“America doesn’t need ‘mandatory’ coverage, America needs guaranteed health care,”

“Senator Clinton’s $110-billion-per-year ‘mandatory coverage’ plan amounts to a gigantic subsidy for the HMO-insurance industry, while shifting the burden — and the blame for lack of coverage — onto people who desperately need health care,” said John Battista, MD, former Green Party candidate for state representative in Connecticut and co-author of his state’s single-payer legislation in 1999 (the Connecticut Health Care Security Act).

“As Michael Moore’s documentary ‘Sicko’ showed, predatory insurance companies are the reason for America’s health crisis, with 47 million uninsured and millions more whose coverage doesn’t give them adequate treatment,” added Dr. Battista. “Clinton’s solution is to reward these companies for their greed, giving them more money. Clinton has been Congress’s top recipient of money from the insurance industry [source: Center for Responsive Politics, http://www.opensecrets.org, which explains her dedication to corporate insurance and HMO profits.”

“America doesn’t need ‘mandatory’ coverage, America needs guaranteed health care,” said Linda Manning Myatt, Michigan Green and spokesperson for the National Women’s Caucus. “Unfortunately, the Democratic presidential candidates are pandering for their insurance lobby friends. They care more about profits for their campaign contributors than about health care for the American people. Sen. Barack Obama has even admitted that his plan would sustain HMOs and insurance firms. Calling the Democrats’ proposals ‘universal health care’ is fraudulent, cynical, and cruel.”


Green Party leaders claim that Clinton promoted a disastrous reform plan in 1993, under her husband’s administration, and has introduced an even worse plan in 2007. Greens have insisted that fair and accurate discussion of Single-Payer/Medicare For All be included in the media debate over health care.

“The only political party that supports Single-Payer Medicare For All is the Green Party,” said Connecticut Green Justine McCabe, PhD, a psychologist and co-chair of the Green Party’s International Committee. “We demand that the Green Party and Green candidates and other Single-Payer supporters be allowed to participate in the health care debate. Just as urgently, we need to get a few Greens elected to Congress. A few Green wins in congressional races in 2008 will jolt more Dems and even some Republicans into backing Single-Payer.”

Secretary DHHS Leavitt......"BrownieYour doing a GREAT JOB",

Let us not forget that Mike Leavitt is the recipient of the Leavitt Group in Utah.
What credentials does this man have to be Secretary of our Health Care in OUR COUNTRY.
Let us look at this man's family business in Utah.......similar to the Frist family in Tennessee.

The Leavitt Group!

A conglomerate of insurance companies that insure many state workers outside of utah as well as the many pirvate insurance companies within their "GROUP"

SOUTH FLORIDA BILLS BILLIONS FOR HIV

Doctors and clinics in three South Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, according to the Inspector General for the U.S. Department of Health and Human Services.

Consider:

Health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.
By contrast, providers in the rest of the country submitted less than $1 billion in claims combined.
Federal health care regulators call the lopsided billing patterns "egregious" and warn that South Florida is a potential hotbed for health care fraud, waste and abuse:

Coral Way Professional Health Services Inc., for example, was charged with giving kickbacks to patients.
At the clinics, workers injected the patients with a saline solution but later billed Medicare for actual prescribed drugs, authorities said.
Overall, a federal task force aimed at rooting out Medicare fraud has resulted in 34 criminal cases involving a combined $142 million in Medicare bills in Southern Florida.
The fraud often happens in disenfranchised communities and sometimes involves illegal residents because they're paid cash for virtually no labor, says Benson B. Weintraub, a health care fraud lawyer based in Fort Lauderdale.

Source: Jim McElhatton, "South Florida Bills Billions for HIV," Washington Times, September 21, 2007.

For text:

http://www.washingtontimes.com/apps/pbcs.dll/article?AID=/20070921/NATION/109210084/1001

Medicare Scam Results in Indictment of California Doctor and Employee

Dr. Kenneth Ferguson, a physician of record at Huntington Beach Medical Center which operated from July through October 2004 was indicted by a federal grand jury in Santa Ana, California along with his employee Olena Kulakova for health care fraud. According to the allegations, Dr. Ferguson and his employee Kulakova would bill Medicare for physician services for care rendered to patients by Kulakova. Kulakova had no medical license in the State of California even though she held herself out to be either a doctor or a physician’s assistant. Both Dr. Ferguson and Kulakova caused Medicare to be billed for comprehensive evaluation and management visits for patients even though face time with patients lasted only 5 to 10 minutes as opposed to the usual 25 to 45 face to face time with a patient. In addition, it is alleged that both Dr. Ferguson and Kulakova directed and caused kickbacks to be paid to patients to come to the Huntington Beach Medical Center for Services

SEC estimates that $2.5 billion of that total was linked to fraud.

In all, the NCFE sold $4.4 billion worth of notes to investors between May 1998 and May 2001. The SEC estimates that $2.5 billion of that total was linked to fraud.
Ex-Auditors Settle Securitization Charges
A securitization scheme results in civil charges for three former auditors of a now-defunct factoring firm.
Marie Leone, CFO.com
September 21, 2007
The securitization fraud that is partly responsible for putting a financial-services firm out of business is now causing problems for that company's former auditors. On Wednesday the Securities and Exchange Commission reached a settlement with three former auditors of National Century Financial Enterprises (NCFE), who were charged with "improper professional conduct" linked to their audit of a receivables securitization.

Press C. Southworth, a retired PricewaterhouseCoopers auditor; Robert M. Harbrecht, a retired Deloitte and Touche auditor; and Brian R. Spires, a former audit manager with Deloitte; were cited by the SEC for violating generally accepted auditing standards (GAAS) and generally accepted accounting principles (GAAP). Without admitting or denying the commission's findings, all three agreed to a bar from practicing before the SEC, which means they cannot sign off on audits of public companies or hold the CEO or CFO position at a public company. Southworth can request reinstatement in two years; Harbrecht and Spires can request the same in 18 months and one year, respectively.

"Press is glad to have this unhappy chapter put behind him," says Southworth's attorney, Christopher Davies, a partner at Wilmer Cutler Pickering Hale and Dorr, noting that the auditor had retired from accounting before he ever became involved in the investigation. Attorneys for the other two former auditors did not return CFO.com's request for comment.

A spokesperson for PwC notes the allegations made against Southworth stem from audits that are nearly a decade old, and that the former auditor, who retired from the firm in 2001, no longer practices accounting. Deloitte declined to comment.

At issue are various violations of GAAS and GAAP related to fraud at NCFE that went undetected until 2002, the same year the finance company filed for bankruptcy. In 2004 NCFE began liquidating its assets.

The SEC contends that inaccurate financial reporting and disclosures related to the securitization should have prompted the auditors to question management's integrity, as is their responsibility under GAAS. In particular the SEC charged that the auditors failed to properly address evidence of possible fraud and illegal acts by the company and its officers. Instead, the auditors placed an "undue reliance on management representations," with Southworth giving an unqualified audit opinion to NCFE in 1998, and Harbrecht doing the same for the 2000 audit. Spires participated in the 2000 audit.

Securitizations have come under intense scrutiny in recent months as a result of the subprime mortgage crisis. While securitizations of corporate receivables represent a much smaller proportion of the asset-backed commercial paper market than securitized mortgages, they share the same basic structure. That structure has been criticized for poor disclosures and its dependence on legal and rating-agency opinions that are paid for by the issuer.

Although the SEC characterized the deal as "complex," the NCFE structure is considered a plain vanilla securitization by industry players. NCFE was in the business of buying up medical receivables at a discount from health-care providers that wanted cash up front. NCFE raised funds by securitizing those receivables — selling notes to investors backed by the receivable assets. Investors received regular interest payments and a lump-sum payment when the debt was retired, according to the U.S. Attorney General's office in Ohio, which has charged eight former NCFE executives with fraud.

Instead of investing the funds in the purchase of high-quality accounts receivable as promised in the indenture, however, the company "diverted the funds to healthcare providers, many of whom they owned in whole or in part, creating shortfalls in account balances," added the Attorney General. In all, the NCFE sold $4.4 billion worth of notes to investors between May 1998 and May 2001. The SEC estimates that $2.5 billion of that total was linked to fraud.

Hillary, Mitt, Health care

Thursday, September 20, 2007
Hillary, Mitt, and health care
I was disappointed twice this week in regards to the health care plan that was announced by the Hillary Clinton campaign.

The first disappointment was how Senator Clinton's plan, though well thought out, was studiously conservative and cautious, and shied away from tackling some of the most glaring problems of the current system, like reducing the incentives for waste, fraud and excessive profits. Indeed, most commentators who have studied it say it it modeled after Mitt Romney's plan in Massachusetts, which in turn was modeled after the plan Republican Senator John Chafee proposed as an alternative to Hillary's plan in 1994. In other words, it appears Senator Clinton has proposed a Republican plan for health care reform. It's hard to blame her for this approach; as we have seen this week, the Republicans were just waiting to pounce on whatever she proposed as "Hillary Care II" or the usual ideological war cry, "socialized medicine". Her plan seems more designed to avoid criticism than to really tackle the glaring problems of our current system. Still, given the political realities of how politicians from both parties are owned by the drug and insurance companies, it may be the best we can do.

The second disappointment was the latest chapter in how my fellow Mormon, Mitt Romney, reinforced his well-earned reputation as being willing to say anything to pander to the Right. Despite the fact that Clinton's health care plan is basically modeled after the Massachusetts's system, he was first out of the gate with the typical Republican Noise Machine name calling. Joe Klein of Time.com had the following comment:

"Mitt Romney is already blasting Hillary Clinton's new health care plan--which resembles nothing so much, in its broad outlines, as the individual-mandate plan that Romney himself passed in Massachusetts. The intellectual dishonesty is just staggering; how sad to see a smart, pragmatic and essentially moderate politician continue to embarrass himself in this way." How different this guy is from his father, who basically lost the nomination for President in 1968 because of his courageous opposition to the Vietnam War.

One question I continue to ask my LDS Republican friends. Which guy most resembles Brigham Young: Mitt Romney, who has gained a reputation for changing his political values more often than his underwear, or Harry Reid, who tells you what he thinks and if you don't like it, you can go live with the devil in hell? I know who gets my vote.

Once again...IT IS ALL UP TO THE DOJ

US Department of Justice Official Release - 03128-115 txt

FOR IMMEDIATE RELEASE DAG
THURSDAY, MARCH 2, 1995 (202) 616-2765
TDD (202) 514-1888

REPORT SHOWS FOUR-FOLD INCREASE IN
HEALTH CARE FRAUD INVESTIGATIONS


WASHINGTON, D.C. -- Federal investigations of health care
fraud quadrupled in the last four years, according to a report
issued today by the Justice Department. The report noted that
Attorney General Janet Reno designated combatting health care
fraud a major initiative.
Gerald Stern, Special Counsel for Health Care Fraud, said
both public and private health care plans had been defrauded
through false billing, kickbacks, unapproved devices and
unlicensed personnel. Stern said as much as $100 billion dollars
may be lost annually in fraud and abuse. In once case, patients
died when a Fortune 500 company sold unapproved heart catheters.
"While most health care providers are honest and care first
and foremost about their patients' welfare," said Stern, "fraud
is perpetrated by every kind of provider from individual
physicians to multi-state publicly traded companies. We have
investigated fraudulent schemes by medical equipment dealers,
ambulance companies, laboratories, hospitals, nursing homes and
others who prey upon the system."
"The Administration's efforts to ensure that all Americans
have access to quality health care at a reasonable cost will be
undermined if fraud goes unaddressed," he said.
The Department reported the FBI had 1,500 cases under
investigation in the fiscal year that ended last October,
compared with 1,051 the year before, 657 in FY 92 and 365 in FY
91. Two hundred anf forty one defendants were charged with
crimes last year. One hundred and forty defendants were
convicted in cases that reached conclusion during the year.
The report described frauds ranging from a billion dollar
mobile testing services scheme that ran thousands of unnecessary
and expensive diagnostic tests on patients who had come for
supposedly free or low-cost physical examinations, to
telemarketers who preyed upon the elderly by offering ostensibly
free knee braces and wheelchairs to senior citizens who neither
needed nor wanted the equipment, to cases in which ambulance
companies substantially overbilled for "intensive care"
ambulances to transport fully ambulatory patients to routine
follow-up medical appointments.
The report stated that these kinds of frauds are most
effectively fought by simultaneously pursuing criminal, civil and
administratie proceedings. This year's cases have resulted in
record jail sentences (over 21 years for each of several
defendants in one case), record financial recoveries (over $350
million in one case), groundbreaking administratively-required
future compliance programs and substantial recoveries for the
states (over $16 million in one case to more than two dozen
states).
The report stated that improving coordination among DOJ
criminal and civil prosecutors, their state counterparts and
administrative entities is a key to effective health care fraud
enforcement. The Executive Level Health Care Fraud Policy Group,
formed with the HHS Inspector General in November of 1993 to
coordinate federal health care fraud prevention and
investigations, is an example of this effort. The report also
emphasized the need to continue close cooperation with state
Medicaid Fraud Control Units, which have special expertise in
this area.
The report credited attorneys in the Justice Department's
Civil and Criminal Divisions and the U.S. Attorneys' Offices
around the country, the FBI, and the Inspector General of the
Department of Health and Human Services for their leadership in
this successful enforcement effort. The Department also relied
heavily on the investigative and audit activities of the Defense
Criminal Investigative Service, the Office of Personnel
Management which supervises the Federal Employees Health Benfit
Plan, the Inspector General of the Railroad Retirement Board, the
Inspector General of the Department of Veterans Affairs, the
Inspector General of the Department of Labor, and the Office of
Labor Racketeering of the Pension and Welfare Benefits
Administration. Vital support also was provided by the U.S.
Postal Service Inspection Service, the Drug Enforcement Agency,
the Internal Revenue Service, the Food and Drug Administration
and the Federal Trade Commission.

Massive -???- Medicare fraud scheme

Posted On: September 18, 2007 by Robert David Malove
Palm Beach Medicare Fraudster Pleads Guilty to Mail Fraud & Money Laundering
On September 6, 2007, Gianni Suarez Vazquez, a participant in a massive Medicare fraud scheme, pled guilty in federal court in West palm Beach, Florida, to mail fraud and money laundering charges. He is scheduled to be sentenced before U.S. District Judge Donald M. Middlebrooks on November 15, 2007.

According to the court records, between November 2003 and August 2004, Suarez Vazquez incorporated or set up two medical equipment companies, GK Medical, Inc. and Suplident International Corporation, in Palm Beach County. Thereafter, he obtained Medicare provider numbers for both companies to enable the companies to submit claims directly to Medicare. To conceal his ownership and control of the companies, Suarez Vazquez designated "strawmen" as company owners, including his mother, on the corporate documents and Medicare Provider Agreements.

After setting up the companies, Suarez Vazquez and his partners obtained patient and physician information, which they used to prepare bogus prescriptions and/or certificates of medical necessity. The bogus prescriptions and certificates purported to authorize the provision of various types of medical equipment for the named Medicare beneficiaries. In truth, however, the prescriptions and certificates were prepared by the defendant’s accomplices and contained forged physician signatures.

Suarez Vazquez and his partners provided the bogus prescriptions and certificates to Miami billing companies for submission to Medicare. The billing companies prepared Medicare claims that sought reimbursement for the cost of the equipment listed in the bogus prescriptions and certificates, even though such equipment was never authorized by a physician or provided to the beneficiaries.

During the four-month period between November 18, 2003 and March 23, 2004, GK Medical caused the billing companies to submit more than $5.2 million in fraudulent claims. During the two-month period between June 7, 2004 and August 12, 2004, Suplident caused the billing companies to submit more than $4.5 million in fraudulent claims. Medicare processed the fraudulent claims and issued reimbursement checks, most of which the defendant and his accomplices cashed at Miami check cashing stores. In total, during the course of the scheme, the defendant Suarez Vazquez and his partners submitted more than $9.8 million in bogus Medicare claims.

On August 4, 2004, the defendant and his mother, Maura Vazquez, fled the United States for Costa Rica after Maura Vazquez received a federal grand jury subpoena requiring the production of business records for GK Medical. Suarez Vazquez was brought back to the United States to face these charges in June 2007.

NEW QUI TAM LAWS---IRS

Posted On: September 18, 2007 by Finch McCranie, LLP
Whistleblower Law Attorneys to Gather for Symposium on False Claims Act, State False Medicaid Claims Act, and New IRS Whistleblower Rewards Program
Some of the country's leading attorneys in qui tam whistleblower cases and IRS Whistleblower cases will gather for the "First Annual Whistleblower Law Symposium," which will take place at the Georgia State Bar Headquarters on Thursday, September 20, beginning at 9:00 a.m. (See Agenda below). This Whistleblower Law Symposium is organized and co-chaired by the authors of this whistleblower lawyer blog, Michael A. Sullivan and Richard W. Hendrix.

The presenters will include the very successful Pat O’Connell of the Texas Attorney General’s Office, whose group has recovered more than $216 million in health care fraud cases since 1999; and Jim Breen, who has represented relator Ven-A-Care of the Florida Keys Inc. in many very substantial qui tam cases, including the action that led to last week’s announcement by DOJ of a settlement with Aventis Pharmaceuticals Inc.

In addition, Steve Cowen of King & Spalding, LLP will chair a discussion of issues in defending False Claims Act cases; Marlan Wilbanks and other relators’ counsel will speak as well; and Charlie Richards of the Georgia Attorney General's Office and Georgia’s Inspector General Doug Colburn will discuss the new Georgia State False Medicaid Claims Act.

We will also discuss the bill introduced last week by Senators Grassley, Durbin, Specter, and Leahy to make substantial modifications to the federal False Claims Act, the “False Claims Act Correction Act of 2007.” (See http://grassley.senate.gov/public/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=fac0a482-1321-0e36-ba6f-0150b8a2b182&Month=9&Year=2007).

Further, my partner Richard Hendrix and I will explain and discuss the new IRS Whistleblower Program created by Congress in December 2006. I spent several hours this past week in Washington with the Director of the new IRS Whistleblower Office, Stephen Whitlock, to prepare for and appear in a panel discussion to explain the new IRS Whistleblower Program. I also enjoyed lunch with the lead IRS official responsible for IRS Whistleblower claims in the financial services industry, Stuart Mann, and with Nicole Cammarota, an IRS official who is working on the new regulations. There is a great deal of excitement about this new IRS Whistleblower program, which rewards citizens who report large tax fraud, tax evasion, and other tax law violations to the IRS. (Our firm is pursuing a variety of IRS Whistleblower cases across the country.)

For anyone who believes that taxpayers pay too much to allow fraud against the federal and state governments, these exciting new developments in the law are important.

We are excited to be hosting this Whistleblower Law Symposium, and to discuss recent developments in the False Claims Act, the new state False Claims Acts, and the new IRS Whistleblower Program. The Agenda for the Symposium is below.

FIRST ANNUAL WHISTLEBLOWER LAW SYMPOSIUM:

GEORGIA’S NEW “STATE FALSE MEDICAID CLAIMS ACT”
AND OTHER QUI TAM WHISTLEBLOWER LAWS

September 20, 2007
State Bar of Georgia Headquarters

Congress and the states are enacting a wave of new “whistleblower” statutes, based on two decades of successes with the federal False Claims Act in recovering money for the government. This seminar will explore how these new statutes work, and how lawyers should handle cases brought under them. This seminar will focus on the federal False Claims Act, the new Georgia “State False Medicaid Claims Act,” and the new IRS Whistleblower Program.

Hunt Oli-Richard Rainwater? You remember...Bush's partner

The Rude Awakening
Wall Street, New York
Monday, September 18, 2006

-------------------------

Time to make a strategic jump onto the energy train,


Jacking up your profit potential with jacked-up rigs,


Oil and Rainwater do mix, the week in the markets and
more...
-------------------------

Eric Fry, still in Baltimore, reports...

Houston, 1986. Oil prices are tumbling, real estate prices
are crashing, banks are going belly-up and no one wants
anything to do the oil business...Well, almost no one.

At this very moment, Richard Rainwater decides to start
buying oil-drilling rigs on the cheap. He arranges a clever
deal with Texas banks to snag 65% of the nearly bankrupt
Blocker Energy. Shortly thereafter, he scoops up Penrod
Drilling, the large offshore drilling rig company owned by
the infamous Hunt brothers of Dallas.

After Rainwater merges these two companies in the early
nineties, he finds himself atop one of the world's largest
drilling companies – the company we now call ENSCO
International (NYSE: ESV). Unfortunately, by the late
1990s, the oil sector's fortunes had failed to improve and
Rainwater's foray into oil-drilling begins to appear more
foolhardy than brilliant.

"Rainwater's empire is a mess," a 1998 issue of Business
Week declared. "His huge bets on three sectors - energy,
real estate investment trusts, and health care — 'are all
in the crapper at the same time,' says pal Henry R.
Silverman, chairman and CEO of Cendant Corp., though he
feels that Rainwater's bets will eventually pay off."

Eight years later, it's clear that Rainwater's "energy
bets" are paying off nicely. In an era of rising demand for
oil-drilling rigs, ENSCO International is flourishing.
Individual investors cannot duplicate Rainwater's gutsy
investment in the oil-drilling industry, but they can do
the next best thing...as Dan Amoss explains in today's
column.

Florida Durable Medical Equipment Owner Convicted of Medicare Fraud

On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida

After a jury trial at federal court in Miami, the jury found Marianela Smith guilty on all charged counts including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit health care fraud; and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.

Smith faces a maximum sentence of 30 years in prison. Prior to sentencing the U.S. Probation Office will complete a pre-sentence investigation and submit a Pre-Sentence Report to the judge for consideration. The PSI will contain an advisory guideline sentence which the court must consider in determining what type and length of sentence is sufficient, but not greater than necessary, to comply with the statutory directives set forth in 18 U.S.C. § 3553(a).

Smith is scheduled to be sentenced November 9, 2007, before U.S. District Court Judge Joan A. Lenard.

Is this the BEST THE DOJ can DO?

On August 28, 2007, a federal grand jury indicted the former operations director of A-Care EMS Inc. on charges that he sent fraudulent claims to the Centers for Medicare and Medicaid Services to pull in more money.

The indictment, filed Tuesday in the U.S. District Court for the Southern District of Texas, claims Rodney Lee Ramos, 34, of Weslaco, instructed emergency medical technicians to transport patients for dialysis who were not confined to bed."

According to the indictment, Ramos worked as an EMT coordinator for A-Stat Ambulance Services Inc., which was owned by Guadalupe Garces Jr. and Araceli Garces. Medicaid and Medicare placed a vendor hold on that ambulance provider -- withholding payment to the company -- after federal agents determined that the owners were defrauding the federal and state health insurance programs.

Cuomo Seeks Legislation To Uncover Medicaid Fraud

Cuomo Seeks Legislation To Uncover Medicaid Fraud
By Staff Reporter of the Sun
September 13, 2007

Attorney General Cuomo is calling on Albany to pass legislation that would help state government better uncover Medicaid fraud in the home health care industry. The proposed legislation would require that the state keep a database of certified home health aides, which would include certification records and employment history about each aide. A probe by the attorney general's office has disclosed that many aides use forged certification and that home health care agencies frequently over-bill.

When will Tenet transform to a "Private" company? Just like HCA?

Tenet wins $1B federal lawsuit over outlier payments

Things were looking a bit ugly for Tenet, which was facing a huge potential liability over a suit claiming it deprived thousands of hospitals of their share of Medicare outlier payments. But, now that a federal judge has shot down the lawsuit, it looks like the hospital chain won't have to pay back any money.

The suit alleged Tenet set things up to feather its own nest by more than $1 billion. Those suing said Tenet, along with West Orange, N.J.-based St. Barnabas Health Care System, raised charges in an effort to collect better returns from the federal outlier program. Because CMS apparently has been setting limits on what percentage of DRG payments it will pay back out in outlier money, Tenet and St. Barnabas took money away from competitors directly by overbilling, plaintiffs contended.

The judge, however, rejected that argument, brought by 380-bed Boca Raton (Fla.) Community Hospital. Meanwhile, both Tenet and St. Barnabas settled with the Department of Justice over the allegations, with Tenet agreeing to shell out $788 million and St. Barnabas paying out $265 million.

United Health Group, Inc. and United Healthcare....Is there a difference?

United Health Group, Inc. and United Healthcare
A class action lawsuit has been filed against the health groups alleging misrepresentation and fraudulent marketing in violation of the Florida Medicare Supplement Act. The Florida statewide civil lawsuit was filed in Pinellas County Civil Court. The suit claims United Health Group, Inc. and United Healthcare of Florida Inc. enrolled Medicare recipients into their Medical Advantage HMO and PPO plans without obtaining signatures or consent to enter into the insurance contract and without informing or advising clients that enrollment into their HMO and PPO Medicare advantage plans disenrolls them from their rightful benefits under the United States Medicare Program.

These enrollees were also not informed that the Medicare Advantage Plans such as Secure Horizons and Complete Care provide limited or no skilled nursing home care, while US Medicare covers 100% of such care for 20 weeks. The companies also failed to inform clients that the United plans have significant co-payments and significantly more limited availability of physicians who will accept their plan than will accept medicare.

The suit also states that United Healthcare's marketing practices fraudulently imply by names such as CompleteCare and SecureHorizons that the United insurance policies provide equal or complete care when in fact they provide far less care that the Medicare coverage that they replace.

David Anderson, senior vice president and/or treasurer of ......

Columbia Greater Houston Division Healthcare

Columbia Greater Houston Division Healthcare Network, Inc.

Columbia Home Care Group, Inc.
Owning Corporation 100 %:Earthstone HomeHealth Company

Columbia/HCA Healthcare Corporation of Central Texas, Inc.
8-14-01
Owning Corporation:Galen Hospital Corporation
8-12-02
Owning Corporation:Women's Hospital Indianapolis

Coronado Community Hospital (1996)
Owning Corporation: 100% : Health Trust, Inc.-The Hospital Co.
1998
Owning Corporation:Columbia/HCA Healthcare Corp.

HCA kicks off giving campaign

Nashville Business Journal - August 29, 2007


For several weeks, the hospital company provides opportunities for its employees to donate money and time to local non-profit organizations.

Last year, the company's campaign raised more than $2 million for 515 local agencies, donated 7,200 hours of time and had 83 percent employee participation.

Wednesday's event brought 110 non-profit agencies to Centennial park, where an estimated 1,200 HCA employees gathered.

The company distributed 10 tokens worth $2 each to employees to give to the organizations of their choosing.

Opening the event were Jack Bovender, chairman and CEO; David Anderson, senior vice president and treasurer; and Richard Bracken, president and COO.

HealthSpring partners with Bordeaux

Nashville Business Journal - August 30, 2007


SpecialCare is a Medicare Advantage Institutional Special Needs Plan designed specifically for the long-term care residents of the Nashville nursing facility and will be available to Bordeaux residents Sept. 1.

"The SpecialCare program is specifically designed for older, frailer members," says Shawn Morris, president of HealthSpring of Tennessee in a release. "By partnering with Bordeaux Long Term Care, we can combine our efforts to keep these members healthier and improve their quality of life."

Bordeaux is Middle Tennessee's largest nursing facility, licensed for 419 beds.

The SpecialCare program provides a personal HealthSpring customer service representative to answer questions for the plan member and family, as well as a nurse practitioner who works with the facility's physicians for additional preventive-care.

HealthSpring (NYSE: HS) is one of the country's largest managed care organizations, focusing primarily on the Medicare Advantage market.

HCA's hospital building boom

August 28, 2006

Yesterday we reported hospital construction costs are skyrocketing in the midst of an industry-wide building boom. Today The Tennessean reports HCA is moving forward with several hospital construction projects despite the fact the hospital chain is in the midst of a $33 billion buyout. HCA has spent an average of $1.5 billion in capital projects in the last five years and will spend $1.8 billion in 2006. Among the planned projects is the 126-bed Spotsylvania Regional Medical Center in Virginia, which the hospital chain just received approval for yesterday. Last month HCA also was approved to build 56-bed hospital in Spring Hill, Tennessee. And the building boom isn't limited to HCA. Spending on healthcare facility construction, according to the Census Bureau, was just $15.3 billion in 1995. That number jumped $26.7 billion in 2004.

The Tennessean

SEIU plans to form healthcare unit

January 30, 2007

Long the bane of healthcare administrators, the battlin' Service Employees International Union has announced plans to take things to the next level by forming an SEIU Healthcare division. The new union, which is intended to expand organizing efforts, will represent 30 SEIU locals. The SEIU has already been quite vocal in nursing matters, in particular, supporting nurses in efforts to expand nurse to patient ratios for what it says is needed safety upgrades. It has 84,000 registered nurses as members, including a particularly vocal subgroup who have been very active in California's medical politics.

SEIU Healthcare plans to attract workers in ambulatory surgery centers, laboratories, clinics and any other area where healthcare workers work, rather than roughly 1 million hospital, nursing and long-term-care workers who current work with the organization. The new group will kick off sometime in mid-2007, with a $40 million budget in place for its first two years of operations.

HCA hospitals strike FL union deal

June 11, 2007

HCA and the SEIU Florida Healthcare Union have agreed on a contract covering 4,000 workers at six of the state's hospitals. The contract raises wages, setting the lowest pay rate at $9.15 an hour, as well as creating patient-care committees giving staff members an avenue for proposing process improvements. It also offers some job security features, a real plus given that some fear HCA will eventually sell some hospitals to pay off debt. Nurses are particularly happy about the patient-care committee feature of the new deal, as they believe it will give them a chance to speak up about nurse understaffing in some of the hospitals. Of course, they're also pleased by planned wage increases, which should boost salaries up to 23 percent for some nurses through the end of the contract in 2011.

HCA profits fall, since private investors acquired it.

August 3, 2007


Hospital chain HCA's profits fell dramatically during the second full quarter since private investors acquired it. While the chain's revenues for the quarter were up 5.8 percent, to $6.7 billion, its net income fell 60.7 percent during the quarter to $116 million, down from $295 million during the same quarter the previous year.

HCA's income fell primarily due to paying down debt it took on when it went private. The company spent $361 million more this year than it did last year to pay off interest on the debt it took on in going private. That's just a drop in the bucket, meanwhile, compared with the $16 billion in new debt and $11.7 billion in existing debt it faces. At the same time, the amount of revenue it set aside to cover unpaid medical bills went up to 11.2 percent from 10.6 percent last year.

On the positive side, HCA was touting the 7.1 percent increase in average price charged to patients, more money from managed care companies and higher volumes of sicker, more profitable patients.

HCA settles shareholder suit

November 9, 2006

HCA has settled with a group of shareholders trying to block the planned sale of the company to a group of private investors. The settlement, which still must be approved by a judge, involves no direct cash payout, though HCA has agreed to pay the shareholders' attorney fees. HCA also agreed to slash termination fees, payable to the proposed buyers if the deal doesn't close, from $500 million to $220 million. In addition, the shareholders also won the right to appeal the sale price, currently set at $33 billion, or $51 dollars a share. If they're not happy with the deal, shareholders can file a new suit within 30 days after the deal closes. The suit would give them the right to have their shares appraised, and either fight on or accept the deal if the appraisal is lower than $51 per share. However, experts note that shareholders seldom file for appraisal after the deal closes. HCA shareholders will vote on the proposed sale next week.

HCA to pay $20M to settle shareholder suits

August 16, 2007

HCA has agreed to pay $20 million to settle a group of shareholder suits that accused the company of making misleading statements in early January 2005. The suits contended the execs spoke highly of their prospects in January, but released bad news in July 2005, selling almost 1 million shares of stock in the interval. (If true, that certainly does raise some questions.)

After the lawsuits were filed, the SEC and the U.S. attorney in New York filed subpoenas to HCA and former Senator Bill Frist to determine whether insider trading took place. However, neither agency filed charges. Nonetheless, HCA settled on the civil suit, keeping larger questions of potential wrongdoing off the table. Smart move, I think.

$33B HCA sale approved by shareholders

This deal has dragged on for so long that its conclusion is almost an anticlimax. Finally, after months of strife, shareholders have approved the $33 billion sale of HCA Corp. to a private investor group. The sale should represent the largest leveraged buyout in history, topping the $31.3 billion sale of RJR Nabisco in the late 80s. The buyers, which include Bain Capital, Kohlberg Kravis Roberts & Co and Merrill Lynch Global Private Equity, along with HCA managers and founder Tommy Frist, are taking the company private--though they've admitted they may go public again within the next several years. In making the acquisition, the group is taking on $11.7 billion in HCA debt. The sale will pay stockholders almost 20 percent more per share than the stock was worth when the agreement was announced in July, a nice deal given that analysts expect HCA growth to fall by 13 percent during the next quarter.

HCA posts hospital prices online

March 6, 2007

HCA has decided to roll with the transparency trend. Over the next few months the hospital chain will begin making prices for its services publicly available, starting with hospitals in Dallas, San Antonio and Austin, Texas. HCA expects to start disclosing prices in Tennessee over the next few months, and should roll out the program to all of its 165 U.S. hospitals by this summer. Prospective patients will be able to check out prices for common procedures by following a link on the hospital's website. The sites will also give insured patients instructions on how to get a price estimate. (Given how much managed care contracts differ, the hospitals won't be able to offer a pre-packaged answer on what an insured's care will cost.) While HCA seems to be ahead of the curve in posting prices across its entire network, other hospitals are increasingly providing price quotes when asked, observers note.

To get up to date on HCA's plans:
- read this piece from The Tennessean

HCA moves gingerly to resolve debt

September 4, 2007

When HCA completed its $33 billion sale to a group of private equity firms last year, the deal left the company with $28 billion in debt. The company has since made moves to reduce the debt, but has voted against selling off assets to make that happen. That stands in sharp contrast to the last time it went private, in 1989, when it sold off a string of non-core holdings including a lab unit, hospital management subsidiary and its 50 percent stake in an insurance business.

HCA does say that it plans to sell a hospital in Miami, and has dumped both of its hospitals in Switzerland, but won't speak about its other plans. In the mean time, it has stuck with old-fashioned internal cost cutting--notably marketing expenses and travel budgets--and worked to increase cash flow. These moves have allowed it to reduce the debt by a net $312 million.

However, many analysts believe that over time, HCA will be forced to be more aggressive. The cost of interest on the debt is so high that it's sucking up the hospital company's cash flow, making it difficult or impossible to work on the principal. Predictably, HCA executives pan this idea, citing a 9.7 percent increase in earnings as one sign that the company's on the right track. Execs are also talking about refinancing the debt to cut interest costs.

To learn more about HCA's earnings, strategy and finances:
- read this article from The Tennessean

Related Articles:
HCA to pay $20 million to settle shareholder suits. Report
HCA profits fall, smacked down by debt payments. Report
$33B HCA sale approved by shareholders. Report
HCA posts hospital prices online. Report

The Commission is continuing its investigation in this matter.

SEC Sues NCFE Executives for Role in $2.6 Billion Fraud
FOR IMMEDIATE RELEASE
2005-181
Washington, D.C., Dec. 21, 2005 — The Securities and Exchange Commission today sued top executives of National Century Financial Enterprises, Inc. (NCFE), alleging that they participated in a scheme to defraud investors in securities issued by the subsidiaries of the failed Dublin, Ohio company. NCFE, a private corporation, suddenly collapsed along with its subsidiaries in October 2002 when investors discovered that the companies had hidden massive cash and collateral shortfalls from investors and auditors. The collapse caused investor losses exceeding $2.6 billion and approximately 275 health-care providers were forced to file for bankruptcy protection.

Named in the suit were Lance Poulsen, principal and former Chief Executive Officer of NCFE; Donald S. Ayers, principal and former Chief Operating Officer; Rebecca S. Parrett, principal and former Director of NCFE’s Accounts Receivable Servicer Department; and Randolph H. Speer, former Chief Financial Officer of NCFE.

Linda Thomsen, Director of SEC's Enforcement Division, said, “Investors in private offerings, just like investors in public companies, must be able to rely on the truthfulness of the information they receive before investing. We continue to actively pursue those who provide false information to investors in both private and public securities.”

Merri Jo Gillette, Director of the Commission's Midwest Regional Office added, “These defendants, together with others whom the Commission has sued previously, engaged in an elaborate scheme that defrauded investors out of more than $2.6 billion. The Commission will continue to use the full range of its enforcement powers to prosecute individuals who deceive investors and profit at their expense.”

The complaint, which was filed in the United States District Court for the Southern District of Ohio, alleges that NCFE, through two wholly owned subsidiaries, NPF VI and NPF XII (“the Programs”), purchased medical accounts receivable from health-care providers and issued notes that securitized those receivables. From at least February 1999 to October 2002, the Programs offered and sold at least $3.25 billion in notes, through 15 private placements, to institutional investors.

According to the representations in the offering documents and the Program agreements, the Programs were required to maintain certain reserve-account balances and medical accounts receivable as collateral to secure the notes. Nevertheless, the complaint alleges that Poulsen, Parrett, Ayers and Speer depleted the Programs’ reserve accounts and collateral base by “advancing” at least $1.2 billion from the Programs’ funds to health-care providers without receiving eligible receivables in return. These advances were essentially unsecured loans by the Programs to distressed or defunct health-care providers — many of which were wholly or partly owned by NCFE, Poulsen, Parrett and/or Ayers.

According to the complaint, Poulsen, Parrett, Ayers and Speer concealed their fraud from investors and others by:

repeatedly transferring funds between the subsidiaries’ bank accounts to mask cash shortfalls of as much as $350 million;

recording $1 billion or more in non-existent or ineligible medical accounts receivable on the subsidiaries’ books;

creating and distributing false offering documents, false monthly investor reports, and false accounting records to trustees, investors, potential investors, and auditors; and

misrepresenting the status of the Programs’ cash accounts and collateral base to investors and others.
In the complaint, the Commission seeks to: (1) permanently enjoin each Defendant from violating the antifraud provisions of the federal securities laws, specifically Section 17(a) of the Securities Act of 1933 and Section 10(b) of the Exchange Act of 1934 and Rule 10b-5 promulgated thereunder; (2) permanently bar each Defendant from serving as an officer or director of a public company; and (3) order each Defendant to pay disgorgement, prejudgment interest, and a civil monetary penalty, in amounts to be determined.

The Commission has already obtained judgments against three other former NCFE executives: Sherry Gibson, a former Executive Vice President of Compliance of NCFE; John Snoble, a former Vice President and Controller; and Brian Stucke, a former Associate Vice-President for Business Services. Each of these individuals has consented to a permanent injunction prohibiting them from violating the federal securities laws; an order barring him or her from serving as an officer or director of a public company; and disgorgement, prejudgment interest, and a civil penalty, in amounts to be determined.

Moreover, each of these three former NCFE executives has pled guilty in federal district court in Columbus, Ohio to criminal charges arising from the scheme to defraud. Gibson pled guilty to conspiracy to commit securities fraud and was sentenced to four years in federal prison, followed by three years of supervised release. Gibson is currently serving her prison sentence at the Lexington Federal Medical Center in Kentucky and is scheduled to be released on March 28, 2008. Stucke pled guilty to conspiracy to commit securities fraud and Snoble pled guilty to money laundering conspiracy; both are awaiting sentencing.

The Commission thanks the United States Attorney’s Office for the Southern District of Ohio, the Federal Bureau of Investigation, the Internal Revenue Service and the United States Postal Service for their assistance in this investigation.

The Commission is continuing its investigation in this matter.

For further information contact:

Merri Jo Gillette, Regional Director, Midwest Regional Office (MRO) – (312) 353-9338

Robert J. Burson, Senior Associate Regional Director, MRO– (312) 353-7428
Additional materials: Litigation Release 19509



http://www.sec.gov/news/press/2005-181.htm

World Bank Hides Incriminating Corruption Report

Posted by Misha Singh

Months after its president was forced out for getting his girlfriend promotions and hefty pay raises, officials at the scandal-plagued World Bank are working to kill a scathing report on the rampant fraud in a major bank-supported health care project in India.

After a thorough investigation, the World Bank’s Department of Institutional Integrity found that an Indian pharmaceutical program called Reproductive and Child Health Project has for years been rife with corruption that has led to the loss of billions of dollars.

A 16-page report reveals that the systematic fraud and corruption includes bribery of government officials and procurement support agencies, falsification of performance certificates and coercion of companies.

This includes costly but sub-standard drugs that exceeded World Bank budgets as well as other equipment that didn’t meet international standards.

Investigators say that multiple witnesses admitted bribing government officials and ministers in order to secure the bank-funded contracts and that there is plenty of evidence to merit sanctions against specific individuals and companies. This risks the future of similar programs intended to help the poor.

In fact, the 185-nation World Bank strives to reduce poverty worldwide by assisting developing countries but instead it has been infested with corrupt officials who have failed miserably to complete the institution’s mission.

When President George W. Bush appointed Paul Wolfowitz as World Bank president in 2006, both men vowed to clean house and fervently pursue anti-corruption policies. Wolfowitz had been a high-ranking official in three different Republican administrations and was the nation’s Deputy Defense Secretary before taking the World Bank post.

But after a rather short tenure Wolfowitz resigned because he was exposed for abusing his authority to get his girlfriend promotions and huge pay increases at the institution. Wolfowitz admitted that he personally directed the World Bank’s head of human resources to offer his girlfriend, Shaha Riza, a pay increase that drew attention because it was more than double allowed under staff rules.

Read the 16 page report :
http://www.corruptionchronicles.com/2007/09/world_bank_hides_incriminating.html

Florida Durable Medical Equipment Owner Convicted of Medicare Fraud

Posted On: September 7, 2007 by Robert David Malove

On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida.

After a jury trial at federal court in Miami, the jury found Marianela Smith guilty on all charged counts including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit health care fraud; and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.

Smith faces a maximum sentence of 30 years in prison. Prior to sentencing the U.S. Probation Office will complete a pre-sentence investigation and submit a Pre-Sentence Report to the judge for consideration. The PSI will contain an advisory guideline sentence which the court must consider in determining what type and length of sentence is sufficient, but not greater than necessary, to comply with the statutory directives set forth in 18 U.S.C. § 3553(a).

Smith is scheduled to be sentenced November 9, 2007, before U.S. District Court Judge Joan A. Lenard.

Posted by Robert David Malove

Home Care Union Announces Support for Cuomo

By ELIZABETH SOLOMONT
Special to the Sun
September 7, 2007

Union officials representing more than 70,000 home care workers announced their support yesterday of Attorney General Andrew Cuomo's investigation of fraud within the home care industry. Leaders of 1199 SEIU United Healthcare Workers East said they applaud the investigation, which has uncovered Medicaid fraud and the use of false credentials. "We support quality care for all patients and any scheme that deprives the system of public dollars only devalues the good work our members perform," the union's executive vice president for politics and legislation, Patrick Gaspard, said. Union officials also proposed a new registry of home health aides that would ensure proper certification, as well as a special program to train aides assigned to challenging patients.