Judicial Watch • Medicare

Medicare Archives | Judicial Watch

The U.S. government’s health program for the elderly and disabled can no longer refuse to pay for the costly sex reassignment operations of transgender patients who claim to have gender identity disorder, according a recent federal board ruling.

First President Obama’s hostile—and disastrous—takeover of the nation’s healthcare system and now American taxpayers must finance sex reassignment operations for transsexuals. For decades Medicare has automatically denied requests for sex reassignments surgeries, but a U.S. Department of Health and Human Services (HHS) review board recently issued a shocking ruling that acknowledges the procedures as medically necessary and effective treatment for individuals who don’t identify with their biological sex.

Officially known as the HHS Departmental Appeals Board, the panel is an independent entity within the agency and is staffed with career civil servants that wield tremendous power. In fact, the board’s decisions constitute final HHS decisions that can’t be reversed and can only be challenged in federal court. The board’s mission is to provide impartial, independent review of disputed decisions. In this case, a 74-year-old transgender Army veteran, Denee Mallon, disputed Medicare’s refusal to pay for his genital reconstruction surgery.

Mallon, who lives in New Mexico, was born a man, joined the U.S. Army at 17 and worked as a forensics investigator a city police department after leaving the military. He “lived as a woman on and off” since his teen years and “full time since 2009,” according to a national news story. Mallon was later diagnosed with gender identity disorder and he’s been trying to get Medicare to pick up the tab for gender reassignment surgery, which can run anywhere from $10,000 to $50,000. Since 1981 Medicare recipients have been ineligible for transsexual surgery.

The HHS board ruling changes this by eliminating Medicare’s blanket exclusion on transsexual operations. Justifying the change, the panel said that studies and experts have shown the efficacy of surgical interventions as a treatment for gender dysphoria, a diagnosis issued to those who undergo extreme distress over a disconnect between their gender at birth and the one they identify with. “Transgender surgery is a treatment option for the medical condition of transsexualism,” the ruling says, further stating that the National Coverage Determination (NCD) “recognized that transsexualism is a diagnosed medical condition.”

Here is a description of the medical condition, as per the recent HHS ruling that forces the government to pay for sex-change operations: “The disorder is characterized by intense and persistent discomfort with one’s primary and secondary sex characteristics—one’s birth sex. The suffering that arises is often described as being trapped in the wrong body. The psychiatric term for this severe and unremitting emotional pain is gender dysphoria.”

This is hardly the first time that American taxpayers have been forced to fund transgender benefits. This occurs regularly in prisons across the country where convicted felons, who claim to be diagnosed with “gender identity disorder,” get hormone treatments, laser hair removal and makeup while serving their sentence. For instance Massachusetts pays for the hormone shots of at least four inmates diagnosed with gender identity disorder. Colorado pays for the female hormone treatment of a convicted child molester who is suing the stat to provide him with a gender specialist in hopes that the specialist determines he needs a sex-change operation.

Last year a federal appellate court ruled that denying a transgender bank robber’s sex-reassignment surgery violates the Constitution’s Eighth Amendment protections against cruel and unusual punishment. That case involves a felon (Michael Stokes) serving a 73-year sentence in Virginia. A federal judge in Roanoke denied the surgery, finding that hormone therapy and psychological counseling provided by the prison are sufficient accommodations for a transgender prisoner. Officials also allow the convict to dress and live as a woman. Determined to get his sex-change operation, the convict took his case to the United States Court of Appeals for the Fourth Circuit, which ruled that Virginia prisons can’t justify providing partial treatment for other medical needs, so why this one?

“By analogy, imagine that prison officials prescribe a painkiller to an inmate who has suffered a serious injury from a fall, but that the inmate’s symptoms, despite the medication, persist to the point that he now, by all objective measure, requires evaluation for surgery,” the appellate court opinion says.  “Would prison officials then be free to deny him consideration for surgery, immunized from constitutional suit by the fact they were giving him a painkiller?”





Lack of timely communication between federal agencies has cost the U.S. government as much as $125 million for medical care that isn’t even supposed to be provided to illegal immigrants and incarcerated criminals.

It’s yet another case of government incompetency that’s like a swift kick in the stomach during a $16 trillion (growing by more than $3 billion daily) national debt crisis. Because the Social Security Administration can’t seem to provide accurate information on time, Medicare, the government insurance for the elderly, makes improper payments for services it shouldn’t even be financing.

During a recent two-year period U.S. taxpayers spent $92 million for the medical care of 2,600 illegal aliens and $34 million to treat 12,000 prisoners, who already get their healthcare needs met by states, according to separate federal audits. The fleecing was first reported a few days ago by a weekly publication that covers the healthcare industry.

The story cites two reports issued this month by the Department of Health and Human Services Office of Inspector General. The first reveals how Medicare, the government program that provides health insurance for people aged 65 and over and those with disabilities who have worked in the U.S., regularly pays for the healthcare costs of ineligible foreigners living in the country illegally.

During a sample probe that spanned from 2009 to 2011, investigators reviewed 133,541 claims on behalf of 2,575 unlawfully present beneficiaries with $91,620,548 in associated Medicare payments. The Centers for Medicare & Medicaid Services (CMS), the agency that runs the program, approved payments because the Social Security Administration didn’t give it verification data relating to unlawful presence in a timely manner, the probe found. When CMS got the information on time, it was able to flag illegal aliens who are not eligible for services.

Each year a chunk of the money paid for the inpatient and outpatient hospital care of illegal aliens. In 2009 the tab for those services was around $31 million, with $25 million in 2010 and nearly $10 million in 2011. The other high expenses were for physician services and skilled nursing facilities. This is only a small sampling so the cost could very well be much higher. The inspector general recommends implementing policies and procedures to recoup the “improper payments” rendered to unlawfully present beneficiaries. Since it’s not their money, the feds currently have no such process.

The second report identifies 135,805 Medicare beneficiaries who had been incarcerated at some point during calendar years 2009 through 2011 and were therefore not eligible for the program. This is because state’s pick up the healthcare costs of jailed populations. Auditors limited the review to 75,639 claims on behalf of 11,619 incarcerated beneficiaries with $33,587,634 in associated Medicare payments, so again, there are probably a lot more. Like in the case of illegal aliens, the feds have no process to recoup the money. That’s because it’s not coming out of their pocket.


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