ORANGE COUNTY, CA — Two Southern California medical and health plan providers agreed to pay a record sum of money to settle allegations of wrongdoing, the Department of Justice announced Thursday.
Los Angeles-based Pacific Health Corporation, which owns Newport Specialty Hospital and Anaheim General Hospital, agreed to a $16.5 million fine to settle allegations that its hospitals hired people to recruit the homeless from Skid Row for unnecessary medical procedures that could be charged to the government under Medicare and Medi-Cal.
Also on Thursday, SCAN Health Plan, which is based in Long Beach and provides health plans to patients from all over the region, agreed to pay a record $320 million to the state and federal governments to resolve allegations that it received overpayments from Medi-Cal. According to the Department of Justice, SCAN inflated costs and took advantage of calculating errors that enabled the company to charge Medi-Cal higher rates than the medical services warranted, racking up about $320 million in overcharges. The settlement is the largest recovery ever obtained from a single Medi-Cal provider, according to the justice department.
“This massive settlement demonstrates the commitment of the United States Justice Department to eradicate fraud, waste, and abuse in this nation’s public health care programs,” said United States Attorney André Birotte Jr. “We want the entire health care industry to know that we will use every tool at our disposal to ensure that the taxpayers are getting what they pay for when they finance public health programs.”
Skid Row Kickback Scheme
The two Orange County hospitals were part of the criminal probe in which investigators believe the corporation paid more than $2.3 million in kickbacks to marketers to recruit patients who were admitted to the hospitals for in-patient care, whether they needed it or not. The scheme bilked the government out of $16 million in improper payments to the hospitals, allege investigators.
The Pacific Health Corporation and its subsidiaries also face criminal prosecution for the homeless patient kickback scheme, according to the Department of Justice. But if the company abides by the deferred prosecution agreement announced Thursday, the charges will be dismissed in six years.
“Hospitals colluding with marketers to fatten profits through illegal referrals for costly and sometimes needless medical services are pocketing millions of taxpayer dollars,” said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the Office of Inspector General of the U.S. Department of Health and Human Services. “Our agents are monitoring such schemes, and those entering into similar sham contracts should expect investigation and prosecution.”
You are right on....Obama has circumvented congress on at least 3 occasions. Congress may as well be dissolved or at least stay home and get their pay checks because Obama rules the monarchy with an iron hand while his subjects gasp in awe and admiration!
When Obama is covered under Obamcare then it will be good....
It is time for HOPE & CHANGE.
to Suzanne Michael... our country has to sets or rules. one set for the rich and one for the rest of us. if you are rich and/or famous, you get a little slap on the wrist. for the rest of us who are not rich and/or famous, we go to prison.
Guess again. "Finding other alternatives to jail or prison for non-violent offenders that will provide restitution & deterrent should work better all the way around." Yes, consider how the death penalty has deterred murder, jail time has deterred theft, alternatives to jail time (such as living in their own luxury apartments) will deter fraud. "And ye shall eat the flesh of your sons, and the flesh of your daughters shall ye eat"--Leviticus 26:29
Yet, the SEC continues to make very similar deals: large fines on corporations, no admission of guilt. Maybe if there were more judges (unelected officials) doing a conscientious job: http://onforb.es/v8q51m Maybe it is not the fault of the ones catching these fraudulent activities once in a while. Maybe it is that of the fraudsters.
Over-regulation? Obamacare? Socialized medicine? Unelected officials telling private corporations (corporations are people, except when it comes to prison time) what to do? Too many government employees collecting fat pensions? The Fast and Furious program? Or is it simply because we elect people who cite one or more of the above as a reason, convince their minions that it is the case, or elect people who look the other way because they'll be criticized for not chanting the above? The problem is that corporations have realized how to win this game. Grow big enough that a large portion of the population is reliant on you for their existence. After that, you can basically do anything, and the cheaply bought politicians will do your bidding. You are too big to fail. Witness the tongue bath the Senate gave Jamie Dixon after he lost 2 or 7 billion. The problem is not that politicians are being bought, it is that they are being bought so cheaply. 750 million (if it is Obama) or 1.2 billion (if it is Romney) will buy you the presidency. Vote for someone else. In a decade, if a Gary Johnson (or whoever is Gary then) gets 14% of the vote against the 48% and 35% of the leading parties, then it'd cost them more, and perhaps they'll co-opt such issues instead of ignoring them.
If you don't show them you're capable of not voting for them, they don't have to listen to you, I promise you that. I worked within the Democratic Party, I didn't listen, or have to listen, to anything on the left, while I was working in the Democratic Party because the left had nowhere to go. Lawrence O'Donnell Political Analyst http://www.youtube.com/watch?v=B37zCueHfFM
Odd way of saying ROMNEY RYAN 2012, in response to an article that highlights the Obama Justice Dept. actually catching an unlucky corporation in a fraudulent activity. "When are Americans going to put a stop to selling the presidency and demand that a ceiling be put on how much a candidate can spend on their campaign?" Me? Probably never. I'd prefer that Americans are educated enough that they learn to ignore a barrage of ads instead of feeling afraid that having a large number of those ads will fool them into voting for the wrong guy. Besides, it is a greater win for all us Americans if we make candidates spend large amounts of money and they still lose. That will be the easiest way to achieve what you want. There is NO way that any ceiling will be placed on spending. The ones spending the money have enough of it to let some legislators decide it.
I cannot fathom how those against wars, Gitmo, Patriot Act, Bush tax cuts, bombing of seventeen different countries, for gay rights, for single payer, against marauding big businesses, etc. vote for Democrats. There is this pervasive "lesser of the two evils" that scares people into voting for Obama, but that is a tacit admission that they are both evil. I certainly cannot understand that in a non-swing state like ours. Obama will win California. He knows, Romney knows it, and that is the reason neither of them will visit here except to collect campaign contribs. Obama 61, McCain 37. In 2012, it might be Obama 57, Romney 41. I just want it to be Obama 48, Romney 37, Gary Johnson 14. In a decade. Besides, Gary Johnson *is* the right candidate, and not a gimmick like Perot. (unless he screws it up completely by picking Wayne Root again as VEEP or something) I know because I tried this completely accurate software: http://www.isidewith.com/ and it told me that I should vote for Gary Johnson. Software like this is never wrong. But I still checked with what Gary has been saying.
& actually these I think were Medicaid payments which are reportedly really low--lower than Medicare I think. Of course another issue w insurance is how hard it is to collect & how long it takes. I think that is part of the problem w some of the programs like Medi-Cal especially.
If consumer households were considered businesses, that would be negative annual growth of 1.5 percent, which would constitute a deep and prolonged recession. “This latest report continues our efforts to help chronicle one important dimension of the economic hardships now being experienced by a large number of American households,” said Gordon Green of Sentier Research. “In many ways, median household income provides a measure of the net effect of economic activity on the middle class and how well they are able to buy food, housing, and other necessities every month, especially now during this unprecedented period of economic stagnation.” Drilling deeper into the numbers, Sentier reports almost every consumer subgroup is worse off now than it was three years ago. For households made up of consumers between 25 and 34 years old, income declined by 8.9 percent. Among households in which the householder has some college but no degree, real median annual income declined by 9.3 percent. For households headed by a self-employed person, income declined 9.4 percent. Among households with a householder between 55 and 64 years old, income fell 9.7 percent. 4 more years..... 4more years...... 4more years.
& after the big crisis w mortgages & the way they were packed & resold & all that garbage, they introduced even more regulations. But the question is are they just regulating or are they targeting the regulations to where the problems actually are. From what I have seen of the recent regulations on lending, they now require everyone that is doing loans to have an individual license. That is both federal & state & there are required courses for each so in CA it ends up costing in the neighborhood of $500. The brokers wanted to knock those operating w branch licenses out of business to lessen the competition & they succeeded. Our co previously had branch licensing & we rescued many people from those bad loans that were unsustainable. But since this was only part of what we did & loan biz had gone down, many of us weren't willing to spend the $ to get licensed. Then the co got out of the loan biz. So what was supposed to be helpful to consumers removed a lot of people from the biz who were actually helping consumers. It seems that Dems like to regulate without making sure that they are using the least intrusive way to accomplish the goal. But having lots of forms to fill out may make them feel like they have done something without really having done so. Too many regulations that are not smart regulations,
Lots of politicians say they will make govt more efficient & they may mean well but its tough to control. A few skilled people may be able to find the right people to tackle the inefficiency & waste & actually reduce it. I saw Poizner make change in the CA dept of Ins, moving more licensing things to online--including ins licenses now being downloaded from a secure website rather than the fancy printed ones w gold trim having to be mailed. & at a time when CA govt was raising fees where ever they could, ins licenses actually went down twice. Obama doesn't seem to have much interest in this. Romney, with his business experience might be able to make some dents in all the bloated & ineffective bureaucratic messes we have. One thing would be to reduce duplicative agencies & consolidate them w out sacrificing effective programs. Obamacare adds lots more govt agencies with lots more employees getting fat paychecks but I doubt that it will really improve medical coverage or care--just make it more costly--contrary to what it was claimed to do. some of the problem comes from too many complicated regulations.
The SCAN issue was a lot less blatant in that it was accounting errors in their favor or accounting misstatements. SCAN is a Medicare Advantage plan w plans in many counties of CA. None of this in the article is from what you mention. Also not clear what kind of policy you are referring to--health insurance? While its possible that this may happen sometimes, when an insurance policy is applied for, the ins co has requirements which include medical history & usually physician statements. That would tend to rule out fraudulent policies although some probably get through. But again, that is NOT the issue of concern here.
I am not impressed that 13 trillion were lost in the MBS disaster, and not one person was prosecuted. Or how you being in financial services managed to rate Lehman Bros. with AAA rating a fortnight before it went bust. "It seems that Dems like to regulate without making sure that they are using the least intrusive way to accomplish the goal. But having lots of forms to fill out may make them feel like they have done something without really having done so." Yes, better to do it like Paulson, a two page self-attested form by a bank to collect your two billion. Like I said, it is over-regulation that is forcing corporations like PHC to commit fraud. If it were unregulated, paradise. Like it was in 2008.
& part of the problem seems to be too many regulations that just make things more complicated & invite ways to get around them, rather then concentrating on effective regulations. When we used to take a loan application, the regulatory forms were longer than the actual application was. So I think we need to have someone go through & get rid of a lot of the regulations that are just ones that make those who want to feel like they are cracking down on bad stuff, feel good, & instead see how we can reduce ineffective regulations that are just a paperwork burden & instead have regulations that actually help deter bad stuff. & w a plethora of regulations that clutter up the regulatory environment I suspect it actually inhibits focusing on needed effective regulations. So big difference between having regulations & having effective ones. Get rid of the ineffective ones & leave or add ones that will actually work. & if they streamlined regulations & got rid of "make work" regulations the cost of doing business likely would go down & enforcement should be easier without all the unnecessary clutter. btw, I'm not part of wall street high finance, but rather main street basic personal finance for the middle class. & it was the fancy "sophisticated" stuff that got us in trouble.
Unfortunately it seems that some see a problem & want to feel that they are dealing w it so they create more regulations & sometimes it seems that it is done, more to show that they are doing something, than because the new regulations will actually address the problems. & w more regulations it gets harder to keep track of them both for businesses & regulators. So its possible that part of the problems, especially the ones SCAN is accused of relate to having a lot of complicated rules to follow so that the essence maybe gets lost. & it seems that probably new regulators, rather than getting rid of older, outdated regulations, usually just add more on top of them further complicating things. Which raises costs on businesses & regulators & maybe obscures the main things. So it would seem to me that regulations should be examined to get rid of confusing & duplicated or contradictory regulations as well as ones that really aren't helpful--getting them out of the way, so that focus could be on the needed, effective regulations & not distracted by unnecessary ones. That would probably save some trees as well.
Ah, that explains it.
Also no bad regulations. Only good regulations. Because bad regulations are bad. Good regulation will prevent fraud, but not too much. Just enough. No unnecessary ones. Only those which are necessary. "Therefore I will wail and howl, I will go stripped and naked: I will make a wailing like the dragons, and mourning as the owls."--Micah 1:8
And who pays for the regulations when they are put into effect?
Obamacare still has private insurance co's. Single payer is just that--no private insurance co's & govt does it all. You like the DMV & PO? There will be similar problems w more govt involvement. Medi-Cal doesn't have a very good reputation for providing quality medical care. Many dr's won't take Medi-Cal patients. Its apparently worse in more rural areas where they are less drs & providers to choose from. & of course Canada has that & people wait extremely long times for even life saving care & a lot of them come to the US for things like hip replacement surgery--if they can afford it--so they can get it done without waiting many months. & I've read in the news about some real neglect in Britain's system. Our system isn't perfect & GOP has submitted quite a few bills to fix things that weren't even considered by Dems--fixes that didn't throw the baby out w the bathwater!