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Guest Voice: Hillary Clinton’s Health Care Plan: One Way To Help Pay For It
Apr 1st, 2008 | 10 responses
Health care proposals in Campaign 2008 have often gotten drown out in bitter campaign exchanges — but what about the issue’s specifics? In this Guest Voice post, D. Cupples , co-administrator of the site Buck Naked Politics, takes a stand-back look at Senator Hillary Clinton’s health care proposal. Guest Voice posts do not necessarily reflect the opinion of The Moderate Voice or its writers.
Hillary Clinton’s Health Care Plan: One Way To Help Pay For It
By D. Cupples
The New York Times recently did an extensive interview with Hillary Clinton about her health care policy and how she would make health care affordable for us Americans. Some naysayers believe that there is little room in the budget to pay for affordable health care coverage.
There would be a lot more room in the budget, if our public servants would truly crackdown on health care contractor fraud — more about that after a bit about Sen. Clinton’s interview:
“Mrs. Clinton said she would like to cap health insurance premiums at 5 percent to 10 percentof income.
“The average cost of a family policy bought by an individual in 2006 and 2007 was $5,799, or 10 percent of the median family income of $58,526, according to America’s Health Insurance
Plans, a trade group. Some policies cost up to $9,201, or 16 percent of median income.“The average out-of-pocket cost for workers who buy family policies through their employers is lower, $3,281, or 6 percent of median income, according to the Kaiser Family Foundation, a
health research group.A cap on premiums has been part of Mrs. Clinton’s universal coverage proposal since she announced it in September. (NY Times)
Every tax dollar devoted to waste or fraud is one less dollar for legitimate health care services. And private contractors are necessarily involved in state and federal health care programs.
That doesn’t mean that we taxpayers must settle for overcharging, waste or fraud.
Health care contractor fraud was so rampant that Department of Justice (DoJ) finally started cracking down in the ’90s under Bill Clinton.
In 2003, the DoJ said that health care contractors’ settlements were the lion’s share of fraud-suit settlements from 2000-2003 (larger, even, than defense contractors’ settlements).
Since 2000, America’s two largest for-profit hospital chains (HCA and Tenet) have settled massive DoJ fraud suits over allegedly fraudulent conduct that had occurred for years. Contractors tend to settle fraud suits without admitting guilt, because if contractors are found guilty of fraud, the government can bar them from receiving lucrative contracts.
It’s not just the big fish who’ve been sued, and it’s not just hospitals. Below are more than a dozen examples of healthcare contractors that faced lawsuits, their alleged conduct, and the outcomes.
Note: it’s hard to know exactly how many tax dollars are going toward contractor waste or fraud, because we know only about those contractors who got caught. That and contractors may settle for less than they’d actually taken from us taxpayers.
Hospitals
In 2006, Tenet Healthcare (America’s second largest for-profit hospital chain) settled DoJ suits for $900 million after allegedly false billing of Medicare and other federal programs. The alleged conduct included: patient diagnoses (billing for more expensive treatment than was done or called for), unreasonable inflation of charges, and illegal kickbacks to doctors.
In 2005, Health South settled DoJ suits for $327 million after (among other things) allegedly charging for false claims for outpatient physical therapy, over-billing Medicare for hospital costs, and billing Medicare for un-allowable costs (e.g., employee travel, entertainment, and even an administrator’s meeting at Disney World).
By 2003, HCA (America’s largest hospital chain) had agreed to pay $1.7 billion to settle DoJ suits. The alleged conduct included falsifying hospital-cost reports and giving doctors illegal kickbacks for patient referrals. Some of the alleged conduct dated back to the 1980s.
Drug Companies & Pharmacies
In 2005, GlaxoSmithKline settled a DoJ suit for $140 million after allegedly submitting false claims to Medicare and other federal programs by falsely reporting inflated drug prices.
Retail pharmacies Wal-Mart (2004) Rite Aid (2004), Eckerd (2002), and Walgreen (1999) settled unrelated DoJ suits for a combined $23.4 million after allegedly charging federal healthcare programs full price for partially filled prescriptions.
In 2003, AstraZeneca settled DoJ suits for $280 million after allegedly conspiring with health care providers to charge federally funded insurance programs for free samples of a prostate cancer drug.
Laboratories
In 2003, Abbott Laboratories settled DoJ suits for $382 million after getting snared in a federal undercover investigation. Apparently, a division of Abbot had offered kickbacks to federal agents to buy the company’s products, then “advised them how to fraudulently bill the government for those items.”
In 2002, four individuals in Florida were sentenced to prison and ordered jointly to pay a total of $11.7 million after conspiring to defraud Medicare and Medicaid by submitting false claims for laboratory tests that were not actually performed.
In 1997, SmithKline Beecham laboratories settled a DoJ fraud suit for $325 million after allegedly over-billing federal programs by: double billing for tests for kidney dialysis patients; paying illegal kickbacks to doctors; and billing for tests that weren’t done, weren’t
medically necessary, or weren’t ordered by a doctor.
HMOs & Insurance Companies
In 2004, Lovelace Health Systems, (a Cigna-owned hospital and HMO) settled a DoJ suit for $24.5 million after allegedly falsifying Medicare cost reports for ten years. Among other tactics, the company reportedly shifted the costs of its HMO patients to Medicare.
In 2002, PacifiCare Health Systems agreed to pay $87 million
to settle allegations that it (and its predecessor companies) had
inflated insurance claims while contracted to provide
government-employee benefits under the Federal Health Benefits Program.
In 2002, General American Life settled a Medicare-fraud case for $76 million after allegedly failing to perform its contractual duties to the Centers for Medicare and Medicaid Services (CMS). The company allegedly failed to process claims, submitted false information to CMS, failed to report errors, and disguised true error rates by deleting claims selected for CMS-review.
Equipment Suppliers
In 2000, an Ohio medical supplier was ordered to pay $15.1 million and sentenced to 70 months in prison after pleading guilty to defrauding Medicare by billing for urinary incontinence supplies that were not provided and by falsifying paperwork to hide the schemes from Medicare.
In 1997, Olympus of America settled a DoJ suit for $22.8 million
after allegedly overcharging the Department of Veterans Affairs (VA)
for medical-imaging equipment.
Doctor Fraud
In 2004, a Connecticut pediatrician pleaded guilty to fraud and agreed to pay back $548,000 after billing Medicaid and other insurance programs from 1997-2002 for childhood vaccines that the doctor had received free-of-charge via the joint federal/state Vaccines For Children program.
In 2001, a U.S. doctor was sentenced to 10+ years’ prison after conspiring to dispense/distribute controlled substances, committing Medicare fraud, and taking illegal kickbacks. He was also ordered to pay $229,384 in restitution. Reportedly, the doctor routinely wrote large quantities of prescriptions for highly addictive pain medication, billed Medicare for services not provided, and upcoded office visits.
In 2000, a Texas doctor and his lawyer brother were convicted and sentenced to prison after carrying out a "sophisticated scheme to defraud local, state and federal heath programs and private insurers of over $46 million from 1986 to 1998." In the process, the doctor upcoded his services, falsified medical reports and engaged in multiple billing.
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10 Responses to “Guest Voice: Hillary Clinton’s Health Care Plan: One Way To Help Pay For It”
[...] to Quit Race AssociatedPresshttp://ap.google.com/article/ALeqM5j-yFl91SZQSuxY6iahMsbW_3FCHAD8VOTVCO0Guest Voice: Hillary Clinton??s Health Care Plan: One Way To Help Pay For It Health care proposals in Campaign 2008 have often gotten drown out in bitter campaign exchanges ?? [...]
While some cases of fraud and waste may require sophisticated or hands-on auditing, much could be done with existing software.
A doctor in NY was discovered by the NYT to have billed fMedicaid for services whidh would have required him to see several patients every minute. If the NYT could unearth this information in a few hours on a laptop, I don't understand why the government doesn't have a software program to discern some forms of fraud as part of their regular operations.
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The aggregate amount of penalties listed in the post above come to $4.361 billion over a period of 11 years or a little less than a half billion dollars per year. That's roughly .5% of the total annual cost of Sen. Clinton's plan—a spit in the ocean. And that's assuming that all of the amounts realized could be used to defray the costs of the plan. They can't. These suits have costs of their own.
Should we pursue cases of waste, fraud, and abuse aggressively? Of course we should if only to deter future instances. But we shouldn't kid ourselves into thinking that we can pay for the plan by eliminating waste. We can't.
[...] US residents or getting taxpayer-subsidized services. …http://www.azstarnet.com/business/232267Guest Voice: Hillary Clinton??s Health Care Plan: One Way To Help Pay For It Health care proposals in Campaign 2008 have often gotten drown out in bitter campaign exchanges ?? [...]
The only way you pay for this kind of plan is to Pay for this kind of plan.
Just as we pay to eat. Pay to drive our cars. Pay taxes. Pay for rent.
However I believe that in this country there is still a sincere lack of will to provide adequate health care coverage for the average American. The kind of health care coverage that exists in Canada or England or in other countries is not feasible in the United States.
Instead we should concentrate on providing preventative medicine, prescription drug coverage as well as Catastrophic coverage of say anything over 25,000 dollars with modest premiums of say 1 percent of your income based upon last years taxes. To pay for this we should institute a national one penny sales tax which is added to the states already current sales tax and then the proceeds are forwarded on to Washington.
In addition taxes should be raised for everyone on the order of about 3 percent which would pay for this type of coverage.
NO…….its not perfect. But until you actually get something on the books their will be 100 years of think tanks, books written, government studies, debates and when we finally come to a logical conclusion then we will have more debates, filabusters and on and on it goes.
Get it on the books, see how to pay for it then move on. Add to it, tweak it, change it but get it done.
Once we have it in place then we can address how to pay for the coverage gap. In the meantime people will get the health care they need because we have covered 3 of the 4 legs of the health care chair.
[...] [...]
The 'nibblers' that Hillary allluded to, those that are operating in an ideological sphere rather than a pragmatic one, are cropping up all over.
First, the word 'universal' throws them. That strikes me as extremely peculiar, since our problems with health care affect everyone, and this is decidedly a universal problem.
Many energetic fact finders don't recognize cost unless it's a number on a bill labeled plainly enough for a grade schooler to identify. Many of the current costs to each and everyone of us, though obvious, are not clearly labeled, however.
Consider the savings if the cost of a visit to a GP's office were affordable via insurance, jmaking a visit to the extravagantly expensive ER unneccesary. . That's a cost the most individualistic citizen pays today,.
Consider the cost to business when an employee can't show up for work because his originally minor health problem escalates to being a debilitating one because of lack of access to health care.
Consider the cost to our economy when, due to a lack of proper health care, people drop out of the ranks of contributing taxpayers to become dependent on government sustenance programs.
The most recent example of general economic cost is being played out in the recession death watch. Consumer confidence, is cited by every economist as a major factor. Yet, people's lack of confidence is partially based on their insecutiry about the effects of the next illness in their family.
Medical bills are a major factor causing bankrupcies
And do on and so forth.
I see the repetition of the same arguments on different issues.
Do something about global warming? 'The cost, the cost! ' we hear.
Meanwhile some communiteis are forging ahead with energy saving programs that prove to be quite cost effective over the course of some years. They reduce polution and improve health while doing their thing.
The trouble is, I think, that the demand for immediate profit, with the resultant aversion to undertaking any risk whatsoever has replaced long term investment strtegies in current economic culture. That, more than anything else, stifles innovation, creative thinking and progress.
Runasim,
I hadn't thought about the software. Good point!
Dave Schuler,
The examples I listed are only a FEW out of hundreds. Adding up the total settlements in those few cases doesn't indicate much.
Also (as with the Columbia HCA case), we aren't sure whether the companies paid as much as they'd taken from us taxpayers over the years (or decades). Usually, defendants settle cases for less than they truly owe.
My point is that it's an ice-berg's-tip situation. I view it in terms of opportunity cost: every dollar that goes to contractor waste or fraud is one less dollar for health care.
[...] programs for free samples of a prostate cancer drug. Laboratories …article continues at JOE GANDELMAN brought to you by cancer.medtrials.info and [...]
Last year the Missouri legislature started talking up penalties for defrauding the state Medicaid program. Every Republican proposal went after the “patients” involved. The Democrats pointed out that the greatest amount of money lost by far to fraud was that committed by providers and proposed an appropriate amendment to the Republican's proposed law. Needless to say, it wasn't accepted.