Owner of Houston Home Health Agency Sentenced to 80 Yrs for Involvement in $13 Million Medicare Fraud

Owner of Home Health Agency Sentenced in Absentia to 80 Years in Prison for Involvement in $13 Million Medicare Fraud Conspiracy and for Filing Fraudulent Tax Returns

U.S. Department of Justice press release Dec. 8, 2017                                                                             

The owner of a Houston home health agency was sentenced today to 80 years in prison for his role in a $13 million Medicare fraud scheme and for filing false tax returns.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Acting U.S. Attorney Abe Martinez of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region and Special Agent in Charge D. Richard Goss of the Houston Field Office of the Internal Revenue Service Criminal Investigation (IRS-CI) made the announcement.

Ebong Tilong, 53, of Sugarland, Texas, was sentenced by U.S. District Judge Melinda Harmon of the Southern District of Texas. In November 2016, after the first week of trial, Tilong pleaded guilty to one count of conspiracy to commit healthcare fraud, three counts of healthcare fraud, one count of conspiracy to pay and receive healthcare kickbacks, three counts of payment and receipt of healthcare kickbacks, and one count of conspiracy to launder monetary instruments. In June 2017, Tilong pleaded guilty to two counts of filing fraudulent tax returns. Tilong failed to appear for his original sentencing, which was scheduled for Oct. 13, 2017.

According to the evidence presented at trial and Tilong’s admissions in connection with his guilty plea, from February 2006 through June 2015, Tilong and others conspired to defraud Medicare by submitting over $10 million in false and fraudulent claims for home health services to Medicare through Fiango Home Healthcare Inc. (Fiango), owned by Tilong and his wife, Marie Neba, 53, also of Sugarland, Texas. The trial evidence showed that using the money that Medicare paid for such fraudulent claims, Tilong paid illegal kickbacks to patient recruiters for referring Medicare beneficiaries to Fiango for home health services. Tilong also paid illegal kickbacks to Medicare beneficiaries for allowing Fiango to bill Medicare using beneficiaries’ Medicare information for home health services that were not medically necessary or not provided, the evidence showed. Tilong falsified medical records and directed others to falsify medical records to make it appear as though the Medicare beneficiaries qualified for and received home health services. Tilong also attempted to destroy evidence, blackmail a witness, and suborn perjury from witnesses, including a co-defendant while in the federal courthouse, the evidence showed.

According to the evidence presented at trial and his admissions to the tax offenses, from February 2006 to June 2015, Tilong received more than $13 million from Medicare for home health services that were not medically necessary or not provided to Medicare beneficiaries.

In connection with his guilty plea to the tax offenses, Tilong admitted that to maximize his gains from the Medicare fraud scheme, he created a shell company called Quality Therapy Services (QTS) to limit the amount of tax that he paid to the IRS on the proceeds that he and his co-conspirators stole from Medicare. According to his plea agreement, in 2013 and 2014, Tilong wrote almost a million dollars in checks from Fiango to QTS, purportedly for physical-therapy services that QTS provided to Fiango’s Medicare patients. The evidence showed that QTS did not provide those services. According to his plea agreement, in 2013 and 2014, Tilong’s fraudulent tax scheme caused the IRS a tax loss of approximately $344,452.

To date, four others have pleaded guilty or been convicted based on their roles in the fraudulent Medicare scheme at Fiango. Nirmal Mazumdar, M.D., of Houston, Texas, the former medical director of Fiango, pleaded guilty to a scheme to commit health care fraud for his role at Fiango. Daisy Carter, 58, of Wharton, Texas, and Connie Ray Island, 49, of Houston, Texas, two patient recruiters for Fiango, pleaded guilty to conspiracy to commit health care fraud for their roles at Fiango. Neba was convicted after a two-week jury trial of one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiracy to pay and receive health care kickbacks, one count of payment and receipt of health care kickbacks, one count of conspiracy to launder monetary instruments and one count of making health care false statements.

On Aug. 11, Neba was sentenced to 75 years in prison and Island was sentenced to 33 months in prison. On Oct. 3, Mazumdar was sentenced to time served with three years of home confinement. Carter is awaiting sentencing.

The case was investigated by the FBI, IRS-CI and HHS-OIG under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas. The case is being prosecuted by Trial Attorney William S.W. Chang, Senior Trial Attorney Jonathan T. Baum, and Trial Attorney Andrew Pennebaker of the Fraud Section.

The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Trump Puts Health Care for Millions At Risk as Republican Tax Plans Look for Revenue

The Republican tax plans are suddenly looking a lot more like healthcare bills, with provisions that may affect coverage and increase medical expenses for millions of families.

article by Toluse Olorunnipa and Anna Edney for Bloomberg News | Nov 16, 2017                
The House version of the tax bill, which President Donald Trump endorsed on Tuesday, would end a deduction that allows families of disabled children and elderly people to write off large medical expenses. The Senate plan would repeal the Obamacare requirement that most Americans carry insurance, a move that insurers promise would raise premiums in the nationwide individual insurance market.

The provisions would help offset the cost of large tax cuts for corporations and individuals. But the move has sparked a new wave of opposition from the health-care industry and others who are concerned about its impact -- the same political headwinds that tanked Republican efforts to repeal the Affordable Care Act earlier this year.

Either proposal, if signed into law, "could be devastating for some families with disabilities," said Kim Musheno, vice president of public policy at the Autism Society, a Bethesda, Maryland, organization that advocates for people with autism. "Families depend on that deduction. And if they deal with the individual mandate, that's going to cut 13 million people from their health care," she said, citing a Congressional Budget Office estimate

Republicans and some conservative groups, though, argue that removing the penalty for uninsured individuals would represent a tax cut for many low-income people who pay it now. Americans for Tax Reform, the group led by anti-tax crusader Grover Norquist, said that Internal Revenue Service data from tax year 2015 show that 79 percent of households that paid the penalty earned less than $50,000 a year.

Most Americans already think the tax legislation is designed to benefit the rich and oppose the bill by a two-to-one margin, according to a Quinnipiac University poll released on Wednesday. The survey was conducted between Nov. 7 and Nov. 13 -- before the repeal of the Obamacare mandate was introduced -- and has a margin of error of 3 percentage points. Some of the details in both tax plans have changed since the survey, and the Senate tax-writing committee is still working on its draft.

Few Republicans have spoken out about the House bill's repeal of the medical-expense break. The bill faces a vote on the House floor Thursday. But some criticism has begun to surface as advocacy groups including the AARP and the American Cancer Society have highlighted the harm the House bill could have on families battling diseases and on the elderly. People with tens of thousands of dollars in annual medical expenses often rely on the tax deduction to make ends meet.

Rep. Walter Jones, a North Carolina Republican, said Wednesday he'll vote against the House bill in part because it eliminates the deduction for out-of-pocket medical expenses.

"There are a lot of seniors in my district and this is life and death for them," he said.

The deduction is allowed under current law if medical expenses exceed 10 percent of a taxpayer's adjusted gross income. Almost 9 million taxpayers deducted about $87 billion in medical expenses for the 2015 tax year, according to the IRS.

Rep. Greg Walden, an Oregon Republican who chairs the Energy and Commerce Committee, said some of his constituents who live in expensive elder-care facilities could be harmed if the deduction is scrapped.

"I think it's one we have to continue to massage a bit," he said. "There's a lot of things out there and there's maybe going to be an opportunity to adjust some of them."

He declined to elaborate.

On the other side of the Capitol, Senate Republican leaders' sudden decision to add a partial Obamacare repeal to their bill has energized Democratic opposition.

"You don't fix the health insurance system by throwing it into a tax bill and causing premiums to go up 10 percent," Sen. Sherrod Brown, an Ohio Democrat, told reporters Wednesday.

Were the ACA's insurance mandate repealed absent a new policy to compel the purchase of coverage, the CBO projects that premiums would rise 10 percent for people who buy insurance on their own and more than 13 million Americans would lose or drop their coverage.

But a reduction in the number of people with insurance also translates to less taxpayer money spent to provide subsidies for premiums under the ACA. Ending the requirement as of 2019 would save the government an estimated $318 billion, helping to offset the cost of lowering the corporate tax rate.

In addition, the Senate's tax plan could trigger sharp cuts to Medicare and other programs in order to meet budget deficit rules, according to CBO.

The move to target Obamacare comes after Republicans lost elections in Virginia and other states earlier this month. Health care was a significant factor in those races and Republicans will face punishing campaign ads if they try to chip away at Obamacare or end the medical-expense deduction while cutting taxes, said political analyst David Axelrod, a former top adviser to President Barack Obama.

"The thing that makes it more of a potent issue is that it's all being done to facilitate what essentially is a massive corporate tax cut and an individual tax cut that's skewed to wealthy Americans," he said in an interview. "You don't have to work very hard to make those ads."

The White House argues that the ACA's insurance mandate isn't popular and disproportionately affects low- and middle-income Americans who are forced to buy insurance that may be more expensive than they can afford.

"The President's priorities for tax reform have been clear from the beginning: make our businesses globally competitive, and deliver tax cuts to the middle class," White House spokesman Raj Shah said in a statement. "He is glad to see the Senate is considering including the repeal of the onerous mandates of Obamacare in its tax reform legislation and hopes that those savings will be used to further reduce the burden it has placed on middle-class families."

Trump, though, has said proceeds from repealing the insurance mandate should be used to cut taxes even further for wealthy people.

"How about ending the unfair & highly unpopular Indiv Mandate in OCare & reducing taxes even further?" Trump said Monday in a tweet. "Cut top rate to 35% w/all of the rest going to middle income cuts?"

Like Republicans' failed attempts to repeal the ACA, the tax plan is amassing a growing list of opponents from the world of medicine.

Insurers, hospital groups and disability advocates have spoken out forcefully against the health-care proposals in the bill. Hospitals and insurance groups wrote a letter to congressional leaders on Tuesday warning of dire health-care outcomes if the tax measure becomes law.

"Repealing the individual mandate without a workable alternative will reduce enrollment, further destabilizing an already fragile individual and small group health insurance market on which more than 10 million Americans rely," said the letter, signed by six health-care groups, including the American Hospital Association and America's Health Insurance Plans.

U.S. Senate November 2017 Tax Bill Goes After Obamacare (again)!

WASHINGTON ― Republicans in the U.S. Senate want to gut Obamacare in the latest draft of tax reform legislation they released late Tuesday (Nov. 14). 

article by Arthur Delaney for HuffPost | Nov 14, 2017                                                                 
The new version of the tax bill repeals the Affordable Care Act’s requirement that all Americans either purchase health insurance or pay a penalty.

“By scrapping this unpopular tax from an unworkable law, we not only ease the financial burdens already associated with the mandate, but also generate additional revenue to provide more tax relief to these individuals,” Sen. Orrin Hatch (R-Utah), chairman of the tax-writing Senate Finance Committee, said in a press release.

Obamacare’s individual mandate, as it’s often called, is a core part of the law designed to bring healthier people into the insurance risk pool in order to offset the cost of sicker people who are more likely to buy insurance without the incentive of a mandate.

Until this week, Republicans had not signaled major interest in gouging the Affordable Care Act as part of tax reform. The tax bill in the House, which could see a floor vote this week, does not include the Obamacare provision. Including the mandate repeal helps put back some of the money that the bill loses through tax cuts for the wealthy and corporations.

In another big twist, the new Senate tax legislation makes many of the individual tax cuts in the plan temporary in a bid to comply with Senate rules that forbid certain legislation from adding to the federal budget deficit after 10 years.

The heart of the bill, a reduction in the top corporate tax rate from 35 percent to 20 percent, will be permanent ― but things like reductions in the individual income tax and an increase of the standard deduction would expire at the end of 2025. So would an increase in the child tax credit.

The tax cuts enacted during the George W. Bush administration had similar “sunset” provisions in order to comply with budget rules. Republicans at that time did not actually intend for the cuts to be temporary and correctly predicted that Congress wouldn’t allow most of the cuts to expire.

Senate Minority Leader Chuck Schumer (D-N.Y.) said in a Wednesday morning statement that with the sunsetting tax cuts, Republicans would put themselves in the position of later imposing big tax increases on the middle class.

“Either tens of millions of taxpayers will pay significantly more the longer this plan is in effect, or a future Congress will extend the tax breaks, making the deficit hole they create massively deeper,” Schumer said.

Republicans are advancing their legislation according to special “budget reconciliation” rules that allow bills to pass the Senate with only 51 votes instead of 60. Since Republicans control only 52 seats in the Senate, the reconciliation process allows them to cut taxes without any Democratic support.

This post has been updated with a statement from Schumer.

https://www.huffingtonpost.com/entry/senate-tax-bill-obamacare_us_5a0bb637e4b00a6eece51eb3

And in a major gimmick, many of the bill’s tax breaks expire in 2025.

Autistic Self Advocacy Network Condemns New Attacks On The Affordable Care Act

 

Press Release - Oct 16, 2017 - The Autistic Self Advocacy Network (ASAN) condemns the multiple new attacks on the Affordable Care Act (ACA) from the Trump administration in the past 24 hours. These attacks undermine our health care system, will raise costs for everyone, and threaten the lives of people with disabilities. ASAN calls on Congress to step up to the plate and exercise real leadership by passing a bipartisan bill that will restore funding for Cost Sharing Reductions, protect and fully fund Open Enrollment, and shield the American people from future attacks on our health care. 

The recent actions from the White House hurt our country in multiple ways. The executive order signed yesterday threatens critical protections for people with disabilities by making it easier for insurance companies to discriminate against people with pre-existing conditions. It also allows insurers to sell junk coverage that doesn’t cover critical services and won’t protect consumers from soaring health care costs. In addition, last night’s decision to withhold funding for Cost Sharing Reductions will raise costs for everyone, but particularly for working- and middle-class Americans who rely on this basic assistance to afford health insurance. These actions will directly harm millions of people and are without justification.

The American people have clearly and repeatedly rejected these kinds of proposal over the past nine months. As ASAN has stated in the past, any future attempts at health care reform must meet the needs of all Americans, leave the Medicaid program intact, and proactively include the disability community from the beginning of the process. ASAN calls on the Trump administration to listen to the voices of everyday Americans, stop the attacks on our health care, and support a bipartisan process in Congress. Our government must work to develop thoughtful and carefully considered proposals that make healthcare better for everyone and increase access to quality, affordable coverage rather than endangering the lives of people with disabilities.

The Autistic Self Advocacy Network is a 501(c)(3) nonprofit organization run by and for autistic people. ASAN was created to serve as a national grassroots disability rights organization for the autistic community run by and for autistic Americans, advocating for systems change and ensuring that the voices of autistic people are heard in policy debates and the halls of power. Our staff work to educate communities, support self-advocacy in all its forms, and improve public perceptions of autism. ASAN’s members and supporters include autistic adults and youth, cross-disability advocates, and non-autistic family members, professionals, educators, and friends.

source: press release 

Health Insurance 2018 Open Enrollment (OE) begins on November 1, 2017 End Date Vary by State

The American Association of People with Disabilities (AAPD) has shared the following detailed information on Open Enrollment for Government Health Care Programs for 2018. There are important dates and changes noted below. This post will be updated as needed.

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Healthcare Open Enrollment #5Changes and Challenges

From November 1, 2017 through December 15, 2017 (in most states), individuals will be able to purchase health insurance through the marketplace established by the Affordable Care Act (ACA).

IMPORTANT: 2018 ACA Open Enrollment starts November 1, 2017 in all 50 states and DC It ends on December 15, 2017 in all states except: California (1/31/2018) Colorado (1/12/2018) Connecticut (12/22/2017) District of Columbia (1/31/2018) Massachusetts (1/23/2018) Minnesota (1/14/2018) New York (1/31/2018) Rhode Island (12/31/2017) Washington (1/15/2018)   *Special enrollment period (12/16/2017 – 12/31/2017) available for hurricane victims*

There are a number of changes that have occurred to the 2018 OE period, which will run from November 1st to December 15th in most states. Shorter Enrollment Period. The first major change is a shorter enrollment period. The 2018 enrollment period was originally scheduled to run November 1, 2017 through January 31, 2018. However, the Department of Health and Human Services cut the period in half so that it only runs until December 15, 2017. This means it is crucial to get information out to individuals about OE5 before and during the open enrollment period since individuals will have less time to sign up for ACA healthcare. Cuts to the outreach, education, and enrollment budget. The second change refers to a series of deep budget cuts that happened in late August. These cuts include a 90% reduction for marketplace advertising, a 42% cut for HealthCare.gov (the website that allows individuals to sign up for health insurance), and a $25.7 million cut to Navigators (trained individuals that help guide people through the ACA sign-up process). Website Outages. It was recently announced that the federal health insurance exchange – HealthCare.gov – will be shut down for maintenance once a week, every week for 12 hours, during the open enrollment period. With the already shorten open enrollment period, these outages will make it even more difficult for people to sign up for health insurance through the marketplace. These changes will suppress marketplace enrollment and will likely limit the number of people who gain health insurance. Having less people sign up for coverage could lead to less-balanced risk pools and higher costs.

What does this mean for people with disabilities? The ACA has helped, and continues to help, people with disabilities in a number of ways. Providing protections for people with pre-existing conditions opened the door for many people with disabilities to receive affordable, comprehensive health insurance. The ACA also eliminated lifetime benefit limits, meaning there were no caps to the amount of money one could receive in a lifetime from an insurer. Medicaid expansion in 32 states, including Washington, DC, provided individuals with incomes at or below 138% of the poverty line affordable healthcare. These provisions resulted in 20 million people gaining health insurance by January of this year. Government health insurance is extremely important to people with disabilities – in 2015 58.3% of adults with disabilities had government health insurance compared to 17.4% of adults without disabilities. Shortening the Open Enrollment period and cutting funding means less uninsured individuals will have the opportunity to enroll in health insurance, and fewer individuals will be able to take advantage of the opportunities ACA has created for people with disabilities.

What can we do now? Help spread the word about Open Enrollment Period #5! While a significant amount of funding has been cut and the enrollment period shortened, we can make a difference by spreading information through our own networks. Post to Facebook or send a Tweet about the Open Enrollment period. Ask your friends and family if they have health insurance. Every effort helps!

Open Enrollment Resources HealthCare.gov – Open Enrollment website Get America Covered – provides enrollment information specific to your state Get Covered America – locate someone in your area who can help you complete your health insurance application Families USA Enrollment Assister Resource Center – materials to help navigators and assisters be successful during open enrollment and beyond Out2Enroll – Enrollment resources and support for the LGBTQ community ACA Signup Project – Graphics and materials to help promote Open Enrollment #5

Pres. Trump Cutting Billions In Obamacare Payments To Insurers, Low Income Americans Targeted

President Donald Trump plans to halt payments to health insurance companies serving the poorest customers on the Obamacare exchanges, the White House announced Thursday.

article by Jeffrey Young for HUFFPOST | Oct, 12, 2017                                                             

Trump has threatened to withhold these funds, valued at $7 billion this year, since shortly after his election victory last November. The threats alone have roiled the health insurance market, and if he follows through, it promises to be significantly disruptive. Trump will make an announcement Friday, according to Politico, which first reported the news.

In Trump’s mind, dealing damage to the Obamacare market is a means to achieve leverage he believes will force congressional Democrats to cooperate with replacing the Affordable Care Act, the law President Barack Obama signed in 2010 that has brought the number of uninsured Americans to a historic low.

Trump has been undermining the law and its programs since he took office in January, and he has ramped up his efforts in recent weeks in the aftermath of his failure to get the Affordable Care Act repealed by Congress. Earlier Thursday, Trump signed an executive order directing federal agencies to change regulations to allow insurers to sell policies that exclude people with pre-existing conditions and have skimpier benefits than insurance governed by the Affordable Care Act.

The mere possibility that Trump would refuse to pay money owed to health insurance companies created additional instability in market. Insurers are raising premiums for next year even more than they would have as they try to protect themselves against financial losses if the federal government reneges on its obligations.

The open-enrollment period on health insurance exchanges, such as HealthCare.gov and Covered California, begins Nov. 1, less than three weeks from now.

The payments Trump plans to end are related to so-called cost-sharing reductions offered to insurance exchange enrollees who earn up to 250 percent of the federal poverty level, which is $30,150 for a single person. These subsidies serve to reduce out-of-pocket expenses for low-income people by shrinking their deductibles, co-payments and the like.

Almost 6 million people, or 57 percent of Obamacare enrollees, qualified for these subsidies when they enrolled this year, according to the Department of Health and Human Services.

Under the Affordable Care Act, health insurance companies are required to reduce this cost-sharing. The federal government is supposed to reimburse them for the cost, and it has since exchange plans went live in January 2014.

Trump will change that soon. He has the authority to do so because of a lawsuit then-House Speaker John Boehner (R-Ohio) brought against Obama in 2014. House Republicans claimed Obama illegally made these payments without an explicit congressional appropriation of the funding.

A federal judge sided with House Republicans last year but allowed Obama to continue paying back insurers while the case went through the appeals process.

But when Trump succeeded Obama as president, his administration became the defendant in the case, raising doubt about how Trump and House Republicans would proceed. The parties in the lawsuit have obtained several delays in the proceedings in the meantime. The appeals court ruled in August that the attorneys general from 17 states and the District of Columbia are permitted take up the defense, based on the state officials’ concerns that the Trump administration would fail to do so.

New York Attorney General Eric Schneiderman announced Thursday that he and those other attorneys general are prepared to sue Trump over the cost-sharing reduction payments.

White House press secretary Sarah Huckabee Sanders issued a statement on the president’s decision Thursday night.

“Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the government cannot lawfully make the cost-sharing reduction payments. The United States House of Representatives sued the previous administration in federal court for making these payments without such an appropriation, and the court agreed that the payments were not lawful. The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system. Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”

Congress could address the cost-sharing reduction payments issue by authorizing the spending in legislation but has not done so.

The immediate effect of Trump pulling the cost-sharing reduction payments will be mixed. Health insurance exchange customers who earn too much to qualify for subsidies will have to bear the full brunt of the premium increases insurers instituted to protect themselves. Those customers who receive subsidies will mostly be shielded from the rate hikes because their subsidies will rise along with the premiums.

Ironically, cutting off these payments to health insurance companies will actually cost taxpayers more than continuing them. Because higher premiums mean bigger subsidies, federal spending will rise by almost $200 billion, according to the nonpartisan Congressional Budget Office.

The news about the cost-sharing reduction payments comes just hours after Trump signed an executive order that could shake up the Affordable Care Act’s insurance markets ― and quite possibly hobble them more.

Looking ahead, however, ending the payments jeopardizes the future of the exchanges. Many major health insurance companies already have pulled out of the marketplaces, citing financial losses. In future years, it’s likely fewer companies will want to participate in the exchanges knowing might not get expected payments. Some parts of the country would have no health insurance carriers in operation under this scenario, the Congressional Budget Office predicted.

Experts and a variety of health care groups immediately warned that the new insurance plans the executive order might allow would also draw healthy people out of the Affordable Care Act markets, forcing insurers to raise premiums or shut down plans altogether ― leaving the people who want or need comprehensive coverage with fewer, more expensive options, or none at all.

These are the latest moves Trump has made to weaken the health insurance exchanges:

The administration has severely cut back on the Department of Health and Human Services’ programs to promote health insurance enrollment, including major reductions in advertising and in-person assistance. The administration also halved the sign-up period to six weeks and plans to take the HealthCare.gov website down for as long as 12 hours every Sunday during the enrollment campaign.

The Department of Health and Human Services also spent money intended for enrollment support on a campaign that criticizes the programs it’s supposed to be managing.

Jonathan Cohn contributed to this report.
https://www.huffingtonpost.com/entry/trump-obamacare-payments-insurers_us_59e01859e4b03a7be57f71a9?utm_medium=email&utm_campaign=__TheMorningEmail__101317&utm_content=__TheMorningEmail__101317+CID_5e54519d198cb2607833064b39be3028&utm_source=Email%20marketing%20software&utm_term=HuffPost&ncid=newsltushpmgnews__TheMorningEmail__101317

Urgent Oct 4, 2017: Call U.S. Congressman Rush to Save Home and Community Based Services! - UPDATED

Our colleges at Access Living (Center for Independent Living for Chicago)  has shared the following information in the continued Health Care issues debate. PLEASE TAKE ACTION TODAY!

UPDATED MESSAGE:

Dear Access Living friends and allies,

Congratulations! Your hard work has paid off. Congressional staff in Washington DC have confirmed that the HCBS Settings Rule amendment will NOT be included in the package of amendments to the CHIP bill.  Well done! Congressman Rush's office heard you loud and clear.

This struggle is not over, and we believe that there will be continuing efforts to weaken the rule. To learn more about the rule, visit www.hcbsadvocacy.org.

THANK YOU for your advocacy! You made this happen!

Amber Smock

Director of Advocacy, Access Living 

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original action alert.

Congressional alert! Despite all our work over the last nine months to save Medicaid, we are facing a new attack on Medicaid home and community based services. We have reports that Rep. Bobby Rush will be introducing an amendment at this afternoon's U.S. House Energy & Commerce Committee Markup to freeze implementation of the Home and Community Based Settings (HCBS) Rule. The HCBS Settings Rule is an important federal initiative that requires states to make sure people getting HCBS have their rights respected. It took five years of persistent advocacy by PEOPLE WITH DISABILITIES to create this rule. The rule is about self-determination for people with disabilities, and ensuring that Medicaid dollars go to real community settings. The rule prevents providers from deciding when people living in residential settings get to eat or go to sleep or have visitors in their own homes. The rule also makes it harder for states to use HCBS funding to support institution-like settings, such as segregated villages and "gated communities". Again, the rule was crafted with significant input from disabled people stating what is important to them. If Rep. Rush introduces and passes his amendment, states will face more pressure to take scarce HCBS dollars and spend them on institution-like settings rather than supporting people in the real community. We've fought long and hard to move resources into the community - and people with disabilities deserve better than segregation. Call Rep. Rush's office ASAP today at (202) 225-4372. You can use the following script: "Hi, my name is _________. I'm calling to urge you not to introduce an amendment at today's CHIP Markup to stop implementation of the Home and Community Based Settings Rule. People with disabilities deserve the right to live in the true community, not segregated campuses or villages that only house people with other disabilities." The markup is today at 12 PM Central/1 PM Eastern - please make your call ASAP to help us preserve an important disability rights protection! Residents of Illinois especially encouraged to call, but everyone should call. Amber Smock Director of Advocacy, Access Living

Women with Disabilities, Chronic Health Issues Screening For Breast Cancer Less Often

Women with disabilities are a third less likely to participate in breast cancer screening and a quarter less likely to take part in bowel cancer screening compared to women reporting no disabilities, according to a new paper published in the British Journal of Cancer by researchers from the University of Oxford.

originally published by Medical XPress Sept. 28, 2017                                                                   

More than a fifth of the nearly 500,000 women who were offered breast or bowel cancer screening reported some disability; difficulties with mobility were the most commonly reported. Women with two or more disabilities were less likely to take part in screening compared to women who had one disability, according to the Million Women Study partly funded by Cancer Research UK.

Women with disabilities that affected eyesight, mobility and the ability to take care of themselves were the least likely to take part in cancer screening. Women who reported any disability and also did not have access to a car were more likely to miss breast screenings.

Dr Sarah Floud, lead researcher based at the University of Oxford, said: "While taking part in screening is a personal choice, our research suggests that women with disabilities may not have equal access to screening programmes. This is despite the fact that all people of the relevant age groups are routinely invited for free cancer screening, and that the screening programmes offer special arrangements for people with disabilities."

Women were considered to have a disability if they reported difficulty walking up a flight of stairs and said their walking pace was slow or if they reported their hearing, eyesight or memory to be poor. Disabilities also included difficulty bathing or dressing.

Dr Julie Sharp, Cancer Research UK's head of health and patient information, said: "This research highlights the various practical barriers that can prevent women with disabilities from taking part in screening. Having a better understanding of their specific needs means that the design of screening programmes can be improved to ensure people with disabilities can take up invitations to screening if they choose."
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Explore further: Women with severe, chronic health issues are screened for breast cancer less often

More information: Floud et al. Disability and participation in breast and bowel cancer screening in England: a large prospective study. British Journal of cancer, www.nature.com/bjc/journal/vao … ull/bjc2017331a.html 
https://medicalxpress.com/partners/cancer-research-uk/

GOP Graham-Cassidy Health Care Bill Might Be Potentially Dead For Now

The GOP's last-ditch effort to repeal and replace Obamacare received what appeared to be a fatal blow Monday evening when Sen. Susan Collins, R-Maine, announced her decision not to support the bill, becoming the crucial third Republican to oppose it.

nice article by LEIGH ANN CALDWELL for NBC NEWS | Sept 25, 2017                                     

Marilee Adamski-Smith from Brookfield, Wisconsin, left, and Colleen Flanagan of Boston, center, join others outside a hearing room where the Senate Finance Committee will hold a hearing to consider the Graham-Cassidy healthcare proposal, on Capitol Hill in Washington on Sept. 25, 2017. Manuel Balce Ceneta / AP

Collins joins Sens. John McCain, R-Ariz., and Rand Paul, R-Ky., as GOP "no" votes. Unless one of them switches their position, Republicans can't muster the 50 votes needed to pass it.

Momentum for the bill sputtered Monday morning even after a new version was released by authors Sens. Lindsey Graham and Bill Cassidy that included new incentives to appease the concerns of a handful of uncommitted Republican senators.

GOP leaders faced a Saturday deadline to pass Graham-Cassidy with a simple Senate majority and it's still unclear if Republican leaders will put the bill before the Senate for a vote, even without the votes for it to pass.

Leaving a leadership meeting, Sen. Orrin Hatch, R-Utah, said, "I doubt it" when asked if Senate Majority Leader Mitch McConnell would bring the legislation to the floor for a vote. And that was before Collins had solidified her position against it.

Collins' opposition caps off a months long effort to repeal the Affordable Care Act after years of campaign promises to do so. Senate Republicans failed to pass three other version of a repeal to Obamacare in late July when Collins, McCain and Sen. Lisa Murkowski, R-Alaska, all voted against it.

Murkowski has not yet indicated her position on Graham-Cassidy.

"Today, we find out that there is now a fourth version of the Graham-Cassidy proposal, which is as deeply flawed as the previous iterations. The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem," Collins said in a statement announcing her opposition.

Collins announced her position despite changes being made to the bill to get remaining holdouts on board. An analysis of state-by-state health care funding shows that under Graham-Cassidy, Maine would see a 43 percent increase in federal health care funds, Arizona would get an additional 14 percent, Kentucky another 4 percent and Alaska 3 percent. But Collins said despite the positive numbers, Maine would still lose money by dismantling the Affordable Care Act.

"Maine still loses money under whichever version of the Graham-Cassidy bill we consider because the bills use what could be described as a 'give with one hand, take with the other' distribution model. Huge Medicaid cuts down the road more than offset any short-term influx of money," Collins said in her statement.

Collins announced her position after an incomplete analysis of an earlier version of Graham-Cassidy by the Congressional Budget Office found that "millions" would lose their health insurance under the plan.

The rushed process to meet a September 30 deadline before the legislation expires that allows passage with just a simple majority frustrated a handful of senators, including McCain who had more problems with the process than the substance. He came out against the bill on Friday.

In an effort to calm the critics on a closed process, the Senate Finance Committee held the first and only hearing Monday afternoon on legislation. It turned out to be highly attended by passionate activists worried about their health care being stripped from them.

Protestors filled the hallways outside the hearing room that snaked around the corner and down the length of a city block. Hundreds of people chanted "shame" as Graham entered the hearing room to testify before the committee. Voluminous protests inside the hearing room delayed the start of the hearing. Chairman Orrin Hatch, R-Utah, attempted to gavel in the committee but protestors drowned him out. Police dragged them out, many of whom are disabled and in wheelchairs, out one by one.


             NBC News Coverage Sept 25, 2017

Once the committee room was clear of the public, the hearing began. Protestors maintained their chants in the hallway outside; their sound seeping through the doors providing constant background chanting.The Association of Health Insurance Plans and Blue Cross Blue Shield released prepared testimony before the hearing stating that they can't support Graham-Cassidy.

"The bill would have negative consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single-payer health care to grow," a summary of their testimony states.

Graham testified that Obamacare was a “disaster” in his state and boasted that "every major insurance company opposes our bill,” saying it was evidence that his legislation would give states more flexibility in dealing with them.

But Democrats pointed out it wasn’t just insurers upset with Graham-Cassidy: The top industry groups representing doctors and hospitals also publicly opposed the bill along with a parade of patient advocacy groups, from AARP to the American Heart Association. These organizations have argued the bill would cut overall health funding while allowing insurers to treat customers differently based on a pre-existing condition, a practice banned by Obamacare.

Under questioning from Senator Ron Wyden, D-Ore., Cassidy said their assessments were wrong and that it was “not true” that states could charge higher premiums based on their health status under his bill.

But the bill as written allows states to waive Obamacare’s rule preventing insurers from charging sick people more for care as well as its requirements that plans cover certain essential benefits. Outside analysts have consistently said it would weaken protections for pre-existing conditions.

The loosening of the regulations on insurance coverage was seen as an attempt to help conservatives come on board.

Protestors also sat-in the office of Murkowski in protest. Her deputy chief-of-staff came out to address the activists and said that she left Anchorage at 6 a.m. on Monday and is using her flight time back to D.C. “thinking about her decision.”

Marilee Adanski-Smith traveled to D.C. from Wisconsin on Saturday to attend the hearing. She was born without arms and legs and relies on Medicaid.

“We’re here to save Medicaid. Our lives depend on Medicaid,” she said, adding that she’s fearful that the legislation will take away Medicaid recipients' ability to live at home and force people into nursing homes.

“People are going to die in nursing homes if people don’t have the community and home-based services they need,” Adanski-Smith, a small-business owner, added.

Graham-Cassidy would end the Medicaid expansion in 2020 and reduce the money given to Medicaid by changing how it's allocated. It would no longer provide it for whoever is in need — instead, it would cap the number based on population.

The bill would also end the individual mandate to buy insurance and dismantle the structure of the Affordable Care Act, widely known as Obamacare. Instead, it would give money to states to implement their own health care systems. And while it would require that people with pre-existing conditions have access to health insurance, like Obamacare, it wouldn't prohibit insurance companies from charging people with long-term health care needs more money.

The new version of Graham-Cassidy would also provide billions of dollars more for states during the transition from Obamacare and as a contingency fund.

https://www.nbcnews.com/politics/congress/gop-health-care-bill-faces-crucial-uncertain-week-n804546

Jimmy Kimmel Takes Center Stage In Battle To Save Obamacare

Late-night comedian Jimmy Kimmel has become a leading advocate for maintaining Obamacare.

Washington (AFP) - Sept. 21, 2017                                                                                                          
Late-night comedian Jimmy Kimmel has emerged as the unlikely town crier against the latest Republican plan to overhaul Obamacare, highlighting his son's heart disease in an emotional new appeal to salvage America's health care system.

For two straight nights he has stood on stage at an ABC studio in Los Angeles and, using his own son's harrowing story as an example of the extraordinary costs of emergency treatment, argued that poor and middle class families would be priced out of health care under the new plan.

"I want you to know I am politicizing my son's health problems, because I have to," Kimmel said in a lengthy monologue Tuesday night in which he blasted a bill unveiled last week by Republican Senators Bill Cassidy and Lindsey Graham.

Kimmel's wife, Molly McNearney, gave birth in April to William Kimmel, who was born with a serious heart condition that required surgery three days after his birth.

His wealthy parents can easily afford the out-of-pocket costs, but in a tearful on-air appearance in May, the late-night host stressed that "no parent should ever have to decide if they can afford to save their child's life."

After the 49-year-old comedian publicized his son's plight, Cassidy came on "Jimmy Kimmel Live" to promise that the health care reforms he was proposing would "pass the Jimmy Kimmel test," meaning no family should be denied medical care because they cannot afford it.

Kimmel said this week he had felt Cassidy was being honest at the time, and sounded like a "rare, reasonable" Republican voice.

Then came the Graham-Cassidy bill, which converts the Affordable Care Act's complex system of subsidies to help Americans pay for insurance into block grants to the 50 US states.

Several patient advocacy groups have come out in opposition, warning it could lead to millions of people losing health coverage and plunging the health care system into chaos in many states.

Critics say the plan would dramatically slash funding of Medicaid, the federal health program for the poor and disabled; allow states to decide whether insurance companies can hike insurance rates for people with expensive medical conditions or impose lifetime caps on coverage; and no longer require insurers to cover essential health benefits like maternity care.

"This guy, Bill Cassidy, just lied right to my face," Kimmel said on his show.

On Wednesday Cassidy shot back: "I'm sorry he does not understand" the legislation, the senator told CNN, insisting his proposal fully protects people with pre-existing conditions and will lower premiums.

Kimmel pushed back. "There's a new Jimmy Kimmel test for you," he said. "It's called the lie detector test."

- 'Hollywood elites?' -

Kimmel himself has become a sort of celebrity leader of the opposition, using the tense back and forth with Cassidy, which played out on America's television screens and digital devices, to impact ongoing debate over whether Congress ought to move ahead with Graham-Cassidy legislation.

Vice President Mike Pence and several Republican lawmakers have been asked about whether recent versions of Obamacare repeal efforts would pass the Jimmy Kimmel test.

Graham, frustrated at Kimmel's criticism, said Wednesday he believed Kimmel might have been fed a liberal talking point and "bought it hook, line, and sinker."

Among the critics has been conservative-leaning network Fox News, whose morning host Brian Kilmeade chastised "Hollywood elites" for "pushing their politics on the rest of the country."

"My son had an open-heart surgery and has to have two more -- and because of that I learned there are kids with no insurance in the same situation," Kimmel responded.

"I don't get anything out of this, Brian you phoney little creep."

Republicans control 52 Senate seats, and can afford only two defectors. All 48 Democrats are united against the bill.

Republican leadership has signalled it wants a vote on Graham-Cassidy next week.

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RELATED POSTS:

Jimmy Kimmel on Bill Cassidy’s Health “Care” Bill

Illinois Health Plans Frequently Deny Coverage of Mental Health, Addiction Care - 2017 Report

Despite ongoing mental health and addiction crises, Illinois treatment providers responding to a recent survey report frequent claims denials and other barriers to coverage, according to a new report released today by The Kennedy Forum Illinois, Illinois Psychiatric Society, Illinois Association for Behavioral Health, Illinois Association of Rehabilitation Facilities, the Community Behavioral Healthcare Association of Illinois, the Illinois Health and Hospital Association, and Health and Medicine Policy Research Group.
CHICAGO, ILLINOIS  SEPTEMBER 19, 2017
Despite ongoing mental health and addiction crises, Illinois treatment providers responding to a recent survey report frequent claims denials and other barriers to coverage, according to a new report released today by The Kennedy Forum Illinois, Illinois Psychiatric Society, Illinois Association for Behavioral Health, Illinois Association of Rehabilitation Facilities, the Community Behavioral Healthcare Association of Illinois, the Illinois Health and Hospital Association, and Health and Medicine Policy Research Group.

The 16-page report, which is available here, raises important questions about health plans’ coverage of mental health and addiction conditions. Further investigation is urgently needed to identify and remove barriers, and ensure that Illinois Medicaid managed care organizations (MCOs) and commercial insurance plans are in compliance with federal and state laws that require they cover mental illness and addiction care on par with care for other medical conditions.

Key report findings include:

• Upwards of 75 percent of responding providers reported that Medicaid MCOs sometimes/often/always denied coverage for inpatient treatment, partial hospitalization, intensive outpatient treatment, and medication-assisted treatment. Nearly half of responding providers reported commercial insurers at least sometimes denied inpatient treatment.
• More than 60 percent of responding providers reported that Medicaid MCOs sometimes/often/ always refused to cover the requested level of care and instead approved only a lower level of care, while 54 percent of responding providers reported commercial insurers did the same.
• With Medicaid MCOs, nearly 65 percent of responding providers reported that they were told often or always that networks were simply closed. Nearly half of responding providers were told this often or always with commercial plans. The result: with mental health and addiction care providers unable to join plan networks, patients have more difficulty accessing care, due to the narrow network. 
• More than 90 percent of responding providers report that both Medicaid MCOs and commercial plans have refused to provide requested medical necessity criteria, despite clear legal requirements that plans do so.

The organizations responsible for the report call for regulators, legislators, health plans, and providers to investigate what coverage barriers exist to coverage and work to remove them.

"This survey makes clear that Illinois must do more to remove barriers to coverage of mental health and addiction treatment,” said Kelly O’Brien, executive director of The Kennedy Forum Illinois, a leadership a mental health leadership initiative that seeks to eliminate stigma and change public policy. “Unless we make the promise of federal and state parity laws a reality, we will be unable to make the progress we need in ending Illinois' mental health and addiction crises that are ravaging our communities."

The report highlights evidence from around the country, where health plans have been found to not be in compliance with mental health and addiction parity laws that require most plans to cover mental health and addiction treatment on par with other medical conditions. Former Congressman Patrick Kennedy, founder of The Kennedy Forum nationally and author of the landmark federal Mental Health Parity and Addiction Equity Act of 2008, called on policymakers to work to end stigma and discrimination against people living with mental health and addiction challenges.

"The mental health and addiction coverage barriers reported by Illinois providers are giant red flags that elected officials must urgently address,” said Kennedy. “Illnesses of the brain should be treated no differently than any other type of medical condition. To combat our country's mental health and addiction crises, we must enforce our laws and end discrimination against people with mental health and addiction challenges."

In response to the report, State Representative Deb Conroy (D-Villa Park), chairwoman of the House Mental Health Committee, expressed concern and promised the Committee would hold hearings.

"The General Assembly must get to the bottom of these reported barriers to mental health and addiction coverage. The Mental Health Committee will be holding hearings in the coming months to find out what coverage barriers exist and how we can remove them. To address Illinois' ongoing mental health and addiction crises, all stakeholders must work together to dramatically increase access to treatment and to ensure that state and federal parity laws are being followed."

Based on the report’s findings, State Representative Steve Andersson (R-Geneva), member of the Mental Health Committee, filed a resolution urging action that is co-sponsored by Rep. Conroy, House Deputy Majority Leader State Representative Lou Lang (D-Skokie), and Assistant Majority Leader State Representative Sara Feigenholtz (D-Chicago).

“This report makes clear that barriers to coverage for mental health and addiction issues remain and need to be addressed so that all people get the benefits of the coverage to which they are entitled,” said Rep. Andersson. "That is why I've filed House Resolution 607 asking the Mental Health Committee to formulate a plan to remove barriers to mental health and addiction coverage and improve coverage parity."

Rep. Lang, author of Illinois’ Heroin Crisis Act and chair of the Subcommittee on Substance Abuse of the Mental Health Committee, called for the General Assembly to pass legislation that increases transparency on whether health plans are in compliance with state and federal parity laws.

"This survey raises numerous red flags about barriers to mental health and addiction coverage. Even though Illinois has a strong parity law on the books requiring health plans to cover mental health and addiction treatment on an equal basis with other types of medical care, there is little transparency on whether health plans are complying with the law,” said Rep. Lang. “That is why the General Assembly needs to pass legislation that increases transparency to ensure consumers can access the coverage they're entitled to."

The report offers recommendations for all stakeholders, including health plans, regulators, legislators, providers, and even consumers to remove barriers to mental health and addiction coverage. Consumers should contact the Illinois Attorney General’s office and Illinois Department of Insurance if they are having difficulty with their commercial insurance plans, and Medicaid MCO consumers should contact the Illinois Department of Healthcare and Family Services.

“This report raises important questions about whether consumers can access mental health and addiction insurance coverage when they need it,” said Illinois Attorney General Lisa Madigan. “My office is committed to holding insurance companies accountable to our state’s mental health parity laws. Anyone who has problems with their health insurance coverage should contact my Health Care Bureau for help at 1-877-305-5145.”

Jennifer Hammer, Director of The Illinois Department of Insurance (DOI), said, “The Illinois Department of Insurance strives to make Illinois families aware of the resources & coverage available to them. Families dealing with mental health issues and substance use disorder deserve support and understanding. Our goal is to ensure consumers learn their rights under state and federal law." DOI encourages Illinois residents to use DOI’s free Consumer Toolkit for Navigating Behavioral Health and Substance Use Disorder Care Through Your Health Insurance Plan or call DOI toll-free at 866-445-5346 for consumer assistance.

The organizations authoring the reports said they have sent copies of the report to all members of the Illinois General Assembly, Governor Bruce Rauner, Attorney General Lisa Madigan, Illinois Department of Insurance Director Jennifer Hammer and Department of Healthcare and Family Services Director Felicia Norwood, with the intention of sparking necessary conversation to remove barriers to mental health and addiction coverage and treatment.

Additional expert quotes in reaction to the report’s findings: Meryl Sosa, Executive Director, Illinois Psychiatric Society: "Psychiatrists across Illinois regularly see patients' health plans deny coverage of needed mental health and substance abuse disorder treatment. Plan networks are often very difficult for psychiatrists to join, and plans often don't even provide requested medical necessity criteria, as required by law. To improve patient outcomes, health plans, regulators, and legislators must urgently work to remove these barriers to treatment."

Marvin Lindsey, CEO, Community Behavioral Healthcare Association of Illinois: “Access to mental health and substance use disorder treatment is incredibly important for the health and well-being of Illinois. Any barriers to needed behavioral healthcare services harm communities, individuals and their families and must be completely eliminated."

Margie Schaps, Executive Director, Health and Medicine Policy Research Group: “Ensuring health plans cover mental health and addiction care on par with other types of medical conditions is critical to patients being able to access the care and treatment they need to stay healthy. Untreated mental health and substance use disorders drive higher rates of disease and mortality, and contribute significantly to high health care and other social costs.”

Janet Stover, President and CEO of IARF, the statewide association of community-based providers serving children and adults with intellectual/developmental disabilities, mental illnesses and substance use disorders: “Parity in health care is essential for all of us, and is especially important for individuals with serious mental illnesses and substance use disorders. Barriers to care are not only detrimental to the health and well-being of individuals we serve and support, but to the overall healthcare system as well. IARF looks forward to working with our partners in health and long-term care to eliminate these barriers, resolving issues raised in the report, and ensuring better health outcomes for those we serve and support."

Sara Moscato Howe, CEO of the Illinois Association for Behavioral Health: “Compliance with state and federal behavioral health parity laws must be a top priority for managed care organizations and commercial insurance alike. Compliance must be built on a solid foundation of rigorous, transparent, and comprehensive data analysis, which must be mandated by the Illinois General Assembly.”

Click here to view and download complimentary versions of The Kennedy Forum’s policy papers. For more information about The Kennedy Forum and other helpful resources addressing behavioral health and substance use disorders, please visit http://www.TheKennedyForum.org.

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About The Kennedy Forum Founded in 2013 by former Congressman Patrick J. Kennedy (D-R.I.), The Kennedy Forum focuses on advancing evidence-based practices, policies, and programming in behavioral health. This is achieved through promoting public discourse in health and addiction issues, ensuring equal access for patients living with mental health and/or substance use disorders; and advancing prevention and treatment throughout the entire continuum of the healthcare delivery system. The Kennedy Forum’s collaborative partnerships help to foster greater provider accountability, integration and coordination, cutting-edge technologies, and brain fitness and health. The nonprofit organization publishes frequent issue briefs and is a repository of other educational resources on behavioral health parity issues. To learn more about The Kennedy Forum’s efforts to eradicate the stigma often associated with behavioral health, or to access related materials visit http://www.thekennedyforum.org, http://www.paritytrack.org, and http://www.parityregistry.org.

Source: PRWEB press release http://www.prweb.com/releases/2017/09/prweb14713424.htm