To all brethren good
Citizens,
President Obama had a vision which
he shared and got full public support and mandate. The vision that are good,
fair and balanced for all people. The President is paying the price
for the promise he made to save people’s lives with economic
collapse.The President promised to serve diligently without veering
off into the convoluted plot twists with unnecessary melodrama that afflicted so
many people with economic downturn and loss of job opportunities.
The country’s economy suffered from budget deficits over the years, a
situation created by special business interest who evaded paying taxes and
equally defaulted in paying back Government loans on time. There
were many other instances of business theft that went on for many years
undetected including twisted bankruptcy where businesses shut-down, with
instances of irregular ponzi-schemes and Hedge Funding that were reasons that added to serious budget deficits by the selfish and greedy special interest
group.
To suspend Obamacare for another
year is a crime against the people on their medical security. To protect from
further medical fraud, the program must commence on time as
legislated.
It must be known that, once a
federal law has been enforced, it remain a validated law of the land. It is a
requirement by law that the Presidency must be respected by all
irrespectively. Knowing that President being in-charge of the
executive branch, and that the Obamacare having gone through checks and balances
in the normal legal dispensation process without a hitch; it is a crime, illegal
and contemptuous for any group of politicians or the Speaker to change its
course to allow Government Shut-down that serve fundamental public interest to
favor special interest of a few, is unacceptable. It is as well
breaking the law of many to short-change in ways or form, to bring such matter
to be a subject for discussion. Delaying or suspending healthcare
for people is deninately a crime that must be disputed by all to protect health
security concerns; and politics must not be allowed to interfere with peoples
livelihood and health interests.
How does this Gov. Shut-down impact
debt default, when the nation's borrowing go double from default and the limit
must be raised from default? How will this help the Government from not
defaulting???Does it not mean that these politicians who are after the
Government Shut Down are into a jig-saw-cut-deal for their self and greedy
interest, and that they are trading short-change business by using Gov.
Shut-down purposefully to push Government to default to benefit benefactors? How
can people trust Ted Cruz with those behind him pushing for the same??? This is
definately a tango to test President Obama ability to leadership. Who will
President Obama support, the people or the special interest??? Law is Law and no
one is above the law. Obamacare is legally binding and it remains the law. This
is the feel President Obama should guard against political actions that are in
contempt of the law. This is asking the President to compromise on what is
the LAW.......is this right??? Is this what the American people want???
It is unthinkable and despicable
that a few special interest Republicans behave this way in a selfish manner to
disrepute and embarrass this great Nation on the face of the world. Business
community as well have a duty to respect the law.
It is therefore our concern and
rights that we the people engage public support to reject the motion of
Government-Shut-Down and petition the President to oppose this bad melodrama and
instead, use his prerogative to save this ugly situation for the sake of many
and equally protect democracy on fundamental service to the people. In these
instances and for the sake of security of majority people and the Nation,
President Obama has right to use the obligated power vested for the Presidency
to VETO any such proceedings to save a situation.
Judy Miriga
Diaspora Spokesperson &
Executive Director for
Confederation Council Foundation for Africa
USA
email: jbatec@yahoo.com
------------------------------------------
What ObamaCare Will Mean for You
Published on Sep 27, 2013
http://www.healthcare.gov and use the new Health
Insurance Marketplace to see all of the health plans available in your area and
sign up for the one that fits your needs and budget. You can also find out if
you're eligible to pay less for private health insurance or whether you qualify
for other free or low-cost programs.White House White Board: What Obamacare Means for You
The Affordable Care Act - also known as Obamacare - means better coverage for
those who already have health insurance, and more options for those who don’t,
including a new way to shop for affordable, high-quality coverage.
Watch the latest White House White Board to learn more about what the law means for you.
For more information:
Watch the latest White House White Board to learn more about what the law means for you.
- HealthCare.gov
- What is the Health Insurance Marketplace?
- Learn how the Affordable Care Act protects you
Related Topics: Health
Care
---------------------------------------------
To Ask China's
Permission First
Bruce
Tonkin The current
Democrats are certainly not infallible, nor are they immune to criticism. The
Republicans, however, have gone from being fiscally reckless (rai
[...] Frank Sharon This country is lucky to have men
like Ted Cruz–Scott Walker—Ron Paul because they are for the people of united
states. Obama and the Clintons and quite a [...] James Pleiss Senator Cruz is a rare politician
in that he understands logic and reasons deductively as any prosecuting attorney
would; this presents a problem to so man [...]
Comment Now
Ted Cruz, an
ultra-conservative Cuban American who is leading the current assault on
Obamacare, has done more than anybody to bring the federal government to the
brink of shutdown. What he has not considered is how America’s foreign creditors
will react.
Although China, Japan, and
other major creditor nations have no dog in the Obamacare fight, they have a
strong interest in preserving America’s basic financial, economic, and social
stability. From their point of view, Cruz, a junior senator from Texas and a Tea
Party favorite, is not following the script. It is essential that he be smacked
down – and he will.
Bruce
JapsenContributor
Unbeknownst to Cruz, and
seemingly to most of the rest of the Republican party, the creditor nations hold
the high cards. If they were to sell just a small proportion of their American
assets, they could send Wall Street into a tailspin. They are unlikely to do
this but even if they were merely to slow the pace of their buying, bond yields
would rocket and stocks could fall 15 percent in the space of a couple of
weeks.
It is sometimes suggested
that by triggering a sell-off, creditor nations would be cutting their own
throats. Actually this is a characteristically myopic Western way of looking at
things – a view that completely misunderstands how things have changed now that
East Asians call the tune. The point is that the creditor nations are long-term
holders who are largely indifferent to short-term fluctuations.
As a general rule, the East
Asian creditor nations hate drawing attention to themselves. But they are quite
effective behind the scenes in making their views known. One of the most
important ways they wield influence is through major Wall Street investment
banks. These latter in turn spend large amounts on political contributions,
typically backing both Republicans and Democrats. Their money gives them plenty
of face time to advise American elected representatives on “good economics,” a
term that more and more these days amounts to economics that serves East Asia’s
interests. Meanwhile American investors generally are short-term thinkers who
rarely show much intestinal fortitude in riding out downturns. As they generally
vote Republican, their bleating can be expected to help soften the attitudes of
Cruz and his cohorts.
It remains to be seen how
markets will react tomorrow but the betting is that, in the absence of a
climbdown by Republicans, we will see a significant correction. And if Cruz and
his allies continue to stick by their guns in the weeks ahead, we could see
damage particularly in techs and other high P/E stocks. For the record, major
tech stocks that seem most richly valued on a forward P/E basis include CRM,
LNKD, CCI, FB, and ADBE. Although future prospects may justify such valuations,
the short-term action could be quite bumpy — certainly bumpy enough to frighten
a lot of the Republican rank and file.
By
Jake Miller /
CBS News/
September 22, 2013, 4:29 PM
Budget bill battle over Obamacare opens new GOP schism
Sen. Ted Cruz, R-Texas,
center, smiles during a news conference with conservative Congressional
Republicans who persuaded the House leadership to include defunding the
Affordable Care Act as part of legislation to prevent a government shutdown, at
the Capitol in Washington, Thursday, Sept. 19, 2013. / AP Photo/J. Scott
Applewhite
After the House passed a bill on
Friday funding the government for roughly three months but
defunding Obamacare, the fight over the budget and the healthcare law shifted to
the Senate.
While most lawmakers,
including many Republicans, have all but conceded that the Senate will never
pass the House bill and will instead re-insert Obamacare funding, Sen. Ted Cruz,
R-Texas, who is leading the fight against the healthcare law in the upper
chamber, insisted it's still possible for the Senate to follow the House's
lead.
"Senate Republicans should
stand united to stop [Senate Majority Leader] Harry Reid from changing the House
bill and, in particular, from inserting the funding from Obamacare with 51
votes," said Cruz on "Fox News Sunday." "That's going to be the fight
procedurally - whether he's able to use a straight party line vote, just
Democrats, to put Obamacare back. And you know what? If Senate Republicans stand
together, we can stop Harry Reid from doing it."
Cruz said he will ask Reid
to institute a 60-vote threshold for amendments to the House bill, which would
enable the Senate's 46 Republicans to block any measure re-inserting Obamacare
funding if they are able to stand united.
Play Video
Rep. Salmon: Defunding Obamacare "the will of the people"
Play Video
Coburn: "We don't have the ability" to defund Obamacare
But when he was pressed by
Fox News' Chris Wallace on whether his GOP colleagues will stand behind him, the
Texas Republican demurred.
"We don't know right now,
and this week, we'll determine that," he said. "Look, this has been a fast
moving target. You know, just a few weeks ago, we didn't have any of the votes
we needed in the House or in the Senate."
If he doesn't get his wish, and the Senate votes to send a bill with
Obamacare funding back to the House, Cruz said Republicans should stand strong,
even if it means incurring a government shutdown - not that such a result would
be the fault of the GOP.
"I believe we should stand
our ground and I don't think Harry Reid and Barack Obama should shut down the
federal government," he said. "Look, the House voted to fund the federal
government. If Harry Reid kills that, Harry Reid is responsible for shutting
down the government and he should listen to the American people, open the
government, fund the government, but don't fund Obamacare because it's hurting
the American people."
Despite Cruz's tough talk, most of the rest of Washington is convinced his push to defund Obamacare will ultimately come up
short. And some of the strongest notes of skepticism are coming
from his fellow Republicans.
"I am sure the Senate is
going to move that bill forward," said Sen. Tom Coburn, R-Okla., on CBS' "Face
the Nation. "We don't have the ability... to put a total stop and defund
Obamacare. It would be nice if we did. I'd be in the fight."
Coburn marveled that those
who were clamoring loudest for a vote on defunding Obamacare, such as Cruz, are
now threatening to halt the legislative the process if it doesn't suit their
ends. "The ironic thing...is that the answer now in the Senate, by those who
proposed this strategy, is to filibuster the very bill they said they wanted,"
he said.
Even Sen. Rand Paul, R-Ky.,
who has sided with Cruz and other Republicans pushing to defund the law, threw
cold water on the likelihood that they could succeed.
"We probably can't defeat or
get rid of Obamacare," Paul told reporters at a Republican gathering on
Saturday, according to the Associated
Press.
The skepticism from Paul and
Coburn echoed that of other Republicans, such as Sen. John McCain, R-Ariz., who
said this week that it's not "rational" for Republicans to think they can defund
the healthcare law during the budget fight, and Rep. Peter King, R-N.Y., who
urged Cruz to "keep quiet" with his hard-line on Obamacare.
- House anti-Obamacare budget bill dead on arrival, senators say
- Obama to Congress: Pass a budget, quit the drama
Democrats, for their part,
agree with their GOP colleagues who believe that de-funding the healthcare law
is off the table. Senate Majority Leader Harry Reid, D-Nev., has vowed that any
bill that touches Obamacare funding is "dead" when it reaches his chamber.
Play Video
Reid: "Any bill that defunds Obamacare is dead"
In the meantime, though,
Democrats are happy to sit back and watch Republicans snipe at each other,
saying the infighting demonstrates just how disorganized and ideologically
bankrupt the GOP has become.
"Let's be really clear about
this: The Republicans put legislation on the floor that was intended to shut
down government. For them, that's a victory, because they're anti-government
ideologues who dominate the Republican Party," said House Minority Leader Nancy
Pelosi, D-Calif., Sunday on CNN. "The effect of putting the Affordable Care Act
on the bill is to shut down government. They know that. They know that has no
prospect of prevailing."
"I call them legislative
arsonists," she continued, warning that Republicans' obsession with Obamacare
could wreak havoc on other, unrelated budget items. "They're there to burn down
what we should be building up in terms of investments and education and
scientific research and all that it is that make our country great and
competitive. I don't paint them all with the same brush. And I certainly don't
paint the speaker with that brush. But enough of them in their caucus to shut
down government. That would be a victory for them."
Sen. Claire McCaskill, D-Mo.,
told "Fox News Sunday" that Republicans are throwing a "tantrum" because they
didn't get their way in the 2012 election.
"It's not brute political
force that is refusing to defund Obamacare. It's called the American people and
elections. I don't think in America, we should throw tantrums when we lose
elections and threaten to shut down the government and refuse to pay the bills,"
she said. "I cannot believe that they are going to throw a tantrum and throw the
American people and our economic recovery under the bus."
Comments:
Unfortunately, partisan dan
doesn't quite understand that both parties spend our money equally -- they just
have different priorities -- and the PPACA fixed the Medicare Part D "donut
hole" that saves seniors billions, since the PPACA funded the unfunded GOP
legislation!
- linkiconreporticon emailicon
- jimsmith90210 says:
- Quite hypocritical of rafael cruz, the Canadian senator living in texas, to be filibustering "until he can no longer stand" in the Senate, while 26% of his constitutents lack health care -- the state with the most uninsured and under-insured residents -- which only means he should be championing the ACA instead of fighting it!
- reply
Au contraire!!!It's
different for the GOP than the Democrats. Things that are okay for the GOP are
an outrage when Democrats do them. If Obama was born in the United States, as
was his mother, but his father was born in Kenya, that makes him not a US
citizen. But if Cruz's mother was born in the United States, and he was born in
a foreign country, that makes him a US citizen. Kind of like how Romneycare is
good, but Obamacare is bad. Or how Obama should be forced to make every single
school record public, but Romney's tax returns were nobody else's business. Or
how Anthony Weiner is a horrible, morally corrupt man (he is) but Mark Sanford
was such a paragon of virtue that he not only was allowed to finish his term in
the House, but then went on to be elected to the Senate. How silly of you,
thinking that the GOP should operate under the same rules. I hope you understand
now, how absurd the very suggestion is.
Maybe not, since the Canadians could agree to take him back on the condition that he will not apply for socialized health care since he is so radically against it, and force him to return to texas for health care - the state that has the highest number of uninsured residents!
House Republicans defy Obama on funding bill; government shutdown nears
Thomas Ferraro and Richard
Cowan 2 hours ago
By Thomas Ferraro and Richard
Cowan
WASHINGTON (Reuters) - The
House of Representatives early on Sunday brought the federal government closer
to a shutdown as it voted to delay President Barack Obama's landmark healthcare
law for a year as part of an emergency spending bill.
By a mostly partisan vote of
231-192, the Republican-controlled House approved the "Obamacare" amendment,
despite a veto threat from the White House.
It also voted 248-174 to repeal a medical device tax that aims to help fund
healthcare programs under the 2010 law.
And in a sign that lawmakers
might be resigned to a government shutdown beginning Tuesday, the House
unanimously approved a bill to keep paying U.S. soldiers in the event the
government runs out of money to run many programs.
Senate Majority Leader Harry
Reid reiterated on Saturday that the House bill would be dead on arrival in the
Democratic-controlled Senate, which is not scheduled to meet until 2 p.m. on
Monday.
View
gallery."
U.S. House Majority Leader Eric Cantor (R-VA) (C)
walks to the House floor for a series of late-nigh …
Obama also threatened to veto any bill that delays his healthcare
restructuring.
There is a slight chance the
two sides could reach a funding deal before the government's fiscal year ends at
midnight on Monday. Congress could also act at any time to end the impasse if a
shutdown did occur.
But the bitterness of the
House debate on Saturday night that spilled into early Sunday did not bode well
for prospects of a compromise.
"You have been hijacked by a
group called the Tea Party," Democratic Representative David Scott of Georgia
said angrily, referring to the powerful conservative, anti-government movement
that holds significant sway over Republicans.
"The American people deserve
to have time to see what this monstrosity will do before it is implemented,"
shouted Republican Representative John Culberson of Texas, referring to
"Obamacare."
The high-stakes maneuvering between Democrats and Republicans is likely to
continue through much of Monday.
View gallery."
The U.S. House of Representatives remains fully lit
during a rare late-night Saturday session at the …
The standoff is also a
harbinger for the next big political battle in Washington: a far more
consequential bill to raise the federal government's borrowing authority.
Failure to raise the debt ceiling by mid-October could result in the government
defaulting on its obligations.
MEDICAL DEVICE TAX
The funding impasse is the
culmination of more than three years of failed conservative efforts to repeal
"Obamacare," a program aimed at extending health insurance to millions of those
without coverage.
Republicans argue that
"Obamacare," which is set to launch on October 1, is a massive and unnecessary
government intrusion into medicine that will cause premiums to skyrocket and
damage the economy.
Failure to pass a funding
bill would close down much of the government for the first time since 1996. More
than a million federal employees would be furloughed from their jobs, with the
impact depending on the duration of a shutdown.
The current timetable could
leave House Speaker John Boehner with the most difficult decision of his career:
whether to approve a straight-forward spending bill passed on Friday by the
Senate or allow the government shutdown to begin.
View
gallery."
The U.S. House of Representatives remains fully lit
during a rare late-night Saturday session at the …
Neither side wants to be the
last to cast the final vote that would lead to a shutdown, a concern that has
turned the funding measure into a hot potato tossed between the two
chambers.
While polls consistently show the American public is tired of political
showdowns and opposed to a shutdown, House conservatives were jubilant about the
fight.
"This is a win-win all the
way around," said Republican Arizona Representative Matt Salmon, who described
the mood of Republicans before the vote as "ecstatic."
Republicans and a handful of
Democrats also approved an amendment to the bill repealing a tax on medical
devices that helps fund the healthcare law to the tune of about $30 billion.
That provision, sought with heavy lobbying by the medical device industry, has
been supported in the past by some Democratic senators.
In a government shutdown,
spending for functions considered essential, related to national security or
public safety, would continue along with benefit programs such as Medicare
health insurance and Social Security retirement benefits for seniors.
But civilian federal
employees - from people who process forms and handle regulatory proceedings to
workers at national parks and museums in Washington - would be temporarily out
of work.
View
gallery."
U.S. House Majority Leader Eric Cantor (R-VA) (C)
walks into the offices of Speaker John Boehner (R- …
The last government shutdown
ran from December 16, 1995 to January 6, 1996, and was the product of a budget
battle between Democratic President Bill Clinton and Republicans, led by
then-Speaker Newt Gingrich.
Republicans suffered a public backlash when voters re-elected Clinton in a
landslide the following November, a lesson never forgotten by senior
Republicans, including Boehner.
This time, Boehner tried to
avoid a showdown but was overruled by his rebellious caucus, largely influenced
since the 2010 election by newcomers endorsed by the Tea Party.
While Boehner and Majority
Leader Eric Cantor, the top House Republicans, worked behind the scenes, they
did not deliver floor speeches in support of the bill - something they often do
on major legislation.
Instead, some of the House's
most conservative members who drove the "Obamacare" delay effort, dominated the
debate.
With Boehner effectively
sidelined, rank-and-file Republicans boasted of their unity. Members chanted,
"Vote, vote, vote, vote," in their closed-door meeting, they reported
later.
Afterward, Democratic
Representative Louise Slaughter of New York, took to the House floor to accuse
Republicans of throwing a "temper tantrum" about "Obamacare" under pressure from
"Tea Party extremists."
Conservative and liberal
groups, from the Tea Party to women's rights organizations, have been cashing in
on the showdown over "Obamacare," using it to rally supporters and raise money
for next year's congressional elections.
(Additional reporting by
Caren Bohan and Kim Dixon.; Editing by Fred Barbash, Christopher Wilson and Paul
Simao)
------------------------------------------------------
Bill Clinton: When It Comes to Obamacare, GOP 'Begging for America to Fail'
View gallery
.
The Republican Party is
"begging for America to fail" by rooting for President Obama's signature health
care law to fail, former President Bill Clinton said during an interview for "This Week" with ABC's George
Stephanopoulos,
"I've never seen a time - can
you remember a time in your lifetime when a major political party was just
sitting around, begging for America to fail … I don't know what's going to
happen. But I'll be shocked if it fails," Clinton, who attempted during his
first term as president to overhaul the country's healthcare system in the early
1990s, said during an interview taped Thursday in New York while the annual
Clinton Global Initiative was taking place.
A recent ABC News-Washington
Post-poll found that more than half of Americans are opposed to the Affordable Care
Act. But for his part, Clinton is optimistic that with time, the
law - known more commonly as "Obamacare" - will grow in popularity.
"I just think that when all
these dire predictions don't come out, if they don't - I believe that pretty
soon, within the next several years, this'll be like Medicare and Medicaid. And
it'll be a normal part of our life. And people will be glad it's there," the
former president told ABC News.
Clinton was responding to a
recent suggestion by Republican South Carolina Sen. Lindsey Graham that former
Secretary of State Hillary Clinton's political
future was tied to the success or failure of Obamacare. Graham
said he thinks the law will fail.
Clinton told Stephanopoulos
he was "not at all" concerned about the potential failure of the Affordable Care
Act having any impact on a potential run by his wife for the White House in
2016.
"I think this bill's already
produced a lot of good results and every - look, they are desperate for this
bill to fail, because if it's not a failure, their whole - everything they've
been telling us since 1980 that government's bad is wrong. They so badly want it
to fail," he said.
Since being passed in 2010,
the Affordable Care Act has been a political lightning rod and has been subject
to attempts by Republicans to delay and defund it. The law is at the center of
the current fight in Congress that could lead to a government
shutdown, which would be the first in almost 20 years.
Go here to find out
when "This Week" is on in your area.
-------------------------------------------------------
------------------------------------------
Example for Heads-up, Please take
note:
Healthcare Fraud - Criminal Investigation (CI)
Overview
Criminal Investigation
investigates healthcare fraud perpetrated against the federal and state
governments, as well as private insurance companies. In these investigations, CI
follows the money trail and considers both tax and money laundering
perspectives. Criminal tax investigations are initiated when income generated
from healthcare fraud is not correctly reported on tax returns, or when there is
an overstatement of expenses on tax returns. Criminal Investigation investigates
money laundering when either illegally obtained funds from healthcare fraud are
used to purchase assets or when the perpetrators of the schemes devise elaborate
methods to conceal their fraudulent proceeds. Money laundering occurs in a wide
range of fraudulent healthcare schemes such as false claims, kickbacks, or
staged accidents.
Typical healthcare fraud
investigations are lengthy, labor intensive, and involve complex issues. To
assist in combating healthcare fraud, CI participates in DOJ-sponsored,
multi-agency task forces and works closely with several state agencies. These
task forces capitalize on the strength and expertise of the participating
agencies and have proven effective in dealing with healthcare fraud.
Criminal Investigation’s
participation enhances multi-agency healthcare fraud investigations by
documenting that the perpetrators of these schemes financially benefited from
their fraudulent activities. Currently, CI is involved in the following areas of
healthcare fraud: false billings, mental health, nursing home fraud,
chiropractic fraud, durable medical equipment fraud, staged accidents,
pharmaceutical diversion, and patient referral (kickbacks) schemes.
Statistical Data
Healthcare Fraud enforcement statistics on investigations initiated, prosecutions recommended, indictments, sentenced investigations and months to serve in prison.
Healthcare Fraud enforcement statistics on investigations initiated, prosecutions recommended, indictments, sentenced investigations and months to serve in prison.
Examples of Healthcare Fraud
Investigations
Examples of investigations have been written from public record documents filed in the district courts where the case was prosecuted.
Examples of investigations have been written from public record documents filed in the district courts where the case was prosecuted.
----------------------------------------------------
June 1st, 2011
Undercover Investigation Reveals Unfair Treatment of Dental Patients
According to the findings of
an undercover investigation, dentists overcharge their patients and do not
inform them correctly regarding the fact that they can get cheaper treatments
through their NHS policies
According to the findings of an undercover investigation, dentists
overcharge their patients and do not inform them correctly regarding the fact
that they can get cheaper treatments through their NHS policies.
Some even go to the point
where they pressure the patients to choose the private insurance, even though
these patients could receive the same quality treatment through NHS, but much
more cheaply.
There has also been a case
where a patient received a quote 4 times more expensive than a non-private
insurance quote for a root canal treatment.
These findings have been
made public through the “Dispatches” team from Channel for on TV. There have
even been sent out members from the public to go for NHS check-up at offices
that offer both private and non-private treatments.
After the “patients” have
spent on an average 15 minutes inside the office, they came out and said that
they have been recommended to go with private care (the focus has been
especially on hygienic dental services). An NHS scale and polish treatment costs
around £16.50, but instead of that patients have been given quotes for private
treatment which is much more expensive.
Some other members of the
public were sent to three surgeries where they have been asking about the root
canal treatment options.
With the NHS this treatment costs around £198, but instead patients have
been quoted rates coming from the private sphere- £678, £598 and £725
respectively.
The opinion of Dr. Anthony
Halperin who is a dentist and a member of the Patients Association is
that these dentists are not sincere and rightful towards their patients.
The next step is that the
coalition is ready to re-negotiate the dentistry deal of the Labour from 2006, to
see what changes can be made in order to enforce fair treatment for the patients
in the dentistry field.
------------------------------------------------------------------------------------------
Health Care Fraud
Trends and Tips
Trends and Tips
06/28/10
A pharmaceutical
company marketed four drugs to doctors. The drugs had been approved by the Food
and Drug Administration (FDA) for specific medical conditions—like rheumatoid
arthritis, schizophrenia, and neuropathic pain—but the company promoted the
drugs for other uses as well—like post-operative pain, dementia, and
migraines—and sometimes in larger doses than the FDA allowed. In some cases, the
company even paid kickbacks to doctors to prescribe the drugs for these other
uses.
What this company did
is known as off-label marketing of prescription drugs, and it’s both illegal and
potentially harmful to consumers. After an investigation involving
the FBI and our federal and state partners, the company pled guilty to
misbranding the drugs and agreed to pay $2.3 billion to settle criminal and
civil violations…the largest U.S. health care
fraud settlement ever.
At the FBI, we take
our health care fraud responsibilities seriously as the primary investigative
agency with jurisdiction over both federal and private insurance programs. But
with total health care expenditures in the U.S. expected to reach $2.26 trillion
by 2016 according to the Centers for Medicare and Medicaid Services, the
opportunity for fraud will continue to grow—so will our workload. That means we
have to find ways to leverage our resources.
Latest Schemes and Scams
As part of its health care fraud
program, the Bureau is looking at various fraud schemes involving:
- Home health care; - Infusion therapy; and - Durable medical equipment. We’re also focused on other health care fraud-related crime problems impacting public safety, such as: - Off-label marketing of prescription drugs; - Drug diversion (prescription drugs diverted from legitimate supply sources for illicit distribution and abuse); and - Internet pharmacies |
---|
Partnerships are key. A
tried-and-true method of leveraging resources is establishing partnerships. And
we’ve done just that—with federal agencies like the FDA and the Drug Enforcement
Administration, various state and local agencies, and private insurance groups
like the National Health Care Anti-Fraud Association.
Our most recent joint endeavor? Our participation in the Department
of Justice/Health and Human Services’ (HHS) Health Care Fraud Prevention and
Enforcement Action Team, or HEAT, and its Medicare Fraud Strike Forces located
in several major metropolitan areas.
The HEAT initiative includes senior Justice, FBI, and HHS officials
who are focusing their efforts to reduce Medicare and Medicaid fraud through
enhanced cooperation. And the strike forces, which use a data-driven approach to
identify unexplainable billing patterns by health care providers and then
investigate these providers for possible fraudulent activity, are a vital part
of the initiative. As a result of strike force efforts, more than 300 cases have
been filed and close to 600 defendants charged.
Health care fraud facts:
- Health care fraud schemes come in all forms—fraudulent billings, medically unnecessary services or prescriptions, kickbacks, duplicate claims, etc.
- Schemes target large health care programs—both public and private—as well as health care beneficiaries. (Medicare and the Medicaid are the largest programs, so they are targeted more often.)
- Schemes are committed by health care providers, owners of medical facilities and laboratories, suppliers of medical equipment, organized crime groups, corporations, and even sometimes by the beneficiaries themselves.
- FBI health care fraud cases sometimes cross over into other investigative areas, like organized crime, gangs, and cyber crime, where we see criminals beginning to use the proceeds from health care fraud schemes to fund their operations.
Tips to help avoid being victimized:
- Protect your health insurance information card like a credit card.
- Beware of free health services—are they too good to be true?
- Review your medical bills, like your “explanation of benefits,” after receiving health care services and ensure the dates are services are correct.
And if you
suspect health care fraud, contact your local FBI office.
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