Money and Finance

Criticizing Cruz

Update, January 25, 2016 Read about the endorsement from Governor Perry

“I wanted to talk about him, who he was, see if I could get a handle on Ted Cruz the man, not Cruz the caricature I’d seen through the political lens. What I found was a very different person than what I had been led to believe.”

I love what Senator Ted Cruz is doing to fight ObamaCare and the Democrats, and totally agree with his stated goal, but strongly dislike one aspect of how he’s doing it.

Unfortunately, Senator Cruz – who was absolutely correct and exactly on target 99% of the time in his 20+ hour stand in the Senate on Tuesday and Wednesday – leads his crowd in attacking fellow conservative Republicans who support the House Bill that would fully fund the Federal government except for ObamaCare.   This, in spite of the fact that Cruz has said that the fight against ObamaCare is “multistaged,” praised the Bill and House Republicans for their action and even joined in Wednesday’s unanimous Senate vote to consider the Bill in the Senate.

Most people either love or hate Ted Cruz, his agenda and his Senate tactics. There doesn’t seem to be any room for distinction between the Senator, his politics, and his actions.   John McCain called him a “wacko bird.” Harry Reid called Cruz an “anarchist” – along with everyone in the Tea Party. Even Dorothy Rabinowitz, of the Wall Street Journal editorial board, went overboard contrasting Cruz and Senator Mike Lee with the “sane” wing of the Republican party. Bloggers and editors, as well as politicians focus more on Cruz’ “self regard,” his certainty that he’s right and everyone else is wrong and his lack of humility, than on the fight to stem the tide of Federal overspending and government interference in our lives. (See Wednesday’s Senate floor rants of Harry Reid And Dick Durbin, with the classic propaganda technique – or possibly, classic psychological projection – of accusing your opponent of doing the worst thing that you’re doing.)

At the same time, Cruz’ supporters have gone out of their way to call any of the Republicans who didn’t “#StandWithTed,” “traitors” and “RINO’s.” They make no distinction between McCain (who is a “RINO” in my opinion), and Texas’ Senior Senator, John Cornyn, promising to “primary” the latter in 2014.

I urge Senator Cruz and all conservatives to work to build up, not tear down. Do not join the Dems in emotional attacks and accusations. Most of all, don’t turn this into a 3-sided fight between the Dems, the Republicans, and the other Republicans.

Edited to add link to article on John Cornyn. BBN

Federal budget: No real Republican divide

If you only read the headlines and first paragraphs of – or the inflamed comments on – the media coverage of the debate over the Federal budget, you might believe that Republican leaders in the Senate are caving to the Democrats on funding Obamacare. In fact, Senators Mitch McConnell and John Cornyn and Senate Republicans recognize and support the House Continuing Resolution which fully funds the Federal government while defunding Obamacare.

There aren’t just two sides to the story. In fact, the media reports obscure that there are three factions: Harry Reid’s Dems, Republicans who support for the House continuing resolution, and In fact, there are three factions: Harry Reid’s Dems, the Republicans who are garnering support for the House continuing resolution, and the Republican efforts led by Senator Ted Cruz to block even the House Bill by filibuster. Hopefully, Senator Cruz will acknowledge that the House CR makes his filibuster unnecessary.

The House Continuing Resolution is a good Bill, allowing the continuation of the Federal government into December. It’s true that the whole budget debate will continue — but wouldn’t it any way?

Just take care of the patient

What causes a frail elderly person to become a patient in the hospital and can we do something in the home to prevent that event?  What causes some people to develop chronic illnesses and can other people intervene to prevent the consequences of those illnesses?

What if healthcare reformers asked these questions rather than focusing (or appearing to focus) only on costs? Better yet, what if they recognized the system changes that work, rather than insisting that all doctors must become employees of mammoth organizations, touting the business opportunities inherent in expensive, user-unfriendly electronic medical records and/or forcing an even more expensive change from the 5-digit medical diagnosis codes in ICD-9 to the 7-digit ICD-10 codes?

The source for the graph above is a report by the Oliver Wyman Healthcare Innovation Center, reviewed in Forbes Magazine last January by author Dave Chase. Yes, 5% of patients are responsible for 45% of the costs. What works to lower costs? Taking care of the patient:

In 2008, when physicians from CareMore, an independent medical group based in Cerritos, California, heard news reports of a brutal heat wave, they began contacting their elderly emphysema patients. Physicians worried that the scorching heat would drive their at-risk Medicare Advantage patients to the emergency room. So when patients said they had no air conditioner, the physicians purchased units for them. The theory was that the roughly $500 cost paled in comparison to the cost of an emergency-department admission. As it happened, this non-medical “intervention” kept CareMore’s patients out of the hospital. But if they had needed to go and lacked transportation, CareMore would have offered a free ride.
CareMore has an expansive, counter intuitive approach to healthcare. The group fends off falls by providing patients with regular toenail clipping and by removing shag rugs—a common household risk for the elderly. Patients engage in iPhone conference calls with healthcare professionals and are remotely monitored with devices that feed data automatically to doctors;  for example, patients with congestive heart failure are given a wireless scale that reports their weight on a daily basis—a key step in preventing hospitalization. They have singing pillboxes that chime when it’s time to take medications.

These unusual tactics produce enviable outcomes: CareMore’s  hospitalization rate is 24 percent below average, hospital stays are  38 percent shorter than average, and the amputation rate among diabetics is 60 percent below average. Overall member costs are roughly 18 percent below the Medicare average.

The electronic medical record helped CareMore identify patients at risk, but the EMR is a minor tool compared to the minds of the innovators who recognized the real problems and acted in the best interest of the patients.

Obamacare Consumer Cost Protections–Delayed! | National Review Online

Or, as my granddaughter said, “Was he BORN dumb?” We, the people, will now pay more than we were promised!

The Obamacare “train wreck” continues. Now, the NYT reports, the caps on out-of-pocket expenses–you know the “affordable” part of the Affordable Care Act–are being delayed a year

via Obamacare Consumer Cost Protections–Delayed! | National Review Online.

Why not “delay” the whole thing?

Podcast: Stop ObamaCare – Greg Abbott

From the Greg Abbott Campaign website:

Communications Director Matt Hirsch speaks with Dr. Beverly Nuckols on location at The Texas Mailhouse in Austin about the negative impact ObamaCare is having on small businesses and the health care industry, while U.S. Secretary of Health and Human Services tries to sell an unworkable, expensive healthcare takeover in Texas.

via Podcast: Stop ObamaCare – Greg Abbott.

(I’m a doctor, not an audio/visual expert. And I certainly can’t afford one. Since I can’t get the podcast to embed, so please go to the site. While you’re there, volunteer, donate, help out!)

ObamaCare’s effects difficult to measure: USA Today

From the USAToday, August 8, 2013:

When California announced that individual premiums in its health insurance exchange could be 29% lower than expected, President Obama cheered. When Indiana announced premiums might be 72% higher than before, state officials predicted doom. So who is right? Are health insurance premiums going up or down?

We don’t know, at least in part, because both sides are playing with the numbers. To be sure, natural variation exists in how state insurance markets will be affected, but consumers should also be aware of how premium comparisons are twisted to reach predetermined results. Here are five ways they have been slanted: . . .

read more via ObamaCare’s effects difficult to measure: Column.

Edited 8-9-13 – Changed the title and post to make it more clear that this is from the USAToday, not my own writing. BBN

Texas or DC: Who do you want regulating your doctor?

Peggy Fikac once again proves that she’s not a reporter, and most certainly not anything like a fair and balanced media representative.

From the Houston Chronicle’s coverage of events in Austin, today:

“Obamacare is the wrong prescription for American health care, and I will never stop fighting against it,” Abbott said, joined by small business people and a doctor who also oppose the law at a company, the Texas Mailhouse.

One reason that Abbott gave for fighting the law came in response to a doctor who asked him from the audience about what Texas could do to keep the federal law from interfering with doctors’ judgment about the best way to treat their patients.

“You’re raising one of the more challenging components of Obamacare, and a hidden component in a way, and that is government is stepping in between the doctor-patient relationship and trying to tell you what you can and cannot do, interfering with both your conscience and your medical oath to take care of your patient,” said Abbott, who is campaigning to succeed Gov. Rick Perry.

That is similar to arguments raised against tighter abortion restrictions approved in special session, including a ban on the procedure at 20 weeks, along with stricter regulations on clinics and abortion-inducing drugs.

 

I am that doctor from the audience. Ms. Fikac is correct that I voiced concern over the Federal interference between the patient and the doctor. She’s flat wrong about Texas regulation of medicine by bring abortionists up to standards being equivalent to the

I prefaced the question by noting that it is the State of Texas that properly regulates Texas Doctors and medicine. At the State level, patients and doctors have more influence on our elected officials and the people they appoint to write regulations and enforce the law than we do on the Federal level.

I also noted that because of the increasing interference over the years by Medicare, I am concerned about the reach that this new set of regulations will have, including ever-invasive micro-reporting of patient’s private medical conditions. (I named the upcoming move to the ICD-10, which will be a nightmare, requiring doctors to make distinctions between medical conditions, out to five (5) decimal places.

As bad as the bureaucracy of the Office of the Inspector General for the Federal Health and Human Services and the Centers for Medicare and Medicaid Services have been in the past, I don’t look forward to the additional layer of IRS income verification, audits and enforcement.

We could stick closer to home, with the Texas Health and Human Services, the Texas Medical Board, and the Texas Insurance Commission!

Freedom2Care: Now Secretary of Health and Human Services Kathleen Sebelius is not radical enough to work at Rite Aid

Conscience? More “Trust me, I’ll violate my conscience” news:

Tolerance. Diversity. Broad-mindedness. Those are the words.

Bullying. Discriminating. Compelling. Those are the deeds.

The contradictory words and deeds often come from one and the same individuals–and in a case I learned about today, companies. Turns out the words of tolerance, diversity and broad-mindedness only apply to those who comply with the dogma and submit to the will of the speakers.

Here’s an email I received this morning from a pharmacist member of the Christian Medical Association:

“Subject: Forced to resign over mandate to sell the morning after pill.

“Just to let you know that Rite-Aid corporation came out with a stricter policy on July 5, 2013 that requires all employees to accommodate the sale of the morning-after pill to all comers, of either gender and of any age.”

Read more via Freedom2Care: Now Secretary of Health and Human Services Kathleen Sebelius is not radical enough to work at Rite Aid.

While I don’t believe that Plan B is an abortifacient, I do believe it’s a powerful drug and that adolescents shouldn’t be able to buy it over the counter. I also find it hard to trust someone who will agree to go against their conscience!

Dr. Wes: A Case of (Medicare) “Fraud”

A real-life, real medicine tale of the risk that doctors face – and are willing to face – when taking care of our patients under arbitrary and often outdated Medicare regulations. It will only get worse under ObamaCare and the IRS.

He was a slender-framed man, mid- to late-sixties, with a kind of ridden-hard-put-away-wet complexion.  It was clear the years had not always been good to him, but being the kind soul that he was, he had plenty of friends.  It was a beautiful summer day to spend with friends for a barbecue, but he arrived feeling puzzled why he collapsed at home earlier in the day.

He stopped at the keg and poured himself a beer in a red solo cup, and as he approached his friends with a smile, he did it again, this time which such gusto that his beer went flying and the thud he made when he hit the ground made everyone gasp.  He laid motionless for a moment face down on the ground while his friends rushed to his aid.  An ambulance was summoned as others rolled him over onto his back.  He began to move – slowly at first – then more purposefully.  As sirens approached, he asked his friends, “What just happened?’

Read the rest of the story here.

The author’s comments:

It is becoming abundantly clear that conflicts between the [sanctity] of human life will confront the government’s unwillingness to pay for procedures. No where is this more clear than with approval of payment for the implantation of an ICD, which might run in excess of $200K for the procedure at some instituions. As a result, doctors who strive to provide state-of-the-art care to their patients will continue to confront similar ethical dilemmas that risk their legal standing (and credentials) as they care for their sickest arrhythmia patients.

By publishing this case scenario, my hope was to draw attention to these ethical dilemmas that are becoming increasingly prevalent in medicine as a result of these outdated, inconsistent, and incomplete coverage decisions, guidelines for care, and “appropriateness use” criteria. Further, the potential for legal action against physicians y imposes real fear for do

ctors if they stray at all from these outdated decisions. This fear is to the point where it might do actual harm – and even cause death – to patients who are left without appropriate treatment as a result.

via Dr. Wes: A Case of Fraud.

CANCELLED: UN Medical Women International Association Prolife Drs’ Presentations

Last weekend, organizers cancelled officially scheduled scientific presentations at the United Nations sponsored Medical Women International Association (MWIA) meeting in Seoul, Korea.

The American Association of Pro-Life Obstetricians and Gynecologists have reported the information and published the women doctors’ planned presentations on their blog.

According to the published official press release (available in Word format) by the President of MWIA, Ghana’s Dr. Afua Hesse, she personally “intervened” to cancel “listed speakers at our 29th International Congress of MWIA who would deny women their basic right to choice.” She further claimed that the presentations had “no scientific merit and threaten women’s reproductive rights and therefore do not belong at our triennial meeting.”

Dr. Donna J. Harrison, an OB/Gyn and member of AAPLOG, was one of the three presenters who found out that their presentations were cancelled only after arriving at the site. The other two presenters were OBGyn Dr. Mary L Davenport, MD, FACOG and Psychiatrist Dr. Martha Shuping, M.D.  After their session was cancelled, Dr. Anna Choi, Chair of the Public Relations Committee of the MWIA 2013 Organizing Committee, invited the three to speak at a press conference.

Canadian Family Physician Dr. Shelly Ross, Secretary-General to the United Nations for MWIA, physically intervened in an attempt to stop a press conference to which the three were invited. Here’s an excerpt from Dr. Davenport’s letter to AAPLOG members about the confrontation:

“They put the three of us up front like a “panel” discussion, and the reporters started asking us questions about our presentation, allowing us an opportunity to talk about what we came to present. About 20 minutes into the interview, the Secretary General of MIWA, a Canadian woman, burst into the room (I kid you not. …and all of this is on camera), and came up to the table and said “What presentation is this? Donna Harrison said “it’s not a presentation”. So she snarled “Why are you being interviewed? At that point, the answers were left to Anna, our host. Anna said that this was a requested interview by the press.

“The SecGen then said “Who gave you permission to interview these people?” And the reporters said “We are the press, we don’t need anyone’s permission. We have freedom of the press” And the Sec Gen snarled at Anna and said “Did you arrange this? Did you talk to the organizing committee?” And Anna said “I am on the organizing committee. I don’t need to talk to anyone.” And the Sec Gen stood in front of the camera, and refused to move, and said “The interview is over.” Then the reporters said “You can’t do this. We have the freedom of the press. You are interfering with the freedom of the press.” But the Sec Gen would not move and said “The interview is over.””

If you’ve never been to one of these big conferences, I’ll explain how they are set up. The tentative schedule is published months in advance. The separate presentations are grouped with similar- or same-topic presentations per “breakout” session, and many separate sessions may be held at one time. In this case, the final schedule of talks and even the signs (as you can see above) had been printed and posted.

I have viewed the three presentations and found them scientifically sound. They’re in PowerPoint format and easy to read, with great graphics and the first, by Dr. Davenport, is excellent and includes the bibliography of her references.

Texas Still Fighting Funding to Planned Parenthood!

In spite of repetitive fraud, in spite of Texas’ laws prohibiting sending money to affiliates of abortionists, in spite of all our work.

Planned Parenthood clinics could be facing a legal fight that could keep them from receiving funding for impoverished Medicaid patients.

When the state passed the Women’s Health Program in 2005, legislators said the intent was to provide more family planning services, but not abortions, to low-income Medicaid patients.

State Sen. Bob Deuell said due to a loophole in the law, Planned Parenthood is part of the program, but thinks they shouldn’t be. As such, he has requested the attorney general clear up the matter.

*****

While Sen. Deuell admits he isn’t in favor of Planned Parenthood, he said his “goal is to provide comprehensive care and — abortion issue aside — the Planned Parenthood clinics don’t provide comprehensive care.”

It could take Attorney General Greg Abbott months to give his opinion.

In a brief HHSC officials sent to Abbott, they told him if the agency limits providers based on the way the law currently reads, the state risks violating Medicaid rules. State health officials said that could result in a loss of federal funding for the program.

via AG to rule on Planned Parenthood funding question – YNN – Your News Now.

Every Slice of Drug-Rep Pizza Counts Starting Aug. 1

It’s possible that I can be bought, and no one’s come up with the right amount of money (or pens or pizzas), yet.

Or maybe, just maybe, I’m honest. Of course not!

I’m assumed to be guilty (where’s the opportunity to prove innocence, much less their duty to prove me guilty?) of all sorts of fraud by authors of the Physician Payments Sunshine Act included in the thousands of pages of PPACA – otherwise known as Obamacare:

From now on, companies must keep track of virtually every payment and gift bestowed on each clinician and report them to the Centers for Medicare & Medicaid Services (CMS), which will report them to the world.

This accounting exercise stems from a provision in the Affordable Care Act (ACA) that seeks to expose the financial dealings between industry and physicians and discourage conflicts of interest for the latter that might skew education, research, and clinical decision-making. Under the ACA provision, called the Physician Payments Sunshine Act, drug and device makers must report any “transfer of value” of $10 or more made to a physician. Transfers of value under $10 — a cup of coffee, say — aren’t reportable unless they add up to more than $100 in a year. Companies also must disclose whether physicians have any ownership stake in them.

via Every Slice of Drug-Rep Pizza Counts Starting Aug. 1.

Of course lawmakers assume that we’re being bribed – that’s what they do! Why aren’t the limits at least as high as those our Senators and Representatives are allowed? Like Democrat Senator Harry Reid, can we form a “Friends of Dr. Practice” and get more, as long as we don’t accept donations at our office?

BTW,  there’s an app available to help doctors keep up with the bribes.

Texas Planned Parenthood pays $4.3M (but media attacks Greg Abbott)

The $1.4 Million previously reported was the part that Texas will receive, not the total. Can you guess how the (very few) media reports (if you can find them) are playing the story?

From the July 30, Houston Chronicle:

Planned Parenthood Gulf Coast Tuesday settled a whistle-blower lawsuit that alleged the Houston nonprofit engaged in fraudulent Medicaid billing for $4.3 million – nearly $3 million more than was announced last week by Texas Attorney General Greg Abbott.

Yes, Planned Parenthood is quoted as claiming that the settlement for the AG’s finding that they are guilty of over $30M in fraud is “baseless” and simply a way to end harassment and to avoid turning over the (altered) medical records of patients. But the spin on the story is that Texas’ Attorney General, Greg Abbott, didn’t report the total and sent out his announcement before the settlement was signed by all parties.

My news search yields some op-eds and stories by Texas’ newspapers and a few more on pro-life sites.

‘Obamacare’ National Marketing Campaign To Cost Nearly $700 Million « CBS DC

In the meantime, doctors who still accept Medicare (not hospitals or other “providers”) are facing decreased payments and increased hassles.

As President Barack Obama’s health care law moves from theory to reality in the coming months, its success may hinge on whether the best minds in advertising can reach one of the hardest-to-find parts of the population: people without health coverage.

The campaign won’t come cheap: The total amount to be spent nationally on publicity, marketing and advertising will be at least $684 million, according to data compiled The Associated Press from federal and state sources.

via ‘Obamacare’ National Marketing Campaign To Cost Nearly $700 Million « CBS DC.

Democratic Congressman: ‘Not Fair’ To Subject Congress To Obamacare Just Like Everyone Else – Forbes

Brain drain? In DC? Oxymoron?

Now that the time to sign up for exchange coverage is nearing, a Democratic member, Rep. John Larson (D., Conn.), is saying that “this is simply not fair” – as key staff members head for the exits to avoid Obamacare.

Politico reports that “many on Capitol Hill fear it could lead to a brain drain” and notes that “[t]he problem is far more acute in the House, where lawmakers and aides are generally younger and less wealthy.

via Democratic Congressman: ‘Not Fair’ To Subject Congress To Obamacare Just Like Everyone Else – Forbes.

Protect the right to life – San Antonio Express-News

I wrote this to the San Antonio Express News, in response to an “Other Views” Commentary a couple of weeks ago that claimed our pro-life HB2 violated the “separation of church and state.” It was rife with errors, easily corrected:

1. Abortion isn’t “private.” It is performed by licensed doctors in licensed abortion facilities, under laws regulating the practice of medicine passed by the elected Legislature of the state of Texas.

2. Women’s health and family planning clinics that offer federal and state funded health and cancer screenings and contraception are prohibited by both state and federal law from performing elective abortion. These clinics aren’t licensed abortion facilities and aren’t affected by HB2.

3. After Pennsylvania, Virginia and Missouri passed laws requiring safety standards similar to those in HB2, most abortion facilities in those states remained open.

4. Abortion facilities are allowed 16 months to come up to standard. If abortion facilities close, it will be because business owners decide not to invest in their facilities.

5. HB2, like earlier Texas laws, protects the mother if her life is endangered by continuing the pregnancy.

6. HB2 doesn’t create any criminal charges for the mother, only for physicians who perform illegal abortions after five months.

HB2 does require doctors who perform abortions to have admitting privileges in case their patients have complications requiring hospitalization and abortion facilities to meet building standards known to improve patient safety.

More, including some philosophy, via Protect the right to life – San Antonio Express-News.

Wrinkle in Health Law Vexes Lawmakers’ Aides – NYTimes.com

Oh! What a tangled web we weave . . .

Under a wrinkle that dates back to enactment of the law, members of Congress and thousands of their aides are required to get their coverage through new state-based markets known as insurance exchanges.

But the law does not provide any obvious way for the federal government to continue paying its share of the premiums for the comprehensive coverage.

via Wrinkle in Health Law Vexes Lawmakers’ Aides – NYTimes.com.

Medicaid Expansion: money, politics, and plain talk

Ross Ramsey of the Texas Tribune only sees the political debate behind both HB2’s restrictions on abortion and Medicaid expansion.

The state didn’t expand its Medicaid program, and you’ll still find legislators across the spectrum thinking about the consequences, good or bad.

This summer’s debate on abortion restrictions turned entirely on politics. It wasn’t about the money.

via The Economic Debate Behind the Political Debate | The Texas Tribune.

Lay aside the silliness that any Conservative considers abortion simply about the money or politics. Let’s look at the Medicaid debate.  Rather than the TT’s simplistic view of “9 Federal dollars for every 1 dollar the State spends,” remember that the operative word in “Medicaid expansion” is “expansion.”

Under the expansion, the only criteria would be income. Any asset test or obligation to look for work would be forbidden by Federal law.

Healthy men and women who choose not to work, not those on disability – and even those whose employers offer some sort of health insurance would have come under the State’s Medicaid.  Many more would find it “cheaper” to quit work or avoid work and go under Medicaid and other benefits.(Back when I was delivering babies, I had several two-income families who found it better for mom to quit work after she became pregnant, since Medicaid picked up the cost of insurance and co-pays for her and the kids.)

I remember a tall, healthy-appearing (I’m qualified to judge, BTW) 30-year-old man who testified against HB2 and all its precursors. He not only showed up for repeated Committee meetings, he was there every time there for the House and Senate hearings. He loudly claimed to be a Texas law school graduate who is (STILL!) unemployed – and criticized and ranted at our Legislators for not “giving” him a job and benefits. Who wants to pay his Medicaid?

The expansion wouldn’t significantly cut the oft-quoted high rate of uninsured in Texas, even according to TT’s own numbers. Over 1/2 of Texas’ uninsured make too much money for Medicaid, and 1/3 make more than $50,000 a year.  Lawbreaking immigrants (someone’s bound to be insulted if I use the term “illegal immigrants”) make up 1/4 of the uninsured, but they wouldn’t be covered without breaking a few more laws. The disabled, low-income mothers and children and the elderly in nursing homes would have continued to be covered under current programs – at least as long as the money holds out.

We Paid for Those Abortions | National Review Online

A question for @GregAbbott_Tx: When will charges be filed?

Planned Parenthood has been found to be guilty of Medicaid fraud including altering medical records and even making taxpayers pay for abortions!  History from California in 2004, New York in 2008, others in New Jersey and Washington state. And now, a settlement for $1.4 Million in 2013 in Texas.

“[W]hat are we to make of a consistent pattern of overbilling and fraud across several states, involving millions upon millions of dollars of taxpayers’ money? Given the impenitent attitude of the Texas affiliates and the Planned Parenthood central command, perhaps it is time to inform Cecile Richards & Co. that orange is the new black.”

via We Paid for Those Abortions | National Review Online.

Planned Parenthood settles Medicaid Fraud (Update 2 on 8-5-13)

Good news for Texas, but it seems there should be more penalties for falsifying records!

Texas Attorney General’s Office Obtains $1.4 Million Settlement against Planned Parenthood Gulf Coast for Medicaid Fraud

Planned Parenthood Gulf Coast fraudulently billed Texas Medicaid program for products, services either not provided or not necessary

HOUSTON – The Texas Attorney General’s Office today concluded the State’s Medicaid fraud investigation into Planned Parenthood Gulf Coast, Inc. Under today’s agreement, Planned Parenthood Gulf Coast must pay $1.4 million for fraudulently overbilling the taxpayer-funded Medicaid program.

After a whistleblower lawsuit was filed alleging improper billing practices by Planned Parenthood Gulf Coast, an investigation was opened by the Texas Attorney General’s Office and the Texas Health and Human Services Commission’s Office of Inspector General. The State’s investigation revealed that Planned Parenthood Gulf Coast improperly billed the Texas Medicaid program for products and services that were never actually rendered, not medically necessary, and were not covered by the Medicaid program – and were therefore not eligible for reimbursement. For example, state investigators determined that Planned Parenthood Gulf Coast falsified material information in patients’ medical records in order to support fraudulent reimbursement claims to the Medicaid program.

via Texas Attorney General.

Update: Of course, PP is saying the claims are “baseless,” and that they paid all that money to rid themselves of a nuisance suit! (See Texas Tribune’s “reporting”  here.)

Update 2 on August 5, 2013: The total that PP agreed to pay is actually $4.3 Million. The first number was just that portion that will be paid to Texas.

Rep. Jason Villalba Closing Speech on HB 2 (#Stand4Life )

Texas Alliance for Life has posted the video of the speech given in the Texas House of Representatives by Representative Jason Villalba (District 114, Dallas) in favor of life and HB2. It’s a beautiful testimony to love and humanity, and an answer to all the claims that this Bill is simply a political ploy. Watch for the sonogram picture of the Villalba’s 13 week son and the Representative’s declaration that he will fight for his son and all the babies destroyed by elective abortion.

Pro-abort McClendon Amendment Redefines “Child”

. . .as someone whose mother chose not to abort him!

Democrat Ruth McClendon, from District 120 of San Antonio, proposed an Amendment to HB 2 today that she thinks is necessary, “if we’re not going to allow women to control their own bodies.” The Amendment would re-define “child” as one,

B. whose mother declares in writing in accordance with rules adopted by the executive commissioner of the Health and Human Services Commission, that, because of Section 245.010 (a), Health and Safety Code, or Subchapters C and D, Chapter 171, Health and Safety Code, the mother chose not to or did not have access to a facility to exercise her right to an abortion at the time the child was born.

Isn’t it obvious that the mother of each and every born child chose not to abort them? Whether or not there’s a “constitutional right?”

And, please, “at the time the child was born?” Does that mean the mother chose not to abort at birth or that she made the declaration at the time of birth?

Representative Kenneth Sheets, Republican from the Dallas-area District 107, explained that his family is going through adoption and that he knows that the same benefits are available to his family and to everyone.

Planned Parenthood, big abortion and the battle to save lives in Texas | Fox News

[R]emind me again why pro-abortion activists want healthy five-month pregnant women to abort their healthy child in dirty, unsafe abortion clinics?

via Planned Parenthood, big abortion and the battle to save lives in Texas | Fox News.

ObamaCare’s ‘Liar’ Subsidies (but no qualifying)

Who’s surprised that ObamaCare has one more set of freebies for some, costs for all? How about that recent decision to delay employer reporting of benefits? Turns out that the subsidies won’t be delayed — so they will be based on an honor system. The honor of the people applying for the subsidies.

From the Wall Street Journal’s Taranto and “Best of the Web Today:”

 

HHS promises to develop “a more robust verification process,” some day, but the result starting in October may be millions of people getting subsidies who don’t legally qualify.

via Review & Outlook: ObamaCare’s ‘Liar’ Subsidies – WSJ.com.

“No Cost” Contraception (Obama Administration fantasy)

The Obama Administration has published its final rule on health insurance coverage of contraception. “Religious employers” are supposed to be happy with the Obama decree that insurance companies will provide contraception “at no cost.”

We all know that there’s no such thing as “no cost.” Everyone will “share” the cost, since everyone will be forced to buy health insurance.

Here’s the letter, thanks to one of the Conscience groups I follow:

From:   Lauren Aronson
             Director, Office of Legislation
             Centers for Medicare & Medicaid Services
 
Re:       Administration Issues Final Rules on Contraception Coverage and Religious Organizations
 
Today, the Obama administration issued final rules that balance the goal of providing women with coverage for recommended preventive care – including contraceptive services prescribed by a health care provider – with no cost-sharing, with the goal of respecting the concerns of non-profit religious organizations that object to contraceptive coverage.  The final rules reflect public feedback received in response to the Notice of Proposed Rulemaking issued in February 2013. 
 
Today’s final rules finalize the proposed simpler definition of “religious employer” for purposes of the exemption from the contraceptive coverage requirement in response to concerns raised by some religious organizations.  These employers, primarily houses of worship, may exclude contraceptive coverage from their health plans for their employees and their dependents. 
 
The final rules also lay out the accommodation for other non-profit religious organizations – such as non-profit religious hospitals and institutions of higher education – that object to contraceptive coverage.   Under the accommodation these organizations will not have to contract, arrange, pay for or refer contraceptive coverage to which they object on religious grounds, but such coverage is separately provided to women enrolled in their health plans at no cost.  The approach taken in the final rules is similar to, but simpler than, that taken in the proposed rules, and responds to comments made by many stakeholders.
 
With respect to an insured health plan, including a student health plan, the non-profit religious organization provides notice to its insurer that it objects to contraception coverage.  The insurer then notifies enrollees in the health plan that it is providing them separate no-cost payments for contraceptive services for them for as long as they remain enrolled in the health plan. 
 
Similarly, with respect to self-insured health plans, the non-profit religious organization provides notice to its third party administrator that objects to contraception coverage.  The third party administrator then notifies enrollees in the health plans that it is providing or arranging separate no-cost payments for contraceptive services for them for as long as they remain enrolled in the health plan.  The final rules provide more details on the accommodation for both insurers and third party administrators.

 
To view the Final Rule: http://www.ofr.gov/OFRUpload/OFRData/2013-15866_PI.pdf
 
To view technical guidance on the temporary enforcement safe harbor visit: http://cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/preventive-services-guidance-6-28-2013.pdf
 
To view the self-certification form for eligible organizations visit: http://cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/index.html#Prevention
 
If you have any questions, please contact the CMS Office of Legislation. Thank you

Texas Tops Site Selection’s Most Competitive States of 2012 (from @GovernorPerry)

Texas has taken the top spot in another of Site Selection Magazine’s annual rankings – this time in the magazine’s ranking of the most competitive states in 2012. Earlier this year, Texas was awarded Site Selection’s 2012 Governor’s Cup for the most new and expanded corporate facilities announced over the year.

The magazine highlighted Texas’ commitment to maintaining a strong job creation climate and reducing the tax burden on employers, specifically through Gov. Perry’s $1.6 billion tax relief proposal.

Site Selection considered a number of criteria for the ranking, including total new and expanded facilities in 2012, total new jobs created in 2012, rank in the corporate real estate executive portion of the 2012 Site Selection Business Climate Ranking, state tax climate as ranked by the Tax Foundation, performance in the Beacon Hill Institute’s State Competitiveness Index, and the number of National Career Readiness Certificates per 1,000 residents aged 18-64.

To view the full article, please visit http://www.siteselection.com/issues/2013/may/top-comp-states.cfm.

via Office of the Governor Rick Perry – [Press Release] Texas Tops Site Selection’s Most Competitive States of 2012.

Dems divided on congressional Obamacare changes – Jake Sherman – POLITICO.com

Democrats are seeking to exempt Congress and their staffers from Obamacare.

http://www.politico.com/story/2013/04/dems-divided-on-congressional-obamacare-changes-90648.html

NIH funded study: “the tobacco industry and the Tea Party”

How reliable is a US government funded study that uses the term, “astroturf?”

Research using your tax dollars is under scrutiny – once again – and the subject of recent hearings in Congress. The National Cancer Institute, a wing of the National Institutes of Health, paid for this “study.” It was published in a “peer reviewed” journal, Tobacco Control, one of the “BMJ Group” (British Medical Journal) publications.

Discussion

The tobacco companies have refined their astroturf tactics since at least the 1980s and leveraged their resources to support and sustain a network of organisations that have developed into some of the Tea Party organisations of 2012.

***

 

What this paper adds

Rather than being a grassroots movement that spontaneously developed in 2009, the Tea Party organisations have had connections to the tobacco companies since the 1980s. The cigarette companies funded and worked through Citizens for a Sound Economy (CSE), the predecessor of Tea Party organisations, Americans for Prosperity and FreedomWorks, to accomplish their economic and political agenda. There has been continuity of some key players, strategies and messages from these groups to Americans for Prosperity, FreedomWorks and other Tea Party-related organisations.

***

• Funding This research was funded by National Cancer Institute grants CA-113710 and CA-087472. The funding agency played no role in the selection of the research topic, conduct of the research or preparation of the manuscript. SAG is American Legacy Foundation Distinguished Professor in Tobacco Control.

• Competing interests None.

• Provenance and peer review Not commissioned; externally peer reviewed.

via ‘To quarterback behind the scenes, third-party efforts’: the tobacco industry and the Tea Party — Fallin et al. — Tobacco Control.

Obama Gives $13 Million Grant to Texas Planned Parenthood! @txprolife

We’ve all been hearing about the supposed “War on Women” by Conservative law makers – and, by extension, voters – in Texas. Well, President Obama and Secretary of Health Kathleen Sebellius just fired another shot in the war against Texas and State’s rights.

UPDATE: In an emailed statement, Texas Department of State Health Services spokeswoman Carrie Williams says that the agency just received notice that it will lose the Title X grant and is “reviewing the information to get a sense of the full impact.” The agency hopes the transition is smooth and the provider base remains strong, she wrote.
EARLIER: The federal government has pulled from the state of Texas millions in family planning funding, granting the money instead to a coalition led by the Women’s Health and Family Planning Association of Texas, which says it can serve a greater number of women with the available funds.
For more than four decades, federal Title X funding has been dedicated to funding family planning services and covering clinics’ infrastructure costs. The funds are generally granted to providers (like Planned Parenthood) and/or to state health agencies. In Texas since 1980, the majority of the funding has been administered by the Department of State Health Services — roughly $18 million in 2012, for example; since 2009, DSHS has been the sole grantor of Title X funds.

(Edit, maybe it’s only half of that.)

A Little History

Before this year, Federal tax dollars came back to Texas in two major funds: the Women’s Health Program and Family Planning, or Title X funds. Texas “matched” a certain amount and the Texas Department of Health and Human Services administered the dispersion of the money. Because the money paid for or freed up other funds for staff, marketing, and “infrastructure” or office overhead, PP was helped to keep their abortion clinics running. The overall effect was that State matching tax dollars helped PP to funnel patients, if not dollars, to their abortion clinics.

Texas was forced to make severe Budget cuts across the board in 2011, including Family Planning funds. This led to prioritizing what little money we had:

“State lawmakers cut funding for family planning services by two-thirds in the last legislative session, dropping the two-year family planning budget from $111 million to $37.9 million for the 2012-13 biennium. They also approved a tiered budget system for family planning funds, which gives funding priority to public health clinics, such as federally qualified health centers and comprehensive clinics that provide primary and preventative care over clinics that only provide family planning services.”

Texas Tribune

Finance Chairman Representative Jeb Henserling of Texas

SPEAKING to National Pawnbrokers Association in Washington, School.