This was written with data before the explosion of fraud in the 2000s....the health fraud is now 1/2 of spending on Entitlements.
'It is clear to see why Americans consider this the biggest cause, when health care fraud was estimated to cost approximately $100 billion to $250 billion per year in 1998, or 10 percent to 25 percent of total health care spending'
Health care fraud is an important and visible factor associated with increasing health care costs in the United States. Medicare and Medicaid contribute to a vast majority of those cost sand therefore must be heavily scrutinized. This thesis will investigate the types of fraud, who commits them, and why the health care system is more susceptible to fraud.
Regarding sending patient care to community clinics to 'end fee for service':
Below you see an example of just what these clinics moving to the communities will look like. Maryland is bringing all that is Texas to Maryland and that includes maximizing health profits by privatizing public health.....just as with public education reform Texas-style. We know that clinics being opened by individual doctors are being pressed financially to do assembly-line medicine in order to process enough work to create a profitable business. It is already documented. We know that all of this is fee for service as they get paid to give a shot, stitch a wound, or draw blood for lab readings. So, we not only see fee for service on steroids but these individual clinics are already known for systemic fraud as these groups pad the billing to boost profit.
The idea that sending multiple operations into the city to act individually with no oversight is more cost-effective for patients or public health Trusts is absolutely absurd. The fraud and waste will explode. The Affordable Care Act does nothing to address fraud and waste....it only consolidates the health industry into global health corporations.
No doubt we needed people out of the ER for regular treatment. If hospitals were public they would have a separate department at the hospital just for that. When Dr. Sharfstein speaks of eliminating fee for service in hospitals he is referring to the fact that doctors will now be considered working FOR the hospital and not ATTACHED TO the hospital as an associate. Since the idea of health reform is to create massive health companies....fee for service by doctors would take away profit from the 1% owning the health system. THIS IS WHY HOSPITALS ARE CHANGING THIS PROCESS----DOCTORS WILL BE PAID EMPLOYEES AND THE PROFITS WILL GO TO THE HEALTH CORPORATION.
Creating a profit-driven health corporation that pushes the most costly care to what we already know will be predatory and substandard levels of care that gut the Trusts with fraud will not be good for anyone. Look below at a welcoming advertisement for one of Texas' clinics----and then look at the article below that to what the reality of health care in Texas is all about. REMEMBER, THE PEOPLE SEEKING HEALTH CARE FOR POOR AND WORKING CLASS ARE FAR MORE WOMEN AND CHILDREN AS MEN AVOID THE DOCTOR AT ALL COST. They are creating this tiered level of access to care for mothers and children.
Ten common health care provider frauds
Charles Piper, CFE, CRT
Billing for services not rendered.
Billing for a non-covered service as a covered service.
Misrepresenting dates of service.
Misrepresenting locations of service.
Misrepresenting provider of service.
Waiving of deductibles and/or co-payments.
Incorrect reporting of diagnoses or procedures (includes unbundling).
Overutilization of services.
Corruption (kickbacks and bribery).
False or unnecessary issuance of prescription drugs.
About Our Clinic
People's Community Clinic is a unique Austin institution and one of the oldest continually-running independent clinics for primary care in America. Founded in 1970 by a group of volunteer doctors and nurses, the Clinic has never wavered from its mission: to improve the health of medically underserved and uninsured Central Texans by providing high quality, affordable healthcare with dignity and respect.
Thu Jul 18, 2013 at 12:46 PM PDT
Women's health care going from bad to worse in Texas
by Laura Clawson
Texas ranked worst in the nation for health care by gov’t agency
THE ASSOCIATED PRESS
Friday, July 6, 2012, 3:23 PM
Regarding the MD private health exchanges:
We apologize to the over three hundred people out of 160,000 visiting the exchange for not getting the warning to you about the goal of this health reform! We are glad that everyone is seeing the problem and running.
Continuing with the policies neo-liberals are putting in place to protect the medical community from what will be massive lawsuits as people die from all kinds of malpractice and no oversight.....no definition of health fraud....no malpractice insurance requirement....public health being handed to private non-profits to limit public access.....no attempt to recover tens of billions in halth fraud in Maryland alone.....
We were told several weeks ago that the Obama Administration had cut the USDA inspection of poultry so severely that one inspector would be responsible for inspecting a processing line of chicken carcasses passing by at the speed of light. Basically, inspections are not happening at all with US meat processors. That is happening because in order for global meat sellers to COMPETE with other global third world meat sellers the US must end all first world public protections. THIS IS DONE AS PART OF THE TPP----PUBLIC HEALTH IS A DRAG ON CORPORATE PROFIT AND MUST GO SAY NEO-LIBERALS.
HOW WILL YOU PAY FOR MULTIPLE TRIPS TO THE DOCTOR FROM CONSTANT FOOD POISONING? YOU WILL NOT!
We are hearing on the news ever growing cases of food poisoning, food recalls, and deaths by food contamination. This is because Obama did not rebuild regulatory agencies dismantled by Bush....he keeps dismantling them further. The neo-liberals intend to flood the US market with food from countries having no public health system and is in the process of making sure the US has none as well.
So, how does health care reform handle what we know will be a flood of public illnesses caused from bad food? Remember, in Maryland you have to have a primary health doctor send you to a specialist who then hospitalizes you. The Bronze and Silver Plans being sold in Maryland will have your family paying $10,000 plus 30-40% of costs through co-pays each time you get sick from bad food. Think how long people with Salmonella et al stay in the hospital......you will be medically bankrupt in no time. You will then have an insurance policy that only allows preventative care with no access to specialists that send you to the hospital.
THIS IS REALLY, REALLY, REALLY, REALLY BAD.
I heard Dr Sharfstein state that these reforms had to be made because of the flood of baby boomers hitting the health system. Again, Reagan in the 1980s raised the payroll tax deductions triple the amount at the time BECAUSE HE WAS ADDRESSING THE COSTS OF THE BABY BOOMERS HITTING THE HEALTH SYSTEM THIRTY YEARS FROM THEN. WE PAID THROUGH PAYROLL TAXES FOR THIS FLOOD OF BABY BOOMERS ALREADY!
So why do neo-liberals want you to believe there is a shortfall in funding for senior care? REAGAN SENT ALL OF THESE PAYROLL TAXES TO THE TREASURY AND NOT THE TRUST----30 YEARS OF SS AND MEDICARE TRUST FUNDS INTO THE TREASURY. Then, we have 1/2 of all Entitlement spending stolen from health industry fraud for these few decades....THIS IS WHY DR. SHARFSTEIN IS MAKING IT IMPOSSIBLE FOR PEOPLE TO ACCESS HEALTH CARE.
When the US moves from being a first world country in terms of quality of life and at the same time takes away health care access for most people.....there will be serious consequences.
JOIN EVERYONE IN UNIVERSAL CARE GROUPS----CHECK OUT NATIONAL PHYSICIANS HEALTH CARE FOR ALL. WE NEED TO SHAKE THESE CORPORATE POLS OUT OF THE RUG BY RUNNING AND ELECTING LABOR AND JUSTICE!
October 9, 2013
USDA Wants to Eliminate Poultry Inspectors for Factory Birds
Health Impact News Editor Comments:
Besides the obvious food safety concerns expressed by Ken Ward below, there is quite possibly a far greater risk here in this new USDA plan to privatize poultry inspection. This rule change may exclude small pastured poultry producers from being able to comply and market their products.
Currently, it is very difficult for small-scale poultry producers to find processors that have a USDA inspector present when processing chicken. Several states do not have a single USDA certified processing plant available for smaller producers to process their high end free-range and pastured organic chickens. This is due to the fact that the large factory poultry operations, who do all of their processing in-house, have driven most other processing plants out of business.
Under current regulations, chicken processed without a USDA inspector present has a very limited market. Most farmers who are not growing factory birds sold to the main poultry operations that control all the chicken sold in the U.S., but instead raise pastured chickens outdoors that they market directly to health-conscious consumers, have to process their birds on their farm, due to the lack of processing facilities. In all states, there are limits as to how many chickens you are allowed to process on your farm, and the restrictions on selling those chickens vary greatly from state to state. Some states only allow one to sell these chickens on the farm where they were processed, which often is very far away from urban areas where most of the farmer’s customers would be.
In order to ship high quality chickens directly to customers in another state (as Tropical Traditions currently does through their Grass-fed line of meats produced by small family farms in Wisconsin), the FDA requires that the chickens have to be processed in a facility with a USDA inspector present. There are very few of these left in the United States, and if this new rule that USDA is proposing goes through, even those that are present will probably be eliminated. No one will be able to order chicken over the Internet anymore, greatly restricting your current food choices if you do not want to order factory chickens, and do not live close enough to a farm to drive somewhere to purchase a chicken raised outdoors on pasture.
Given this USDA plan, and the recent FDA plans for egg laying birds that would effectively eliminate eggs from pastured chickens, one can’t help but wonder if there isn’t a concerted effort to squeeze free range and pastured poultry farmers out of the market in favor of factory birds? Factory chickens make up a multi-billion dollar industry that often gets its way with government officials, as was seen recently in Maryland where they convinced the government to delay action at cleaning up the Chesapeake Bay from chicken manure run-off because it would have hurt their sales too much.
Stop the USDA’s plan for unsafe chicken Hi, I’m Ken. I want to tell you about the USDA’s outrageous plan to fleece consumers by handing over our food safety to the very corporations that produce our food.
I can tell you first-hand what a bad idea this is: I’m a retired USDA poultry inspector, with 30 years of experience on the packing house floors, and I was directly involved with this project from the very beginning. From what I’ve seen, this new inspection system is more like a “no inspection” system.
It’s very simple. Who do you want inspecting the poultry that you eat? Trained USDA employees? Or the companies that run factory farms?
When I was an inspector, we went bird by bird to assure that plants were producing clean, wholesome products. But that won’t be the case if this plan goes forward! I worked with the pilot phase of this plan to privatize the inspection of our poultry, but it could soon be approved for broader use… and it turns the “inspection” of our food into a sham.
Privatizing inspection means shifting the actual hands-on inspection of the birds from highly trained, taxpayer-funded, unbiased, Federal employees to plant employees who have no requirement of any training at all — and in doing so, the USDA had to change the name of these employees to ‘sorters’ in lieu of inspectors, because what they’re doing is not inspection.
The USDA needs to hear from you. Tell them that privatizing our food safety is unacceptable!
It is a sad state of affairs when our government is more concerned about saving money than it is about people’s health, but that’s what we’ve got here: a money-saving system that makes it impossible to do adequate inspection of our poultry. A properly trained inspector utilizes ALL of their senses to make a decision about the wholesomeness of the bird. I have no idea of how checking carcasses flying by at unregulated speeds of 3 per second, without any authority to touch, turn or do anything else, can be called “inspection.”
To put it simply, if this plan is approved, there would effectively be no inspection of our poultry. That means no one to make sure that the chicken we eat isn’t contaminated with dirt, feces, or… well, you get the idea. I’ll spare you the gross details.
The USDA should be getting the message about what a bad idea this is. Canada, Australia and New Zealand have had serious food safety problems tied to their privatized meat inspection programs. And just this week, the U.S. Government Accountability Office put out a report that strongly condemned the pilot project being used to justify the plan. But the USDA needs to hear from consumers like you, too. Tell the USDA that privatized poultry inspection is like no inspection at all — and that’s not okay.
As a 30-year veteran in the fight of assuring food safety, and now as a consumer who relies on those unbiased federal inspectors to be my eyes, nose and hands in making sure I get wholesome chicken to eat, I’m urging the USDA not to implement this “no inspection” system — and I hope you will, too.
Salmonella Strain Tied to Nursing Center Outbreak Likely Drug-Resistant
By Dan Flynn | August 15, 2012
A skilled nursing and rehabilitation center in Blue Hill, Nebraska is ground zero for an outbreak of Salmonella Newport, a potentially drug-resistant strain of bacteria that in this case has caused 17 confirmed illnesses and 2 additional probable cases among residents, visitors and staff.
The Nebraska Department of Health and Human Services expects to have results on the isolates regarding susceptibility of the Salmonella Newport serotype later this week, according to spokeswoman Leah Bucco-White.
Four residents of the Blue Hill Care Center were hospitalized for a short time after showing symptoms, and one visitor remains in the hospital.
Blue Hill is located in Webster County about 175 miles south and west of Omaha.
The outbreak is being investigated by the state and local South Heartland District Health Department, and health officials said the “Blue Hill Care Center is cooperating fully with the investigation to help identity the source and eradicate the issue.”
Salmonella Newport causes significant clinical disease in humans, livestock, particularly cattle, and in other animal species.
Multiple antimicrobial-resistant strains of S. Newport have been recorded in the U.S. and Canada, according to Purdue University. All of these strains are resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracycline.
In addition, many of these strains show intermediate or full resistance to third-generation cephalosporins, kanamycin, potentiated sulphonamides and gentamicin.
Salmonellosis is caused by an infection with bacteria called Salmonella, which live in the intestinal tracts of humans and other animals, including birds. It is usually spread to humans when they eat food contaminated with animal feces, such as beef, poultry, milk, or eggs. Non-animal products such as vegetables can also become contaminated. Thorough cooking kills Salmonella.
Salmonella can also be spread through contact with pets and pet feces, including birds and reptiles. People should always wash their hands immediately after handling an animal or touching its environment, even if the animal appears healthy.
It is not yet clear whether the Salmonella Newport bacteria that caused this outbreak originated in a food or water source
Symptoms of Salmonellosis include fever, diarrhea and intestinal cramps. Symptoms usually appear 12 to 72 hours after a person has been infected and the illness and last 4 to 7 days. While most people recover without treatment, severe symptoms or spread of infection to the blood stream can lead to hospitalization.
USDA to Let Industry Self-Inspect Chicken
Print By Jim Avila
Apr 18, 2012 3:11pm Image Credit: Scott Sinklier/AgStock Images/Corbis
Chicken is the top-selling meat in the United States. The average American eats 84 pounds a year - more chicken than beef or pork. Sorry red meat, chicken is what’s for dinner.
Now, the USDA is proposing a fundamental change in the way that poultry makes it to the American dinner table.
As early as next week, the government will end debate on a cost-cutting, modernization proposal it hopes to fully implement by the end of the year – a plan that is setting off alarm bells among food science watchdogs because it turns over most of the chicken inspection duties to the companies that produce the birds for sale.
The USDA hopes to save $85 million over three years by laying off 1,000 government inspectors and turning over their duties to company monitors who will staff the poultry processing lines in plants across the country.
The poultry companies expect to save more than $250 million a year because they, in turn, will be allowed to speed up the processing lines to a dizzying 175 birds per minute with one USDA inspector at the end of the line.
Currently, traditional poultry lines move at a maximum of 90 birds per minute, with up to three USDA inspectors on line.
Whistleblower inspectors opposed to the new USDA rule say the companies cannot be trusted to watch over themselves. They contend that companies routinely pressure their employees not to stop the line or slow it down, making thorough inspection for contaminants, tumors and evidence of disease nearly impossible.
“At that speed, it’s all a blur,” one current inspector tells ABC News.
“I think that there needs to be a critical evaluation of this program,” said Amanda Hitt, director of the Food Integrity Campaign, an organization that empowers industry whistleblowers and citizen activists. “People need to have an opportunity to question some of these results and different things that the agency is coming up with in regard to the safety of this program.
“We’re listening to the people that are actually doing [the inspections] and they’re saying unequivocally the traditional inspection produces higher quality and safer poultry,” Hitt said.