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Health care fraudsters deliver measurably worse care that can harm patients, according to a new study.
Patients treated by organizations later excluded from the Medicare program for fraud and abuse were between 14 percent to 17 percent more likely to die than those who were treated by their law-abiding counterparts, according to a new study from researchers at Johns Hopkins Bloomberg School of Public Health. Fraud and abuse contributed to 6,700 premature deaths in 2013 alone, their analysis shows.
Some fraud and abuse schemes involve organizations that bill Medicare for services that were never provided while others harm patients, said Lauren Hersch Nicholas, assistant professor at Johns Hopkins and lead author. She cited cases where untrained personnel read medical images, physicians doled out opioids that patients don't need and companies developed counterfeit chemotherapy drugs.
"That is an underappreciated part of fraud and abuse crimes," she said.
The most vulnerable populations — low-income, non-white, dual-eligible (in Medicare and Medicaid) and people with disabilities — are more frequently targeted, according to the study. Those who were treated by a compromised organization were 11 percent to 30 percent more likely to experience an emergency hospitalization the year they received care.
"This suggests that fraud and abuse are one of the drivers of racial and socio-economic disparities in the U.S.," said Nicholas, adding that the findings are likely conservative estimates because relatively smaller cases often fall under the radar.
In 2018, more than 47,000 health care professionals were barred from Medicare and Medicaid, federal programs that provide health insurance to elderly, disabled and low-income beneficiaries, because of fraud and abuse.
Fraudulent medical practice costs the federal government an estimated $30 billion to $140 billion annually. Federal prosecutors have recouped more than $2 billion a year in fraud and abuse settlements since 2010.
Researchers compared 8,204 Medicare beneficiaries who were first treated in 2013 by a provider later banned for fraud and abuse and 296,298 patients treated by a randomly selected provider who had not been banned for fraud and abuse. They tracked mortality and hospitalization for up to three years.
Nearly one-quarter (23 percent) of patients seen by excluded providers were non-white, while 16.5 percent of patients treated by non-excluded providers were non-white. More than 27 percent had disabilities compared with 18.6 percent in the control group and 34.7 percent were dual-enrolled compared with 21.9 percent.
H.R. 4334, the Dignity in Aging Act of 2019, which reauthorizes the Older Americans Act and its programs and services, passed the full House of Representatives yesterday unanimously by voice vote. The Elder Justice Coalition supported this bill.
EJC National Coordinator Bob Blancato said, “The bill retains the all-important Title VII of the Older Americans Act, especially maintaining funding for the work of the long-term care ombudsman program. We support a new provision in the bill which updates elder justice activities to include community outreach and education and ensures innovative projects capture programs and materials for developing partnerships in communities.”
Blancato continued, “Further, we are hopeful that the 35 percent increase in authorization provided for the five-year life of the bill will be followed by adequate appropriations to allow this new initiative to go forward without reducing any existing funding related to elder abuse prevention.”
The EJC also appreciates the continued authority contained in the bill for the National Center on Elder Abuse and the National Long-Term Care Ombudsman Resource Center, as well as the new codification of the National Resource Center on Women and Retirement.
Other new provisions in the bill include first-time social isolation screening, further coordination of services to address this issue, and creation of an advisory council on social isolation. Since social isolation is a leading risk factor for elder abuse, neglect, and exploitation, these interventions are critical to preventing abuse and neglect.
Blancato also had special praise for the Education and Labor Committee’s Civil Rights and Human Services Subcommittee Chair Suzanne Bonamici for her leadership on this bill and noted that she is also the co-chair of the House Elder Justice Caucus.
The family of a teenager from Lathrup Village is continuing their legal fight to keep the young man alive.
Sixteen-year-old Titus Cromer has been in a coma for several days now and the hospital has plans to remove him from life support Monday. But an emergency motion has been filed with Oakland County Circuit Court to hopefully prevent that from happening.
“I'm not sure that his prognosis is what's really at issue, what's at issue is who makes the decision to disconnect him from life support,” Attorney Jim Rasor said.
Titus was injured on October 17 but for privacy reasons, Attorney Jim Rasor did not disclose how he was injured.
And as far as his current condition: “I asked Beaumont, sent them a release yesterday so that we could review his medical records with our experts, I have not yet received the medical records,” Rasor said.
The Michigan Certificate of Need (CON) Commission adopted rules restricting patient access to CAR-T cell therapy, a cutting-edge cancer treatment covered in part by Medicare and Medicaid.
The commission adopted the rule at the behest of several of Michigan’s established cancer treatment providers and on the advice of a panel of clinical experts it appointed to evaluate the need for the regulation.
The panel also recommended requiring providers to be accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), a national nonprofit organization that inspects cellular therapy facilities.
Keeping Out Competition
CON laws, which in some states are called Certificate of Public Need laws, are designed to keep health care providers from engaging in unnecessary capital outlays that would ultimately be passed on to patients in the form of higher costs. In practice, this means hospitals and other health care providers must get the approval of a state agency before offering new services, expanding their operations, or implementing new medical technologies. Dominant providers frequently use CON laws to limit competition from smaller hospitals.
CAR-T therapy is different from most health care services, states Anna Parsons, a policy coordinator with the American Legislative Exchange Council, because it does not require a capital investment (see commentary).
“An FDA-certified hospital should be capable of offering these treatments, since all the high-tech bioengineering is done at other locations,” Parsons told Reason.com.
Michigan As Outlier
Michigan state Sen. Curt VanderWall (R-Ludington), who chairs the Senate Health Policy and Human Services Committee, says he opposes CON regulation of CAR-T.
“It is concerning to me that the CON commission expanded a requirement into a new clinical service area that goes well beyond the federal requirement,” VanderWall told Health Care News.
The Centers for Medicare and Medicaid Services makes no mention of FACT accreditation in its August 7 press release stating Medicare will cover the proceedure in “healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies for FDA-approved indications.”
“The new CON requirement to obtain third-party accreditation will be a barrier to access, create an unnecessary financial burden for providers, and limit the sites of care from offering cellular therapies to patients,” said VanderWall.
VanderWall says patients should be allowed to choose their own CAR-T provider.
“Patient choice and access are priorities for me,” said VanderWall. “Patients will be able to work with their doctors to find the best treatment site based on safety and access.
“Michigan should not be an outlier,” VanderWall said. “No other state has a CON standard for immune effector cell therapy (IECT), and safe treatment will be offered according to the established federal guidelines in the other 49 states.”
A Joint Legislative Committee and the governor were allowed 45 days from the September 19 decision to review the new language to regulate IECT, of which CAR-T is a form, and the FACT accreditation requirement.
AnneMarie Schieber ([email protected]) is managing editor of Health Care News.
by Michele R. Berman, MD, and Mark S. Boguski, MD, PhD
Imagine Dragons is as American pop-rock bank from Las Vegas, known for their hit songs "Radioactive," "Thunder," and "Believer." Their lead vocalist, Dan Reynolds, surprised fans in 2015 by announcing that he has been diagnosed with two medical conditions. He was diagnosed with ulcerative colitis (UC) at the age of 21, and ankylosing spondylitis at 24. He also has suffered from depression and anxiety.
With the help of rheumatologist Susan Baker, MD, he started treatment and closely examined his diet and exercise routines. One of the first things that had to go was his "cereal addiction" and a diet high in processed foods.
"I went on an anti-inflammatory diet. Everyone is different," he explains. "What works for me is a lot of fish, chicken, rice, vegetables. I'll avoid bread, dairy, and sugar. I eat fruit and get natural sugar, but I avoid anything that's processed."
He also amped up his exercise routine, making it a daily priority and exercising from 1-3 hours/day. Besides weight training, he also does yoga to prevent stiffness and pain. In January 2019, he was even featured in Men's Health. During disease flare-ups, he takes a biologic medication to ease pain and get him back into remission.
Reynolds recommends that anyone struggling with medical or mental health issues try and be kind to yourself and remove stressors in your life:
"Do things every day that will de-stress your life. Treat yourself to whatever shuts your mind off. If I need to listen to my true-crime podcasts, or go to the gym, or read my book, that's what I'm going to do. My priority in life is my health. If my health isn't there, I can't do anything -- I can't be a good dad, a good musician, a good husband. I can't stress the need to de-stress enough."
Ulcerative Colitis
Ulcerative colitis is a chronic disorder that affects the digestive system. This condition is characterized by abnormal inflammation of the mucosal layer of the rectum and colon. The inflammation usually causes ulcers to develop in the large intestine. UC usually appears from ages 15 to 30, although it can develop at any age. The inflammation tends to flare up multiple times throughout life, which causes recurring signs and symptoms.
UC is most common in North America and Western Europe; however, the prevalence is increasing in other regions. In North America, ulcerative colitis affects approximately 40 to 240 in 100,000 people. It is estimated that more than 750,000 North Americans are affected by this disorder. Ulcerative colitis is more common in whites and people of eastern and central European (Ashkenazi) Jewish descent than among people of other ethnic backgrounds.
What causes UC?
A variety of genetic and environmental factors are likely involved in the development of UC. Recent studies have identified variations in dozens of genes that may be linked to UC; however, the role of these variations is not completely understood. Researchers speculate that this condition may result from changes in the intestinal lining's protective function or an abnormal immune response to the normal bacteria in the digestive tract, both of which may be influenced by genetic variations.
Several of the genes that may be associated with UC are involved in the protective function of the intestines. The intestinal mucosa provides a barrier that protects the body's tissues from the bacteria that live in the intestines and from toxins that pass through the digestive tract. Researchers speculate that a breakdown of this barrier allows contact between the intestinal tissue and the bacteria and toxins, which can trigger an immune reaction. This immune response may lead to chronic inflammation and the digestive problems characteristic of UC.
Other possible disease-associated genes are involved in the immune system, particularly in the maturation and function of T cells. Certain genetic variations may make some individuals more prone to an overactive immune response to the bacteria and other microbes in the intestines, which may cause the chronic inflammation that occurs in UC. Another possible explanation is that UC occurs when the immune system malfunctions and attacks the cells of the intestines, causing inflammation.
Coalition of Disability Rights, Civil Rights, Education, and Privacy Groups Expresses Concern About Senator Cornyn's Bill Linking Mass Violence Prevention to Mental Health Reform
October 23, 2019 - A coalition of organizations including disability rights, civil rights, education, and privacy groups sent a letter to Senator Cornyn expressing concern about legislation he introduced today, the Restoring, Enhancing, Strengthening, and Promoting Our Nation's Safety Efforts (RESPONSE) Act.
The letter applauds the recognition of the need for a federal effort to address mass violence, but expresses serious concern about focusing that effort on people with mental health disabilities. The organizations urge that mental health reform legislation be separated from legislation addressing mass violence, pointing out the clear evidence that mental health disabilities are not predictors of gun violence, and that only 4% of gun violence is committed by people with mental health disabilities. A prior statement from the coalition highlighted the damage done by the false portrayal of people with mental health disabilities as violent.
The letter also expresses concerns about specific provisions in the legislation, such as provisions suggesting that school-based behavioral intervention teams must report any student behavior that could have "potential criminal implications" first to criminal authorities rather than initiating an in-school process to address the behavior. The letter states the organizations' willingness to work with Senator Cornyn to address these concerns.
"We believe it is urgent to address incidents of mass violence in our country," said Curt Decker, Executive Director of the National Disability Rights Network. "However, those efforts should focus on real solutions rather than on mental health reforms that will have little impact on gun violence." "Wrongly blaming people with psychiatric disabilities for gun violence sows prejudice and fear, undermining the opportunities for people with psychiatric disabilities to live, work and be full participants in their communities" said Jennifer Mathis, Director of Policy and Legal Advocacy at the Bazelon Center for Mental Health Law.
The Judge David L. Bazelon Center for Mental Health Law (www.bazelon.org) is a national non-profit legal advocacy organization that advances equal opportunity for people with mental disabilities in all aspects of life.
The National Disability Rights Network (www.ndrn.org) is the nonprofit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and the Client Assistance Programs (CAP) for individuals with disabilities. Collectively, the Network is the largest provider of legally based advocacy services to people with disabilities in the United States.
Media Contacts:
Jennifer Mathis, Bazelon Center for Mental Health Law, 202-467-5730 ext. 1313/ [email protected]
David Card, National Disability Rights Network, 202-408-9514 ext 122/ [email protected]
Kenny Fries, an author and disability rights activist who mainly writes on his experiences as a disabled, gay, Jewish man, visited Tufts yesterday to read from and talk about his recent memoir, “In the Province of the Gods” (2017), as well as preview his forthcoming book, “Stumbling Over History: Disability and the Holocaust.”
The event was organized by Health and Wellness Services and Student Accessibility Services as part of Disability Awareness Month. Michelle Bowdler, executive director of Health and Wellness Services, opened the evening by introducing Fries and speaking about his illustrious career as a writer. Fries has published memoirs, poems and essays and teaches in the MFA in Creative Writing Program at Goddard College. He’s the recipient of numerous awards and grants and has been a Fulbright scholar twice.
“We were undergrads at Brandeis [University] together, and I swear I remember him saying to me ‘I think I want to be a writer,’” Bowdler said.
Fries began by reading from his first memoir, “Body, Remember” (1997).
“Those afternoons I did not take the bus, and chose to walk home from high school, I would find this boy, maybe 10 or 11 years old, sitting on the stoop of the semi-detached house where I imagine he lived. Every time I passed this boy asked, ‘Why your legs the way they are?’ And I would answer, ‘I was born that way,’ never stopping or slowing down,” he read.
This memoir was Fries’ first foray into writing about his intersecting identities.
“I was born missing bones in both my legs. I need specially designed orthopedic shoes, as well as a cane, to get around,” Fries said.
Fries then read the prologue and part of the first chapter of “In the Province of the Gods.” Fries’ memoir tells his story of being a disabled foreigner in Japan. He moved to Japan with no specific interest in the country or the culture, but in retrospect, he says it affected the course of his life.
Posted: 2:38 PM, Oct 17, 2019 Updated:5:22 PM, Oct 23, 2019
By: Ash-har Quraishi
BARTLETT, Ill. — For parents who are caregivers of adults with disabilities the question about who will care for them after they’re gone is haunting. And even for those who understand the system and plan ahead, the course is challenging.
It’s something Liz Mescher knows all too well.
“It should not be this hard,” she says as she puts on display the stacks of forms, denials and appeals she has organized in piles and folders in her kitchen.
Mescher says trying to get the benefits her sons need is a never-ending battle.
“I mean that's all I do, my counter gets filled with paperwork,” Mescher says.
Caring for her two sons is more than a full-time job.
“We're on top of them all day long. So, they're really not out of our eyesight,” she explains.
Both her sons Eric and Ryan, are in their 20s and have autism.
“The younger one has a lot of anxiety and the older one just can't tolerate being touched,” Mescher says.
And as they’ve grown older, caring for the men under the same roof has become increasingly difficult.
“So the goal is to get placement for Eric to go into housing so he can be happy, and we could probably get a little break,” the mother says.
But the wait lists for services like group home placement are long.
As of 2017, 707,000 people were on waiting lists in 40 states. That’s an increase of 8% from the previous year.
In Illinois, where the Meschers live, the wait list is more than 19,000.
Meg Cooch, the executive director of Arc Illinois, says the state is not unique. Cooch’s advocacy organization focuses on people with intellectual and developmental disabilities and their families.
“There are lawsuits around the country looking at waiting lists and looking at people getting access to community services because it's such a problem,” Cooch says.
Resources, funding and housing options for adults with intellectual and developmental disabilities are dwindling.
Professional caregivers are becoming less willing to do the job for what states are willing to pay.
Editor's note: This story has been updated to include the number of graduates from Michigan's osteopathic medical school.
LANSING — Megan Coady was told it could take up to six months to see the doctor, and first, she would have to apply.
She did, answering questions about her personal and family health history, demographic information and insurance provider, then mailing the application to the Lansing internist's office that sent it to her.
Three months and a follow-up phone call later, and she's still waiting to know if she and her husband, who has a complex medical condition, will be accepted as new patients.
"Right now I'm kind of in stasis," she said. "Everything is stable with my husband, so it's not an immediate concern, but I don't want to have to rely on urgent care or emergency services or the pharmacy."
Coady and her husband moved to Lansing in July and despite months of searching have not found a primary care physician who accepts her insurance, can see her within four months and is based close enough to her Lansing home.
It's not because she hasn't tried. As an optometrist, she knows the value in getting regular check-ups with a doctor.
"It's frustrating," Coady said, "but I don't think my experience is unique to my family here in Lansing."
Experts would agree. The Lansing area is a microcosm of a nation facing a primary care shortage that is expected to get worse as a glut of providers retires and America's aging population demands more medical care.
That means Americans likely will face longer wait times for routine doctor visits, leaving them sicker and more in need of urgent or emergency care.
A disability rights group has settled the class action lawsuit it filed against the state of Ohio three years ago over its claims that people are being needlessly institutionalized in state and private run facilities.
The settlement expands access to 700 state-funded waivers through Medicaid that allow people with disabilities and their families to choose to receive services in the community or in institutions.
Disability Rights Ohio filed the suit in federal court in 2016, after saying it had been negotiating with the state for two years. Its executive director Michael Kirkman said this affects the six original plaintiffs, and since it’s a class action, there are potentially 3,000 more.
“These folks are generally very pleased because they have been expressing a desire to move to the community for some time and have not been able to get services," said Kirkman.
Among those in the suit is Caryl Mason. Her sister Cathy Mason-Jordan said Caryl is 46 years old, is non-verbal and in a wheelchair and lives in a group home with seven other residents. But Mason-Jordan said she’s often left alone or put into group activities that she doesn’t enjoy, and she hoped that Caryl would have a choice where to receive services. “This dream is a dream for all of our loved ones with special needs," Mason-Jordan said when the suit was filed in 2016.
There are no monetary damages in the suit. The state will spend $24 million in the next year on housing assistance, and the settlement also expands employment and day services.
The Department of Developmental Disabilities said in a statement the settlement is “fair and reasonable”.
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