Tag Archives: Medicaid

CBO: Debt Headed to 103% of GDP; ‘No Way to Predict Whether or When’ Fiscal Crisis Might Occur Here

CBO Director Keith Hall has a dire warning...

CBO Director Keith Hall has a dire warning…

CNSNews: Testifying in the U.S Senate on Thursday, Congressional Budget Office Director Keith Hall warned that the publicly held debt of the U.S. government, when measured as a percentage of Gross Domestic Product, is headed toward a level the United States has seen only once in its history—at the end of World War II.

To simply contain the debt at the high historical level where it currently sits—74 percent of GDP–would require either significant increases in federal tax revenue or decreases in non-interest federal spending (or a combination of the two).

Historically, U.S. government debt held by the public, measured as a percentage of GDP, hit its peak in 1945 and 1946, when it was 104 percent and 106 percent of GDP respectively.

In 2015, the CBO estimates that the U.S. government debt held by the public will be 74 percent of GDP. That is higher than the 69-percent-of-GDP debt the U.S. government had in 1943—the second year after Pearl Harbor.

By 2039, CBO projects, the debt held by the public will increase to 101 percent of GDP and by 2040 to 103 percent GDP. At that point, Hall told the Senate Homeland Security and Governmental Affairs Committee, the “debt would still be on an upward path relative to the size of the economy.”

The U.S. Treasury divides the federal debt into two main parts: debt held by the public and intragovernmental debt. The debt held by the public includes Treasury securities such as Treasury bills, notes and bonds that are owned by individuals, domestic and foreign corporations, private banks, the Federal Reserve Bank, and foreign governments. The Treasury pays interest on this debt to those who own it. The intragovernmental debt is money the Treasury owes to government trust funds–such as the Social Security trust funds–because the government has spent money belonging to those trust funds (i.e. Social Security payroll taxes) on things other than what the trust fund was created to fund (i.e. Social Security).

As of July 9, according to the Treasury, the debt held by the public was $13,102,609,587,775 and the intragovernmental debt was $5,049,321,696,720. That equaled a total debt of $18,151,931,284,495 (and counting).

While the run up in debt held by the public as a percentage of GDP in the 1940s financed a global war against Nazi Germany and Japan that ended with an allied victory, the current run toward unprecedented debt is based on projected increases in mandatory federal spending for entitlement programs. These include Social Security, Medicare, Medicaid and Obamacare subsidies.

“Mainly because of the aging of the population and rising health care costs, the extended baseline projections show revenues that fall well short of spending over the long term, producing a substantial imbalance in the federal budget,” Hall said in his written testimony.

“As a result, budget deficits are projected to rise steadily and, by 2040, to raise federal debt held by the public to a percentage of GDP seen at only one previous time in U.S. history—the final year of World War II and the following year,” he said.

“Moreover,” he said, “debt would still be on an upward path relative to the size of the economy. Consequently, the policy changes needed to reduce debt to any given amount would become larger and larger over time. The rising debt could not be sustained indefinitely; the government’s creditors would eventually begin to doubt its ability to cut spending or raise revenues by enough to pay its debt obligations, forcing the government to pay much higher interest rates to borrow money.”

Eventually, the nation would face a crisis—with wary investors demanding “much higher interest” rates to buy U.S. government debt.

“How long the nation could sustain such growth in federal debt is impossible to predict with any confidence,’ testified Hall. “At some point, investors would begin to doubt the government’s willingness or ability to meet its debt obligations, requiring it to pay much higher interest costs in order to continue borrowing money. “Such a fiscal crisis would present policymakers with extremely difficult choices and would probably have a substantial negative impact on the country,” he said.

federal debt

“Unfortunately, there is no way to predict confidently whether or when such a fiscal crisis might occur in the United States,” he said. “In particular, as the debt-to-GDP ratio rises, there is no identifiable point indicating that a crisis is likely or imminent. But all else being equal, the larger a government’s debt, the greater the risk of a fiscal crisis.”

Simply keeping the debt in check would require significant changes in federal policy that would hit Americans in the pocketbook. “Just holding federal debt at its current high level of 74 percent of GDP in 2040 would require significant changes in tax and spending policies,” Hall testified. “The combinations of increases in federal tax revenues and cuts in non-interest federal spending relative to current law of about 1.1% of GDP in each year for 25 years would be needed.

“In 2016, this would be a spending and/or a tax revenue increase totaling about $210 billion dollars–and then more than that in each year after that,” said Hall. “If those changes came from increases of equal percentage in all types of revenues they would represent an increase of 6 percent relative to current law for each year between 2016 and 2040,” Hall testified.

“In 2016, for example, an average middle-income household would have to pay $750 more in taxes and more than that in each year afterwards,” he said. “Or if the changes came from cuts of equal percentage in all types of non-interest spending, that spending each year would have to be 5.5 percent less than projected,” he said. “If the reduction was applied across the board to all types of non-interest spending, an average 65 years old in the middle of the earnings income who retires in 2016 would see a reduction of about $1,050 in his or her initial annual Social Security benefits—more than that in each year afterwards.”

“The more ambitious goal of returning public debt by 2040 to its average level over the past half century, which is 38 percent of GDP, would require more than that,” Hall said. “This would require a revenue increase and/or non-interest spending decrease totaling 2.6 percent of GDP every years.

“This means an average middle income household would have to pay $1,700 more in federal taxes in 2016 and larger amounts in subsequent years,” he said. “Or by cutting non-interest spending across the board, average Social Security benefits for a 65-year-old in the middle of the earnings distribution would have to drop by $2,400 in 2016 and by larger amounts in later years.”

my work here is done


Oregon allowing 15-year-olds to get state-subsidized sex-change operations

messed up

Fox News: The list of things 15-year-olds are not legally allowed to do in Oregon is long: Drive, smoke, donate blood, get a tattoo — even go to a tanning bed.

But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation. Many residents are stunned to learn they can do it without parental notificationand the state will even pay for it through its Medicaid program, the Oregon Health Plan.

“It is trespassing on the hearts, the minds, the bodies of our children,” said Lori Porter of Parents’ Rights in Education. “They’re our children. And for a decision, a life-altering decision like that to be done unbeknownst to a parent or guardian, it’s mindboggling.”

In a statement, Authority spokeswoman Susan Wickstrom explained it this way: “Age of medical consent varies by state. Oregon law — which applies to both Medicaid and non-Medicaid Oregonians — states that the age of medical consent is 15.

While 15 is the medical age of consent in the state, the decision to cover sex-change operations specifically was made by the Health Evidence Review Commission (HERC).

Members are appointed by the governor and paid by the state of Oregon. With no public debate, HERC changed its policy to include cross-sex hormone therapy, puberty-suppressing drugs and gender-reassignment surgery as covered treatments for people with gender dysphoria, formally known as gender identity disorder.  HERC officials refused repeated requests by Fox News for an interview and even gave Fox News inaccurate information about the medical director’s work schedule. 

Oregon Health Authority officials directed Fox News to their website. It shows transgender policy was discussed at four meetings in 2014. It was passed without any opposition or even discussion about teenagers’ new access to undergoing a sex change.

Gender dysphoria is classified by the American Psychiatric Association as a mental disorder in which a person identifies as the sex opposite of his or her birth. It is rare, affecting one out of every 20,000 males and one out of every 50,000 females.  According to a 2008 study published in the Journal of the American Academy of Child and Adolescent Psychiatry, “most children with gender dysphoria will not remain gender dysphoric after puberty.” 

Dr. Paul McHugh

Dr. Paul McHugh

Dr. Paul McHugh, who led the Johns Hopkins Psychiatry Department and still practices, said Oregon’s policy amounts to child abuse. “We have a very radical and even mutilating treatment being offered to children without any evidence that the long-term outcome of this would be good,” McHugh said.

Dr. Jack Drescher, a member of the APA who worked on the Sexual and Gender Identity Disorders Work Group, says treatment for gender dysphoria has received a lot more attention in recent years. He said this year New York changed its policy to cover cross-sex hormone drugs and sex-reassignment surgery for Medicaid recipients who are at least 18 years old. He thinks Oregon is offering the treatment too early.  “Children age 15 may not fully understand all the consequences of the procedures they are undergoing,” he said.

Jenn Burleton

Jenn Burleton

Jenn Burleton disagrees. She underwent a sex-reassignment surgery and started the Portland non-profit group TransActive. She said requiring parental consent would lead to more suffering and teen suicide attempts.  “Parents may not be supportive,” Burleton said. “They may not be in an environment where they feel the parent will affirm their identity, this may have been going on for years.”

The science is unsettled. A 2010 Murad study concluded “very low quality evidence suggests sex reassignment … improves gender dysphoria and overall quality of life.” The authors admitted the evidence was “sparse and inconclusive.” 

Lisa Maloney, a parent and Scappoose, Ore., School Board member, is outraged. “To know that taxpayers are now on the hook for that, that a child can do that without their parent’s knowledge or information or consent, parents have absolutely no say, that’s appalling,” Maloney said.

The Oregon Health Authority could not say how many Medicaid recipients have been treated for gender dysphoria since the new policy took effect in January. Oregon has 935,000 people enrolled in the Oregon Health Plan. HERC assumes between 14 and 112 of them may be gender dysphoric. It estimates the total cost of adding cross-sex hormone therapy, puberty-suppressing drugs and sex reassignment surgeries to the coverage will be no more than $150,000 per year.

But HERC also believes the state will save money due to fewer suicide attempts. It estimates there will be one less suicide attempt per year. The Centers for Disease Control and Prevention estimates the average cost per suicide attempt in the U.S. is $7,234.

But Dr. McHugh says a sex-change operation, especially for young people with gender dysphoria, is never appropriate.  “We can help them if we begin to explore with them and their families what they’re fearing about development, what they’re fearing about being a young boy, a young adolescent appropriate to themselves.”


Illegal Aliens Gain Non-Obamacare Health Insurance If Obama’s Executive Action Implemented


Breitbart: Add non-Obamacare government health insurance to the benefits that foreign nationals currently illegally present in the United States could receive should President Obama’s November 2014 executive action be determined constitutional in the courts.

If implemented, DACA (Deferred Action for Childhood Arrivals) and DAPA (Deferred Action for Parental Accountability) would grant legal status to an estimated five million foreign nationals illegally present in the U.S.

“These immigrants are not eligible for health insurance options under the Affordable Care Act [commonly known as Obamacare], but Californians who are granted DACA or DAPA become eligible for comprehensive Medi-Cal coverage under state policy if otherwise eligible based on income,” reads a March joint report from the UCLA Center for Health Policy Research and the UC Berkeley Center for Labor Research and Education. Medi-Cal is California’s form of the federal Medicaid program.

That joint report details the number of potential new DACA and DAPA recipients eligible for Medi-Cal at between approximately 360,000 and 500,000. This reflects the estimate that some 57% of those eligible for DACA or DAPA “lacked private health insurance and had income below the Medi-Cal eligibility threshold in 2013.” However, these are estimates, and the number could be higher or lower depending on a number of variables including estimates of the number of illegal aliens that exist in the state, how many apply for DACA and DAPA, and how many apply for Medi-Cal and meet the criteria.

According to the report, “Approximately half of low-income undocumented Californians are already enrolled in restricted scope Medi-Cal, which covers emergency and pregnancy-related services for undocumented residents under a long-standing federal policy.”

Between 2.2 and 3.2 million “undocumented” aliens are currently illegally present in California according to the joint AC Berkeley-UCLA policy study. Of those, between 1.23 and 1.57 million are estimated to be eligible for either DACA or DAPA.

The study also provided a chart indicating that, as of 2013, only 30% of potential DACA applicants were 18 years old or younger. Another 61% were in the 19-29 range and 9% were 30-44. Approximately 190,000 or 62% of those in California eligible for the first wave of DACA have had their applications approved, the study estimates. The great majority of eligible DAPA recipients are between 30 and 44 at 67%.

The recent decision from Texas Judge Andrew Hanen ordered a halt to implementation of President Obama’s executive action over questions of its constitutionality.

Echoing a recent assertion made by Representative Luis Gutierrez, the joint study pushes the idea that Judge Hanen’s decision will be overturned. However, the study cites “immigration policy experts” in that assertion, then links that reference only to the progressive National Immigration Law Center (NILC), an advocate for legalization of illegally present aliens.

During the Los Angeles stop on Representative Luis Gutierrez’s cross-country DACA/DAPA tour, Saturday, March 21, one woman asked what would happen if her kids got hurt or sick since they are not on Obamacare. AB 60 illegal alien driver license and programs specialist Carlos Leon told the potential DACA/DAPA applicant that “there is insurance available for undocumented individuals and it does not have to be Obamacare.”

Under ‘policy implications,’ the study makes the case that “providing comprehensive coverage will build upon availability of existing federal and state funds,” claiming, “the state’s eligibility policy will also contribute to a healthier California workforce.” The study claims “previous medical expansions,” have been associated with lower death rates and overall general better health. A 2012 study was widely circulated claiming a similar result.

However, multiple other reports correlate Medicaid with lack of sufficient or effective healthcare. The Heritage Foundation reports, “A number of academic studies over the years have illustrated that Medicaid patients have consistently had poor access to care and that Medicaid fails to meet important needs.”

Medicaid expansion is also large part of the plan to extend health insurance under Obamacare, comprising more than half of that new coverage, according to a 2012 Manhattan Institute report.


Massachusetts showers illegals with $35M in free health care, meds, physical therapy

Do you want free health care, free medications, free dental care, and free physical therapy?

Just renounce your U.S. citizenship and become an illegal resident of the State of Massachusetts, and you’ll be showered with all the goodies.

illegals demand free stuff

The nonpartisan citizens’ watchdog group Judicial Watch reports on Jan. 20, 2015, that although it violates both state and federal law, Massachusetts spent tens of millions of dollars to give illegal immigrants medical care—including prescription drugs, physical therapy and dental services—through its taxpayer-funded healthcare program for low-income individuals.

Tax-paying residents of the Bay State should be outraged, to say the least. The information comes straight out of a scathing report that contains the findings of an investigation conducted by Massachusetts State Auditor Suzanne Bump. It reveals that questionable or prohibited medical claims totaling $35,137,347 were reimbursed by the state’s Medicaid agency known as MassHealth. A chunk of it went to non-emergency services for illegal immigrants, according to the audit.

MassHealth costs are divided between the state and federal government to provide healthcare for the poor. Established regulations at both the federal and state level specifically forbid undocumented immigrants from receiving coverage for non-emergency treatment in government-funded Medicaid programs nationwide. Each year MassHealth doles out more than $10.8 billion so that 1.4 million eligible people—legal residents—who can’t afford medical treatment can access it. Of the more than $35 million that funded treatment for illegal aliens, $27.8 million went to inpatient and outpatient services, the probe found. The rest was spent on prescription drugs ($3.6 million), dental services ($1.7 million) and rehabilitation and physical therapy ($1.9 million).

The investigation covers a small period that runs from July 2011 to December 2012 so it only represents a snippet of the actual waste and violations. Evidently MassHealth officials know exactly what they’re doing and hide behind their own interpretation of federal and state rules, according to Bump, the state auditor. “In the course of the audit we saw that MassHealth regularly substituted its own judgment for that of the medical professional in determining whether to cover a service,” Bump said in a statement announcing her findings. “Based on our understanding of the plain language in the regulations, MassHealth Limited is paying for ineligible services, and the tab is costly.”

American taxpayers have long been stuck with the exorbitant cost of providing illegal immigrants with medical care. In fact, Judicial Watch has been reporting it for years, citing figures provided by state, federal and county governments. Besides spending billions of dollars annually as a nation to medically treat illegal aliens, here are  a couple of exceptional cases reported by JW over the years:

  • In California, the state with the nation’s largest illegal immigrant population, offers illegals free organ transplants and the costly follow-up treatment required after the complicated surgery.
  • In Scott County, Minnesota, the public paid for an incarcerated illegal alien’s $50,000 penis pump because it was billed as an “emergency” medical procedure.

The list goes on and on. The problem has gotten so out of control that a few years ago a Democratic congressman from Ohio introduced legislation requiring foreign countries to reimburse American taxpayers for the exorbitant medical expenses of illegal immigrants. The measure, known as the PAYBACK  Act (Preventing All Your Bucks from Aiding non-Citizens is Key) was estimated to save the U.S. government billions annually and ensure that public funds were not used to finance healthcare services for illegal immigrants. The bill was referred to the House Subcommittee on Border, Maritime and Global Counterterrorism for consideration but didn’t get very far after that.

For all the posts we’ve published on the illegals problem, go to our “Illegal Immigration” page.


Illinois overdrew hundreds of millions of federal Medicaid dollars, audit says


thonline.com:  Illinois used faulty methods for withdrawing federal Medicaid money, resulting in “a perpetual ‘treadmill effect’” of regular overdraws of dollars that the state later had trouble repaying, federal auditors said in a report released Monday.

The state’s withdrawals exceeded its actual Medicaid spending by an average of $60 million per quarter during the three years reviewed, according to the report from the U.S. Department of Health and Human Services’ Office of Inspector General.

The federal government may have lost as much as $792,000 in interest during fiscal 2010 through 2012 because the state repaid the money two to six months later, the report said.

Meanwhile, Illinois used the money for other purposes. The state deposited the overdrawn Medicaid money directly into the state’s general revenue fund, the same fund used for transportation, education and pensions, the report said. The money was used to pay non-Medicaid expenditures because it was mixed in with other money in the fund.

Federal rules require states to limit the amount of Medicaid transfers to what the states really need and to minimize the time states hold onto the money.

A watchdog group called the report’s finding an example of Illinois’ irregular budget practices that have led to a multibillion-dollar pile of overdue bills.

“The audit clearly points out that the state has used federal Medicaid dollars to mask other financial challenges and avoid cutting spending or increasing revenue” to balance the budget, said Laurence Msall of the Civic Federation, a Chicago-based policy analysis organization.

But the report concluded that all the money obtained by Illinois was legitimately supported by state spending on the Medicaid program. That’s important, said Ralph Martire of the bipartisan Chicago-based Center for Tax and Budget Accountability.

“It’s not like the state is trying to defraud the federal government,” Martire said, although he said Illinois may have “some sloppy internal systems” it needs to fix.

Illinois “justified every dime that it claimed,” said Michael Casey, finance administer for the state’s Medicaid program at the Illinois Department of Healthcare and Family Services. He called the repayment problems cited by the audit “a matter of timing.” (Try using that excuse with the IRS.)

Casey said that the state’s outdated, 30-year-old computer system can’t do daily calculations of federal reimbursement rates for a half-dozen different programs, making it necessary to estimate how much money to draw. The system will be replaced by the end of 2017, he said.

Medicaid is a federal and state program that pays medical expenses of the poor and disabled. In Illinois, the state and federal governments each pay for about half the program’s expenses. The Illinois Medicaid program now covers 3 million people with a budget of about $18 billion.

The federal review was part of a series related to states’ withdrawals of federal Medicaid money.

Julie Hamos

Julie Hamos

It’s the latest difficulty for Illinois Department of Healthcare and Family Services Director Julie Hamos, who earlier this year was hit with an Illinois audit finding the program overpaid $12.3 million for medical care for 2,850 people who were dead. (In December 2012, Julie was presented the “Excellence in Public Service Award” by Motorola Solutions Foundation, in partnership with the Civic Federation. In January 2013, Julie was named by the Chicago Tribune Business Section as one of the “People to Watch” in 2013.)

In a letter responding to the new federal audit, Hamos said her department is addressing the problem “to reduce the amounts of overdraws and underdraws of federal Medicaid funds.” Hamos said the expansion of managed care in Illinois’ Medicaid program “should allow for more consistent payment cycles and better estimates of the federal share of payments.”

Illinois has lagged behind other states in adopting managed care, which pays insurers and health networks fixed per-patient fees instead of paying separately for every appointment, surgery and test. A 2011 state law required expanding managed care to half the state’s Medicaid patients by 2015.


Fine print with expanded Medicaid jolts many middle-age adults


Yakima Herald: It wasn’t the moonlight, holiday season euphoria or family pressure that made Sofia Prins and Gary Balhorn, both 62, suddenly decide to get married. It was the fine print.

As fine print is wont to do, it had buried itself in a long form — Balhorn’s application for free health insurance through the expanded state Medicaid program. As the paperwork lay on the dining-room table in Port Townsend, Prins began reading.

She was shocked: If you’re 55 or over, Medicaid can come back after you’re dead and bill your estate for ordinary health care expenses.

The way Prins saw it, that meant health insurance via Medicaid is hardly “free” for Washington residents 55 or older. It’s a loan, one whose payback requirements aren’t well advertised. And it penalizes people who, despite having a low income, have managed to keep a home or some savings they hope to pass to heirs, Prins said.

With an estimated 223,000 adults seeking health insurance headed toward Washington’s expanded Medicaid program over the next three years, the state’s estate-recovery rules, which allow collection of nearly all medical expenses, have come under fire.

Medicaid, in keeping with federal policy, has long tapped into estates. But because most low-income adults without disabilities could not qualify for typical medical coverage through Medicaid, recovery primarily involved expenses for nursing homes and other long-term care.

The federal Affordable Care Act (ACA) changed that. Now many more low-income residents will qualify for Medicaid, called Apple Health in Washington state.

But if they qualify for Medicaid, they’re not eligible for tax credits to subsidize a private health plan under the ACA, which requires all adults to have health insurance by March 31.

Prins, an artist, and Balhorn, a retired fisherman-turned-tango instructor, separately qualified for health insurance through Medicaid based on their sole incomes. But if they were married, they calculated, they could “just squeak by” with enough income to qualify for a subsidized health plan — and avoid any encumbrance on the home they hope to leave to Prins’ two sons.

“We’re happy to be getting married,” Prins said last week. “Unfortunately not everyone has such an elegant solution to the problem.”

For Washington state, the solution has been much more complicated. Over the past month, as lawmakers began hearing from worried and angry constituents, state officials began exploring what it would take to fix this collision of state rules with the ACA.

Late Friday, Gov. Jay Inslee’s office and the state Medicaid office said they plan to draft an emergency rule to limit estate recovery to long-term care and related medical expenses. They hope to be able to change the rules before coverage begins Jan. 1.

Fixing the problem will cost the state about $3 million a year, said Dr. Bob Crittenden, Inslee’s senior health policy adviser, but it’s the right thing to do.

“There was no intent on the part of the ACA to do estate recovery on people going into Medicaid (for health insurance),” Crittenden said. “The idea was to expand coverage.”

People in their 50s and 60s make up about 30 percent of the adults who have signed up for health insurance through Washington’s exchange marketplace, and about 18 percent of adults who have enrolled in health insurance through Apple Health (Medicaid).

Some 55- to 64-year-olds, who may have taken early retirement or who were laid off during the recession, have found themselves plunged into a low-income bracket. Unlike Medicaid recipients in the past — who were required to reduce their assets to qualify — they’re more likely to have a home or other assets.

For health coverage through Medicaid, income is now the only financial requirement.

At first, Prins was pleased at the prospect of free coverage.

But the more she thought about the fine print, the more upset she got. Why was this provision only for people age 55 and older? Why should those insured by Medicaid have to pay back health expenses from their estates when people with just a bit more income who get federal subsidies don’t? Why didn’t she and Balhorn know about this before getting to the application stage?

As Prins began searching for answers, she found that even those trained to help people sign up for insurance under the ACA weren’t aware of this provision, nor were some government officials.

Around the country, the issue has sizzled away in blogs and commentaries from both right and left. The National Women’s Law Center noted the ACA and its regulations prohibit age discrimination in programs such as Medicare and Medicaid.

Dr. Jane Orient, executive director of the politically conservative Association of American Physicians and Surgeons, writing in the The Washington Times, called the recovery provision “a cash cow for states to milk the poor and the middle class.”

“People will think this is wonderful, this is free insurance,” Orient said in an interview. “They don’t realize it’s really a loan, and is secured by any property they have.”

Even states that are now limiting estate recovery, she warned, can change the rules again if budget problems become more intense.

One reason this snafu has become so troublesome is that ACA rules appear to give those who qualify for Medicaid little choice but to accept the coverage.

People cannot receive a tax credit to subsidize their purchase of a private health plan if their income qualifies them for Medicaid, said Bethany Frey, spokeswoman for the Washington Health Benefit Exchange.

But they could buy a health plan without a tax credit, she added.

For someone age 55 to 64 at the Medicaid income level — below $15,856 a year — it’s quite a jump from free Medicaid health insurance to an unsubsidized individual plan. Premiums in King County for an age 60 non-tobacco user for the most modest plan run from $451 to $859 per month.

It’s not the first time federal and state rules have clashed, and local officials now find themselves on the hook to ensure that the new law doesn’t create hardship.

In Oregon, state officials changed estate-recovery rules last month. Recovery will no longer apply to health benefits for those 55 and over, the Oregon Health Authority said, although the state will collect expenses for long-term care.

On Friday, Washington Medicaid Director MaryAnne Lindeblad promised to draft an emergency rule very soon. The state also must revise the plan filed with federal authorities, but Lindeblad said she doesn’t expect problems or appeals of the rule.

As for Prins and Balhorn, they’re good with their choice.

Instead of paying $577 a month apiece for an unsubsidized private plan or worrying about losing their assets after death, as a married couple they’ll pay $76 a month for a midlevel “silver” plan with a tax credit. “Since we’ve been in an established relationship and love each other, the decision to get married was pretty easy,” Prins said.

Sunday, they made a big fruit salad, dressed in tango clothing and were married in their home. Afterward, they danced to their favorite tango music and toasted each other with orange juice and a dash of cranberry.

“I’d be very happy if the governor actually makes this change possible,” Prins said late last week. “And I’m very happy to be getting married!”


Scooter Store scammed $108m from U.S. taxpayers

Scooter Store You’ve seen those ubiquitous ads on TV of a seemingly good-hearted store that promised elderly and disabled Americans a motorized scooter FOR FREE! Because, the ad assures its viewers, Medicare will pay for it!!!!

I’ve seen those ads too, and had wondered how the Scooter Store could be so 100% confident that *ANYONE* who wanted a scooter was assured one — FOR FREE!

To quote the eminently sensible Judge Judy: “If it doesn’t make sense, it’s not true.”

When was the last time you’ve seen a Scooter Store commercial? At least many months, if not a year or two.

Here’s why . . . .

Founded in 1991 by Doug and Susanna Harrison, the privately-owned Scooter Store is headquartered in New Braunfels, Texas, and serve 48 states. It is the largest supplier of mobility vehicles in the United States.

In February 2013 the company Store filed for Chapter 11 bankruptcy and ceased all cash sales to the public, after a raid by more than 150 FBI agents and local cops for Medicare-Medicaid fraud of as much as $108 million.

During its heyday, the Scooter Store had employed more than 2,400 people and was New Braunfels’ largest private employer. On September 13, 2013, the company entered liquidation and terminated its remaining 370 employees. Effective October 26, the Scooter Store lost its federal contract with Medicare eliminating the ability to sell assets in a Chapter 11 bankruptcy. So the company’s board of directors made the decision to essentially liquidate the business.

Medicare has accounted for about three-quarters of the Scooter Store’s business, a company representative told a U.S. Senate committee last year. But an independent auditor found The Scooter Store had received between $46.8 million and $87.7 million in Medicare overpayments.

The company is accused by the Justice Department of harassing doctors with constant phone calls and surgery visits in order to wear them down to prescribe scooters to patients who do not need them.

A damning exposé by CBS This Morning in January alleged that the company over-billed Medicare by $108 million between 2009-2012.

Former Scooter Store employee Brian Setzer told CBS that company’s main goal was to use pressure to get doctors to prescribe their vehicles. Setzer described the company’s policy was to “Bulldoze and get them to get the paperwork done.” He said his bosses would order him to annoy doctors into prescribing the scooters: “I’d get a call, ‘Well, can you go in to get him to do this? Could you get him to do this.’ I couldn’t feel right in my heart to do that.”

Here’s the extent of Scooter Store’s scam:

  • The company had a specialized department devoted to getting the scooters for patients who had already been ruled ineligible by Medicare.
  • About 80% of all claims for scooters were found to be medically unnecessary.
  • 61% of claims that were approved should not have been, totaling $95 million.
  • What Medicare paid the Scooter Store was FOUR TIMES the average amount spent by suppliers for standard power wheelchairs.
  • The federal government taxpayers spent $723 million for the scooters in Medicare reimbursements for 2009 alone.

Sources: Wikipedia; San Antonio Express-News; Daily Mail.

Doug HarrisonTom Wilson of The CareGiver Partnerships: wants us to hold the owners of The Scooter Store responsible. He writes:

Doug and Susanna Harrison are the the ‘faces’ behind The Scooter Store.  They founded The Scooter Store and were personally responsible for its operations, policies and procedures – until they jumped ship in 2012. […]

They spent years greasing the palms of politicians.  Through The Scooter Store, they gave $86,273 to federal politicians and were a top source of funds for 19 members of Congress. Since 2007, they have given $473,000 to politicians.

They also spent nearly $4 million on lobbying since 2004 trying to kill laws to curb waste, fraud, and abuse in the Medicare and Medicaid programs.  […]

After being charged with fraud, the company said it would only repay $20 million of the $88 million defrauded from Medicare.  They actually had the audacity to file a lawsuit against the government (really all of us as consumers) for not approving their claims.

Doug and Susanna must be held accountable.  They continue to live the life of luxury. People must be held accountable for fraud, not a company which has no soul or conscience… and now, no assets. […]

Doug Harrison is quoted as saying he’s proud what he and the Scooter Store did.  During March 2012, he jumped ship just before the company began to implode and the majority of its employees suddenly lost their livelihood and creditors lost their money.  He also left the city of New Brunfels high and dry after they gave into pressure from him to relocate the company.  They provided massive tax incentives to stay, which they are now unlikely to ever recoup. 

People, Not Companies Must Be Held Accountable For Stealing From Medicare. ‘We the people’ are out a great deal of money.  In my opinion, the Harrisons must be brought to trial and made an example of if we are to curb fraud of our health care system.  Since no bankers were ever tried, this is sadly, unlikely.