtain compensatory damages. The amendment also requires a court to dismiss the action if the State of Maryland declines to intervene. The Senate's amendment also waters down the provision for attorney fees. It now provides that attorney's fees and costs "may" be allowed by the court, and that the court must consider the amount of penalties and damages recovered. This last provision is contrary to prevailing law that calls on courts to award attorney fees based on market rates, without regard to any proportionality to the amount of recovery. The Senate's bill also allows courts to reduce the amount of the whistleblower's recovery if the court finds that the whistleblower participated in the violation. A more enlightened view would have barred recovery only if the person caused the violation through actions other than following orders of a superior. Also, I mentioned before that Maryland could gain even more if this bill covered all frauds, and not just those arising in medical care programs. Perhaps the Maryland House will consider these shortcomings when its Judiciary and Appropriations committee conducts the bill at its first hearing on April 1. The Senate bill does include an anti-retaliation provision, Section 2-607, that would allow employees to sue if they suffer retaliation for participating in a lawsuit, objecting to a violation, or refusing to participate in a violation. According to a Baltimore Sun article, the state administration estimates that between 5 and 10 percent of the state's $6 billion in annual medical spending is lost in fraudulent claims. The article quotes a spokesperson for the hospital association as saying that the amendment would cost the state the extra 10% it would receive from federal false claims lawsuits in the state. This refers to the Grassley Amendment to the federal FCA which increases a state's share if the state's law meets certain minimum requirements. Apparently, making hospital administrators happy is more important to Maryland's Senators than protecting taxpayer dollars.
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HERE YOU HAVE THE HYPE AROUND LAWS THAT MAKE IT SOUND AS THOUGH THESE POLS ARE GETTING TOUGH ON FRAUD. AS YOU SEE EACH TIME THE THOUGHT GOES OUT TOWARDS PROTECTING THE BUSINESS FROM THE PEOPLE AND AS YOU SEE BELOW YOU END WITH A BILL THAT ALLOWS ABSOLUTELY NOTHING.
WALL STREET IS ALLOWED OFF THE HOOK EACH TIME BECAUSE OF THE SINGLE WORD.......'INTENT'. IT DOESN'T MATTER HOW AIRTIGHT THE CASE IS, THE BURDEN OF PROVING 'INTENT' MEANS THE CASES NEVER COME AND THAT IS WHY THE MARYLAND HOSPITAL ASSOCIATION DIDN'T FIGHT THIS BILL.
OMALLEY AND BROWN PRETEND TO GET TOUGH ON CRIME AND THE FRAUD JUST KEEPS ON COMING BECAUSE THERE WILL BE NO LAWYER THAT TAKES A CASE UNDER THESE TERMS.
Bill could save state millions in Medicaid fraud
March 23, 2010|By Annie Linskey | annie.linskey@baltsun.com
The Maryland General Assembly is poised to get tough on fraud that officials say is sapping hundreds of millions of dollars from the state's health care program for the poor, a crackdown that comes as Maryland braces for an increase in Medicaid patients through the just-passed national health insurance overhaul.
State health and budget officials estimate that between 5 percent and 10 percent of Maryland's $6 billion in Medicaid spending is fraudulent, with companies seeking payment for wheelchairs never delivered and doctors filing claims for patients who never received treatment.
A measure working its way through the legislature would allow anyone with knowledge of false Medicaid claims to file a lawsuit and share a percentage of damages - a concept intended to encourage whistle-blowers. The initiative would allow the state to capture up to three times the amount of the deceptive billing as a civil penalty, and would allow Maryland to join larger multistate federal fraud cases.
"We don't bring nearly the volume [of fraud cases] that are out there because we don't have the right tools," said Lt. Gov. Anthony Brown, who has been pushing the measure on behalf of the O'Malley administration. "We have a little hammer and we have a field of nails out there. If we had a little bit bigger hammer we could get more accomplished with each stroke."
Brown and others say the initiative - similar to a federal program and provisions on the books in 23 other states and the District of Columbia - could yield $20 million yearly.
The need for greater fraud protection comes as the number of patients on Medicaid - a joint federal-state program that provides health care to the poor - is reaching new heights and is expected to grow.
Gov. Martin O'Malley supported broader eligibility requirements for the program, and that change, coupled with a down economy, pushed more people into the low-income health insurance program, adding roughly 160,000 people to the rolls since 2007.
The number of recipients is now 730,000. And another 300,000 could join the program after the health insurance reform plan approved by Congress becomes law. Maryland spends $6 billion yearly on Medicaid payments.
"If we are going to expand Medicaid, it is that much more important that we have the right tools in place," Brown said.
The anti-fraud measure, a top priority of O'Malley's, awaits final approval in the Senate, where it was defeated last year by a single vote. And the House Judiciary Committee has not yet voted on it. But, unlike in earlier attempts, this year's measure has the support of the Maryland Hospital Association, which had successfully fought previous versions out of concern that the bill would unleash an onslaught of meritless lawsuits.
"People see a big building with four walls and see deep pockets there," said Jim Reiter, a spokesman for the hospital association. But in a concession to the hospitals, which account for roughly one-third of state Medicaid claims, administration officials agreed this year to a provision requiring the state to sign off on false claims cases before they go forward.
The legislation requires the state to join fraud lawsuits; if not, judges would dismiss them. "The state does not enter into frivolous lawsuits," said Sen. Brian E. Frosh, a Montgomery County Democrat and chair of the Judicial Proceedings Committee.
The compromise jeopardizes one of the potential revenue-generating aspects of the state bill, and will likely make Maryland ineligible for an enhanced proportion of damages from federal cases enjoyed by 14 states with the toughest whistle-blower provisions.
"That is the trade-off we made," said state health secretary John M. Colmers. "It was a way of trying to listen to the concerns of the hospitals."
Without the compromise, Maryland could have received 60 percent of any damages from a federal fraud case instead of the current 50-50 split.
Hospitals were also nervous that the legislation would make them liable for honest billing mistakes, and insisted on a provision requiring the plaintiffs prove intent. "Hopefully, it will prevent fraud instead of making us a target to go after," Reiter said.
The bill faces stiff opposition from the Maryland Chamber of Commerce, which believes it could drive up the cost of health care. Additionally, doctors worry that the measure doesn't include enough protection from unintentional billing errors.
"Billing in a doctor's office is very complex and the doctors are not typically involved," said Gene Ransom, CEO of MedChi, the state's medical society.
He opposes allowing individuals to sue to recover false billings, saying "we should not create an atmosphere where people are bounty hunting for doctors."
But advocates of the plan say the nation's health care system relies on trust, so it is critical that those with information about false claims come forward.
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