Judicial Watch • Medicaid

Medicaid Archives | Judicial Watch

Records uncovered from the U.S. Department of Health & Human Services (HHS) show that the division blaming cancer treatment curtailment on sequester paid more than $100,000 in bonuses to four of its top earners during the last two fiscal years.  Pursuant to the Freedom of Information Act (FOIA), Judicial Watch, Inc., filed on April 27, 2012 a request for the top earners’ pay records.  Thirteen months later, the Centers for Medicare and Medicaid Services (CMS) released eleven pages which showed the following.

1) The Deputy Chief Operating Officer, whose base pay is $179,700, was awarded:

  •  a 25% bonus on October 1, 2011 worth $44,925;
  • another $10,333 bonus on Dec. 31, 2011; and,
  • an additional $8,985 on Dec. 12, 2012

bringing her total compensation to $423,643 for the two fiscal years.

2) Meanwhile, the Director of the Office of Financial Management, whose base pay was also $179,700, was awarded:

  •  a 15% bonus on October 1, 2011 worth $26,955;

bringing her total compensation for the year to $206,655.

Total bonuses reflected in the documents amounted to $101,531.  Total pay reflected in the documents for the four employees was $820,331.

CMS under fire for blaming cut of cancer treatments on sequester:

http://www.huffingtonpost.com/2013/06/05/cancer-clinics-sequestration_n_3393846.html?utm_hp_ref=politics

Federal authorities have for years ignored a growing crisis involving a fraud-infested government entitlement program that fleeces U.S. taxpayers out of millions of dollars, according to a shocking new audit released this week.

It would almost seem inconceivable—even for today’s bloated government—if it wasn’t laid out in a report issued this week by the offending agency’s inspector general. It involves personal care services provided by the federal/state-funded health insurance for the poor known as Medicaid. In the late 90s the Supreme Court ruled that unjustified segregation of the disabled is a civil rights violation so Medicaid allocated a chunk of change for home health services.

The idea is to allow the sick, disabled and those with chronic or temporary conditions stay home and, in turn, avoid sticking Uncle Sam with a hefty hospitalization bill. Instead, Medicaid’s personal care services program is rife with corruption that was first exposed more than five years ago and continues to be documented annually by the agency’s watchdog. The budget has ballooned to more than $12 billion a year, just to send what amounts to a nanny to provide supportive “nonmedical services” like meal preparation, housework, help with bathing and getting dressed, transportation and even money management.  

The tab for home care has increased by 35% since 2005 and fraud is on the rise, according to the audit. In 2010 state Medicaid fraud units investigated more than 1,000 cases related to home services. Medicaid recipients can hire practically anyone to help them and collect the money and providers undergo virtually no scrutiny. In fact, auditors list examples of Medicaid recipients hiring juveniles, relatives and girlfriends to provide services. One man was in jail while his girlfriend collected money from the government to supposedly provide him with home care.

None of this is new, in fact the report includes six previous inspector general recommendations to combat the fraud yet none have been implemented. In 2008, for instance, the inspector general issued a report finding that five states paid around $11 million in fraudulent personal care services during one quarter alone. The illegal schemes are only getting worst yet the feds have done little to stop the madness.

Auditors stress the importance of cracking down on the costly fraud, writing that “as more and more State Medicaid programs explore home care options” it is “critical” that “adequate safeguards exist to prevent fraud, waste, and abuse.” Then again, this latest inspector general’s report essentially reiterates past assessments and the feds haven’t bothered to take action.

 

 

Judicial Watch, the public interest group that investigates and prosecutes government corruption, announced today that it has obtained documents from the Department of Health and Human Services regarding the controversial review of the prostate cancer treatment Provenge by the Centers for Medicare and Medicaid Services (CMS). Judicial Watch obtained the documents pursuant to a Freedom of Information Act (FOIA) lawsuit filed on January 3, 2011 (Judicial Watch v. Department of Health and Human Services (No. 11-0002)).

According to the documents, the purpose of this review, deemed a National Coverage Determination (NCD), is to determine if the FDA-approved Provenge treatment is “reasonable and necessary” and should therefore be reimbursed on a uniform and national level. The review was triggered by the fact that local Medicare contractors were not uniformly providing coverage for Provenge leading to multiple complaints by patients. Some contractors withdrew coverage in the middle of treatment. CMS is expected to post a “proposed decision” on its website March 30, 2011, with a final decision published 60 days after the public comment period for the proposed decision has ended.

Among the highlights from the documents uncovered by Judicial Watch:

  • The documents include a CMS Q&A sheet that denies cost was a factor in the decision to review Provenge. However, a June 8, 2010, internal email uncovered by Judicial Watch from William D. Rogers, Director of the CMS Physicians Regulatory Issues Team, to Louis B. Jacques, CMS Director, Coverage Analysis Group, states: “We discussed this on the last CMD [Contract Medical Director] call. $93,000 per treatment adds four months to life, 27,000 patients a year $2.6 billion dollars a year.” Medicare and the FDA are legally prohibited from denying approval of a medical treatment based solely on cost. Obama administration officials have denied that the review of Provenge had anything to do with the treatment’s costs.
  • A July 28, 2010, letter to Louis Jacques from Hans Bishop, Chief Operating Officer of Dendreon, the company that manufactures Provenge, and Mark Frohlich, Dendreon’s Chief Medical Officer, objecting to the “highly unusual” review of Provenge.

    While noting the “overwhelming clinical evidence” of Provenge’s effectiveness, and the FDA’s rigorous approval process, Dendreon asked the CMS to shut down the NDA: “We remind you that the patients we serve have late-stage cancer and few, if any, appealing treatment options available to them, with only chemotherapy as an FDA-approved alternative. Not only is Provenge clearly reasonable and necessary…but it provides an unambiguous survival benefit and real hope for patients battling their disease.” Dendreon argued to keep the system’s status quo, with local contractors making coverage decisions as coverage variations have “subsided.” The letter also suggests that coverage is required by law as a result of the FDA’s prior approval of the Provenge treatment for prostate cancer.

  • An internal CMS email indicating that the government hired health insurance giant Blue Cross Blue Shield, identified in public documents as an “external entity,” to conduct a technological assessment of Provenge’s clinical effectiveness. The involvement of Blue Cross Blue Shield raises concerns about a potential conflict of interest as private insurers use Medicare’s coverage determinations in setting their own coverage limits.

  • The documents include back-and-forth discussions between CMS and Dendreon about “comparative effectiveness.” In response to Dendreon’s request for clarification regarding the term “comparative effectiveness,” Jacque’s writes in a July 22, 2010, email to a CMS colleague: “Why do they need clarification?…We need to maintain an arms [sic] length relationship with them. We do no[t] owe them any questions.” Many have criticized comparative effectiveness research as a method to limit needed health care in order to reduce costs (i.e., death panels).

A number of the documents were distributed to CMS Administrator Donald Berwick, dubbed “Death Panel Donald” for his public comments endorsing health care rationing.

“Clearly, there is enormous public interest in the CMS decision to review Provenge given all of the talk of health care rationing and death panels associated with Obamacare. The American people get very nervous when the government decides to meddle in their health care and they have every right to be nervous given that we have unaccountable czars like Donald Berwick running Medicare and Medicaid. One can’t help but conclude from a review of these documents that there is a strong bias against Provenge in the Obamacare bureaucracy,” stated Judicial Watch President Tom Fitton.

A recent study shows that in 2010, only two of the 11 National Coverage Determinations led to “unrestricted positive coverage decisions.” The remaining decisions mandated restrictions of coverage of one type or another.

Documents Uncovered

Judicial Watch Investigates Charge HHS is Unlawfully Rationing Healthcare by Targeting FDA-approved Medical Treatment Based on Cost

Contact Information:

Press Office 202-646-5172, ext 305

Washington, DC — January 5, 2011
Judicial Watch, the public interest group that investigates and prosecutes government corruption, announced today that it filed a lawsuit on January 3, 2011, against the Obama Department of Health and Human Services (HHS) regarding a controversial decision by the Centers for Medicare and Medicaid Services (CMS) to undertake a one-year review of the prostate cancer treatment Provenge to determine if the treatment is “reasonable and necessary” and should therefore be reimbursed (Judicial Watch v. U.S. Department of Health and Human Services (Case No. 11-002)).
Provenge, the first ever therapeutic vaccine cancer treatment approved by the Food and Drug Administration (FDA), was shown to have extended life spans by an average of four months in clinical trials with few side effects. It costs $93,000 to administer the three necessary treatments. Medicare and the FDA are legally prohibited from denying approval of a medical treatment based solely on cost.
Yet multiple press reports suggest that cost is the major factor in the unusual decision by CMS to undertake a review of the treatment which could signal a move by the Obama administration to begin implementing healthcare rationing based on the cost of treatments.
Judicial Watch’s original FOIA request, filed on November 9, 2010, seeks the following information: “All records concerning CMS’s national coverage analysis of the vaccine Provenge, including but not limited to the criteria being used to analyze Provenge.”Health and Human Services was required by law to respond to Judicial Watch’s request by December 15, 2010. However, to date, the agency has failed to provide any documents or indicate why documents should be withheld. Nor has it indicated when a response is forthcoming.CMS Administrator Donald Berwick is on record supporting the idea of rationing healthcare based on cost. Berwick said the following in a June 2009 interview with Biotechnology Healthcare: “The social budget is limited — we have a limited resource pool. It makes terribly good sense to at least know the price of an added benefit, and at some point we might say nationally, regionally, or locally that we wish we could afford it, but we can’t…
The decision is not whether or not we will ration care, the decision is whether we will ration with our eyes open.”Owing to the controversy surrounding Berwick’s statements, President Obama bypassed Senate confirmation and made Berwick a “recess appointment,” a decision criticized by both Democrats and Republicans in Congress.“The Obama administration claims there is no merit to the charge that the Provenge decision is the first step in implementing healthcare rationing so why not release these records? What does the Obama administration have to hide? Provenge is an FDA approved drug that has a proven track record and the Obama administration has no legal right to deny this treatment based on its cost. But the American people are right to be concerned about this Provenge review, given the fact that a man dubbed ‘Death Panel Donald’ Berwick is in charge of Medicare and Medicaid,” stated Judicial Watch President Tom Fitton.

Sign Up for Updates!