Monday, April 5, 2010

WASHINGTON - Senator Chuck Grassley is asking the Secretary of Health and Human Services to account for the fact that the agency that runs Medicare failed to respond for over a year to credible information about fraudulent pharmacies bilking Medicare.

The pharmacies in question included empty store fronts that successfully billed millions of dollars to private insurers, where they were identified, yet Medicare officials completely ignored the warnings, despite repeated warnings.

"Every Medicare dollar that's lost to fraud is a tax dollar wasted and a dollar that doesn't go to serve Medicare beneficiaries, as intended," Grassley said.

Here is Grassley's letter to the Secretary of Health and Human Services.

This information comes on top of Inspector General reports last year about the Department's repeated failure to respond to formal reports about programmatic flaws that led to Medicare fraud, waste and abuse.

Conservative estimates say that at least $60 billion in Medicare dollars are lost every year to fraud, waste and abuse.  Earlier this year, Grassley introduced a comprehensive bill, the Strengthening Program Integrity and Accountability in Health Care Act, to combat this loss in federal health programs including Medicare.  It includes better screening requirements to keep fraudulent providers out of Medicare, as well as a stop-gap to prevent the federal government from paying first and asking questions later about whether claims for payment are legitimate.

-30-

Mar 29, 2010 Tucson, Arizona. The Association of American Physicians and Surgeons (AAPS) became the first medical society to sue to overturn the newly enacted health care bill, the Patient Protection and Affordable Care Act (PPACA). AAPS sued Friday in the U.S. District Court for the District of Columbia (AAPS v. Sebelius et al.).

"If the PPACA goes unchallenged, then it spells the end of freedom in medicine as we know it," observed Jane Orient, M.D., the Executive Director of AAPS. "Courts should not allow this massive intrusion into the practice of medicine and the rights of patients."

"There will be a dire shortage of physicians if the PPACA becomes effective and is not overturned by the courts."

The PPACA requires most Americans to buy government-approved insurance starting in 2014, or face stiff penalties. Insurance company executives will be enriched by this requirement, but it violates the Fifth Amendment protection against the government forcing one person to pay cash to another. AAPS is the first to assert this important constitutional claim.

The PPACA also violates the Tenth Amendment, the Commerce Clause, and the provisions authorizing taxation. The Taxing and Spending power cannot be invoked, as the premiums go to private insurance companies. The traditional sovereignty of the States over the practice of medicine is destroyed by the PPACA.

AAPS notes that in scoring the proposal the Congressional Budget Office (CBO) was bound by assumptions imposed by Congress, including the ability to "save" $500 billion in Medicare, and to redirect $50 billion from Social Security. HHS Secretary Sebelius stated that PPACA would reduce the federal deficit, knowing the opposite to be true if these assumptions are unrealistic.

AAPS asks the Court to enjoin the government from promulgating or enforcing insurance mandates and require HHS Secretary Kathleen Sebelius and Social Security Commissioner Michael Astrue to provide the Court with an accounting of Medicare and Social Security solvency.

Congress recognized that PPACA cannot be funded without the insurance mandates, and will become unenforceable without them.

Court action is necessary "to preserve individual liberty" and "to prevent PPACA from bankrupting the United States generally and Medicare and Social Security specifically," AAPS stated.

AAPS is a voice for patient and physician independence since 1943. The complaint is posted at http://www.aapsonline.org/hhslawsuit

The legislation designates Department of Veterans Affairs medical facilities and state veterans' homes as Health Professional Shortage Areas which allows the facilities to compete for National Health Service Corps fellows.  The program makes student loan repayments to doctors, dentists, and mental health professionals who pledge to practice in a Health Professional Shortage Area for at least two years.

"Making sure our veterans get the care they need also means making sure that health care professionals are available to help them.  This legislation gives our veterans facilities an opportunity to tap into a network of providers ready and willing to support our men and women who fought for our freedom," Grassley said.

Veterans facilities that apply to be designated a Health Professional Shortage Area must show a need for additional health care professionals.  Once designated, the facilities compete with other eligible sites to hire the National Health Service Corps fellows.  The legislation does not allow National Health Service Corps fellows to simultaneously receive scholarship or loan repayment benefits from other VA employee programs.

Grassley said that as more and more Iraqi and Afghanistan veterans seek health care, the VA needs to be prepared to handle an increase in patients.  "This legislation provides another avenue for the VA to get the personnel it needs to help our wounded warriors," Grassley said.

Grassley has also been pressing the VA for answers about its claims backlog.  A recent case before the Supreme Court revealed that VA decisions to deny veterans benefit claims are not only being overturned at a high rate, but that in as many as 70 percent of the cases, the VA's position is not even substantially justified.  Grassley said that the fact that VA decisions are overturned with this kind of frequency, meaning they were wrongly decided in the first place, is an indication of serious, systemic problems with the way the VA considers the benefits claims made by veterans.

-30-

Washington, D.C. - Senator Tom Harkin (D-IA) today released the following statement detailing the benefits Iowans stand to gain from the comprehensive health reform bill passed earlier this week: The Patient Protection and Affordable Care Act and The Health Care and Education Affordability Reconciliation Act, passed today by the U.S. Senate.  Once the reconciliation piece is approved by the U.S. House and signed into law by the President, Iowans will see a number of benefits illustrated below.  Earlier this week, the President signed The Patient Protection and Affordable Care Act into law.  Harkin is Chairman of the Senate Health, Education, Labor and Pensions Committee.

"The legislation passed by Congress this week looks to the future and means big things for Iowa's working families," said Harkin. "Comprehensive health reform eliminates the practice of denying coverage because of a pre-existing condition, lets kids stay on their parents insurance until age 26, provides tax relief for small businesses and provides a historic investment in prevention and wellness to change our current 'sick care system' into genuine health care.

"The second proposal, passed today by the Senate, builds on the strength of comprehensive reform and includes provisions that boost college affordability.  For Middle Class families, one of the biggest challenges comes when their children reach college age.  The questions around the kitchen table are:  How do we pay for college?  And, in a couple years, our child will be too old to stay on the family's health insurance plan; what are we going to do?" continued Harkin. "This bill addresses these challenges head-on.  It allows adult children to stay on their parents' health insurance plan until age 26.  And it increases the maximum Pell Grant for college students from $5,550 in 2010 to $5,975 by 2017.  Starting in 2013, the grant will be indexed to the Consumer Price Index for five years.  Make no mistake, there is a lot at stake for America's Middle Class families in this reconciliation bill - both in terms of health care security, and in terms of access to an affordable college education."

Key Benefits for Iowa in the Health Reform Legislation

• Provide tax credits for up to 48,600 Iowa small businesses to help make coverage more affordable.

• Health reform will ensure that the 302,000 uninsured Iowans and 171,000 Iowans who purchase health insurance through the individual market have access to affordable health insurance options through state-based health insurance exchanges.

• Prohibit insurance companies from excluding coverage of pre-existing conditions for the 713,155 children in Iowa, starting this year.

• Close the "donut hole" and improve other Medicare benefits for 505,000 Iowa seniors.

• Each year, 89,700 Iowa seniors hit the Medicare Part D "donut hole."  Starting this year, seniors who hit this gap in their prescription drug coverage will receive a $250 check, and the "donut hole" will be completely closed by 2020.

• Reduce family health insurance premiums by $1,350 - $1,930 for the same benefits, as compared to what they would be without health reform by 2016.

• Starting this year, 300,466 young adults in Iowa will be able to remain covered by their parent's insurance policy until age 26.

• Create 5,600 - 9,000 jobs by reducing health care costs for employers.

• Provide more federal funding for 83 Community Health Centers in Iowa.

• Health reform will provide immediate access to quality, affordable health insurance for as many as 33,497 uninsured Iowans who are unable to obtain health insurance because of a pre-existing condition.