http://www.cnsnews.com/news/article/ali-meyer/gao-medicaid-made-144-billion-improper-payments


GAO: Medicaid Made $14.4 Billion in ‘Improper Payments’

(CNSNews.com) -- The Centers for Medicare and Medicaid Service (CMS) determined that the Medicaid program doled out $14.4 billion in improper payments in fiscal year 2013, according to a report from the Government Accountability Office (GAO).
Currently, the Medicaid program provides health care coverage to about 71.7 million individuals at an annual cost of about $431.1 billion. Because of the program’s large size, the GAO states it is vulnerable to improper payments.
A significant amount of growth of the Medicare program is due to the Patient Protection and Affordable Care Act (PPACA), popularly known as Obamacare.
The GAO report, Medicaid Program Integrity: Increased Oversight Needed to Ensure Integrity of Growing Managed Care Expenditures, was compiled to ensure Medicaid program integrity, but found gaps in state and federal efforts to maintain that integrity. (See GAO Medicaid Program Integrity.pdf)
“The size and diversity of the Medicaid program make it particularly vulnerable to improper payments – including payments made for treatments or services that were not covered by program rules, that were not medically necessary, or that were billed for but never provided,” states the report.
“The Centers for Medicare and Medicaid Services, the federal agency within the Department of Health and Human Services (HHS) that oversees Medicaid, estimated that $14.4 billion (5.8 percent) of federal Medicaid expenditures for fiscal year 2013 were improper payments,” said the GAO.
To identify gaps in efforts to maintain integrity, the GAO interviewed federal officials as well as states, as part of the performance audit from June 2013 to May 2014. While states have the primary responsibility to reduce, identify and recover improper payments, federal entities provide the oversight as well as program and law enforcement support.
The GAO discovered that “most state and federal program integrity officials we interviewed told us that they did not closely examine Medicaid managed care payments, but instead primarily focused their program integrity efforts on fee-for-service claims.”

“Managed care organizations [MCOs] have responsibility for identifying improper payments to providers within their plans; however, state officials suggested that MCOs might not have an incentive to identify and recover improper payments. Officials from two of the seven state PI units we spoke with told us that they believed managed care organizations were not consistently reporting improper payments to the state to avoid appearing vulnerable to fraud and abuse,” reads the GAO report.
“Similar to states, federal entities – CMS and HHS-OIG – have taken few steps to address Medicaid managed care program integrity,” said the GAO. For example, CMS provides support and guidance to states regarding their managed care programs, yet the “guidance was not available on the CMS website, and six of the seven state PI unit officials we spoke with did not mention it when asked about the guidance they relied on in conducting program integrity activities,” said the GAO.
“Federal laws require the states and CMS to ensure the integrity of the Medicaid program, including payments under Medicaid managed care. However, most of the state program integrity units and Medicaid Fraud Control Units included in our review were not closely examining the activities of managed care organizations citing a lack of sufficient guidance and support,” reads the report. (See GAO Medicaid Program Integrity.pdf)
“Unless CMS takes a larger role in holding states accountable, and provides guidance and support to states to ensure adequate program integrity efforts in Medicaid managed care,” said the GAO, “the gap between state and federal efforts to monitor managed care program integrity leaves a growing portion of federal Medicaid dollars vulnerable to improper payments.

So, why didn't you get to the meat of the issue? Report on the fact that EPA turned thumbs down on any new oil refineries being built in this country. We need new refineries with the new technology and safety features. Our refineries are antiquated to say the least. They are limping along with constant repairs. The EPA has squashed many other improvements that should have been made in our industrialized society. Don't really give a damn about how many words or pages they turned out. GET TO THE MEAT OF OUR PROBLEM WITH THE EPA.

Another ignorant low information progressive, huh chris
Let’s start with 5 comprehensive health reform proposals that have actually been introduced in Congress—some well before President Obama even was nominated for president, and all months before the House (11/7/09) or Senate (12/24/09) v**ed on what eventually became Obamacare. All of them sniffled by the marxist progressive pencil necked Harry Reid in the Senate.

Ten Steps to T***sform Health Care in America Act (S. 1783) introduced by Senator Mike Enzi (R-WY) July 12, 2007.
Every American Insured Health Act introduced by Senators Richard Burr (R-NC) and Bob Corker (R-TN) with co-sponsors Tom Coburn (R-OK), Mel Martinez (formerly R-FL) and Elizabeth Dole (formerly R-NC) on July 26, 2007.
Senators Bob Bennett (R-UT) and Ron Wyden (D-OR) introduced the Healthy Americans Act on January 18, 2007 and re-introduced the same bill on February 5, 2009.
Patients’ Choice Act of 2009 introduced by Senators Tom Coburn (R-OK) and Richard Burr (R-NC) and Rep. Paul Ryan (R-WI) and Devin Nunes (R-CA) on May 20, 2009. [See Update #1 for why this bill was of particular significance]
H.R. 2300, Empowering Patients First Act introduced July 30, 2009 by Rep. Tom Price (R-GA).

Likewise, conservative market-oriented health policy scholars have developed a rich menu of potential replacement plans for Obamacare:

Individual Pay or Play proposed in 2005 by John Goodman; this is a minimalist version of a broader reform envisaged by Goodman built on converting the tax exclusion into universal tax credits.
Health Status Insurance originally proposed by John Cochrane in 1995.
Universal Health Savings Accounts proposed by John Goodman and Peter Ferrara in 2012. This combines fixed tax credits with individual pay or play and health status insurance concepts along with Roth-style Health Savings Accounts.
Fixed tax credits. A variety of proposals have centered on using fix tax credits to replace the current inefficient and unfair tax exclusion for employer-provided health benefits. Two good explanations of how that would work are here:
James C. Capretta and Robert E. Moffit, “How to Replace Obamacare,” National Affairs, no. 11 (Spring 2012).
James C. Capretta. Constructing an Alternative to Obamacare: Key Details for a Practical Replacement Program. American Enterprise Institute, December 2012.
Income-Related Tax Credits proposed by Mark Pauly and John Hoff in Responsible Tax Credits (2002) and endorsed by the American Medical Association. More recently, 8 scholars from Harvard, University of Chicago, and USC–Jay Bhattacharya, Amitabh Chandra, Michael Chernew, Dana Goldman, Anupam Jena, Darius Lakdawalla,Anup Malani and Tomas Philipson—released Best of Both Worlds: Uniting Universal Coverage and Personal Choice in Health Care (2013) which also is built around a model of individual health insurance subsidized with income-related tax credits.
Flexible Benefits Tax Credit For Health Insurance by Lynn Etheredge in 2001.
Near-Universal Health Insurance Exchanges proposed in 2001 by Sara Singer, Alan Garber and Alain Enthoven (covers only non-elderly).
Universal Health Insurance Exchanges proposed in 2013 by former CBO director Douglas Holtz-Eakin and Avik Roy (covers Medicare and Medicaid in addition to privately insured).

Migeli_ take a deep breath and read carefully what these people are saying. Our health care insurance system was doing fine before Obama decided to eviscerate it. It need some tweaking which could have been done piecemeal without disrupting the entire industry. We need the insurance companies as they are the only ones who know anything about what coverage can be provided and at what cost so that the medical profession gets paid, the client receives care, and the insurance company makes a profit. Yes, other countries have national health care but what you forget one very important aspect and that is the population of all those countries combined is less than the population of the USA. We have three government programs in effect right now: Medicare, Medicaid, and the VA system. Both Medicare and Medicaid are relatively small programs but are rife with fraud and abuse which costs the taxpayers billions each year and services are being limited every day. Look at the VA system-if we cannot effectively take care of veterans how do you propose to oversee the health care of over 300 million people in a government single pay program? Health Insurance and Health Care are two areas where we are better off if those are managed by the private sector. The VA problems stem from lack of management as opposed to lack of money. Turn all VA hospitals over to the private sector and they will perform efficiently in short order. The insurance companies know from years of experience what premiums they need to charge in order to survive . Yes, we need insurance company oversight by Congress and they need to justify cost increases but we need them to stay in business to prevent individuals from facing financial ruin. Conversely, we need a smaller less intrusive government designed to serve the citizenry instead of acting as Lord and Master over the populace. Good Luck America!!!

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Having worked for 30+ years in the electric utility industry, I believe I can speak to this topic with some authority. First, the above post is just a bunch of political rhetoric, coming from people who don't like the present administration and its climate policies. Several pieces of "t***h" about the recent EPA proposals have seemingly been omitted from the above posting for political expedience.

To hear, "... the rest of the story," please read the following, recent article from the WaPo. The article only hits the high-spots of the EPA ruling, but, at least, it gives one a basic understanding of the many facets of considerations that go into a ruling, such as the EPA made.

Washington Post, June 2, 2014.
Everything you need to know about the EPA’s proposed rule on coal plants

EPA Administrator Gina McCarthy said during a news conference on Monday that "the high costs of climate inaction" are affecting American children and families today and it is important to limit carbon pollution. She proposed new regulations for a "clean power plant."

BY JULIET EILPERIN AND STEVEN MUFSON June 2
The Environmental Protection Agency on Monday proposed a rule designed to cut carbon dioxide emissions from existing coal plants by as much as 30 percent by 2030, compared with 2005 levels. The regulation has prompted heavy lobbying from industry and environmental groups, and the ensuing battle promises to become, as the Natural Resources Defense Council Climate Director Peter Altman put it, “the Super Bowl of climate politics.”

Why is the EPA regulating greenhouse-gas emissions from power plants?
Under President George W. Bush, the agency argued that Congress never intended to regulate carbon dioxide and other greenhouse gases under the Clean Air Act, so it lacked authority to do so. In 2007, the Supreme Court disagreed, ruling in Massachusetts v. EPA that the law was “unambiguous” and that emissions came under its broad definition of “air pollutant.” It ordered the agency to determine whether greenhouse-gas emissions endanger public health or the environment. The EPA issued an “endangerment finding” in December 2009 that laid the groundwork for the power-plant rule it proposed Monday.

Why target existing power plants?
Existing power plants are the largest source of the nation’s carbon dioxide emissions, accounting for 38 percent. (The t***sportation sector comes in second, at 32 percent.) Much of this pollution stems from aging, coal-fired power plants.

Regulating power plant carbon emissions
The EPA says the average age of the nation’s coal fleet is 42 years, meaning that most of them aren’t nearly as efficient as new coal plants, although many have been updated. Some were built when Dwight D. Eisenhower was president, said Exelon chief executive Christopher Crane.

Of the 983 coal-fired units operating as of December at 523 plants, 63 percent are at least 40 years old, said John Coequyt of the Sierra Club.

The regulations also could ­affect natural-gas-fired power plants, which emit about half as much greenhouse gas as coal plants. The EPA said that natural-gas-fired combined cycle plants in the United States are 14 years old on average.

How will the regulations be implemented?
After the EPA finalizes its proposal in mid-2015, it will give states a year to design their implementation plans. It will let states meet emission targets for power plants in several ways, including through plant upgrades, switching from coal to natural gas, or by improving energy efficiency or promoting renewable energy “outside the fence,” meaning outside the plant site. That approach will give states greater flexibility in designing plans to meet the EPA’s targets.

Many industry groups are insisting that the EPA must limit itself to much more modest efficiency gains that could be made in the plants. The Oklahoma attorney general has vowed to file suit against the EPA’s regulations. If a state does not come up with an effective implementation plan, the EPA can impose a federal plan.

Climate gauges
Temperatures at sea, on land and on ice all point to a warming trend over the past century, according to several indicators in the government's National Climate Assessment.

What is the role of energy efficiency?
The new regulation will provide an impetus for energy-
efficiency measures to flatten out or lower electricity consumption. A March report by the American Council for an Energy Efficient Economy looked at efficiency programs in 20 states from 2009 to 2012 and found an average cost of 2.8 cents per kilowatt-hour — about one-half to one-third the cost of alternative new electricity resource options, the group said.

Moreover, energy-efficiency measures sidestep criticism that some regulation opponents make about wind and solar power: that they lack adequate storage technology and can strain the grid.

“It’s cheaper to save electricity than it is to generate more,” said Rodney Sobin, director of research and regulatory affairs at the Alliance to Save Energy. And, he said, energy efficiency “en­hances” the reliability of the grid by reducing the load on it.

Who are the winners and losers in this fight?
Several constituencies will welcome the administration’s proposal. Environmentalists consider the regulation the most important step President Obama can take to address c*****e c****e, and they have put him on notice that they consider this a litmus test for his second term. Renewable-energy producers from the solar and wind sector stand to benefit from the regulation because it would provide utilities with a greater incentive to invest in carbon-free electricity sources. Some utility companies that have a low-carbon fleet with natural gas or nuclear-powered plants — including Exelon, PG&E and Calpine — also favor strict limits on greenhouse-gas emissions.


By contrast, the coal industry and its allies — including lawmakers from West Virginia, North Dakota and other states — oppose the proposal. So do many business groups, such as the U.S. Chamber of Commerce and the National Association of Manufacturers, which have argued that the rule would boost electricity prices and raise the cost of doing business. Rep. Shelley Moore Capito (R-W.Va.), who hails from a coal-mining state, sent a letter to Obama on Thursday suggesting that he scrap the proposal. “I urge you to consider the impact that your administration’s existing coal plant rule will have on the people of my state of West Virginia who want to go to work, provide for their families and produce affordable energy that powers our economy. I urge you to think of the impact that higher electricity prices will have on senior citizens and others on fixed incomes,” wrote Capito, who is running for Senate. “Washington should not pick winners and losers in the energy economy.”

Will the EPA’s regulations really increase electricity bills?
The Chamber released a report recently saying that the rule would cost businesses more than $50 billion a year; the Natural Resources Defense Council (NRDC) has estimated that it would save money overall; and the EPA’s analysis asserts that benefits would outweigh the costs, either because of avoiding c*****e c****e costs or because of the public health benefits that come from shutting down coal plants.

The American Wind Energy Association, which also supports the EPA rule, recently published a study that found that consumer rates declined over the past five years in the 11 states that use the most wind, while rates increased collectively in all the other states during that same period.


What would be the public health benefits?
The EPA estimates that the new rule would cut traditional air pollutants such as sulfur dioxide, nitrogen oxides and soot by 25 percent, yielding a public health benefit of between $55 billion to $93 billion when it is fully implemented, with 2,700 to 6600 premature deaths avoided and 140,000 to 150,000 asthma attacks a year avoided. The cost, by contrast, would be $7.3 billion to $8.8 billion.

The EPA said that for every $1 invested, Americans would reap $7 in health benefits. If the EPA rule reduces the use of coal, it also would reduce emissions of conventional pollutants that contribute to asthma, other lung diseases and heart attacks, according to a joint study by the Harvard School of Public Health and Syracuse University Center for Health and the Global Environment. “Carbon pollution standards for existing power plants would not only help confront the challenge of global c*****e c****e, they would confer substantial local and regional benefits by reducing power plant emissions of these major co-pollutants by up to 27 percent for sulfur dioxide and mercury and 22 percent for nitrogen oxides” by 2020, the study said. It said the greatest benefits would come in the Ohio River Valley and the Rocky Mountain region.

“Ecosystems would also benefit from decreases in air pollution and atmospheric deposition of sulfur and nitrogen,” the study added. “Reduced ground-level ozone will increase the health and productivity of crops and timber.”

The EPA estimates that the public health and climate benefits of the rule would outweigh the costs by anywhere from 8 to 1 to 12 to 1 by 2030.

What are the political implications of this proposal?
The draft rule faces certain congressional opposition and has become hotly contested on the campaign trail. Last week, Senate Minority Leader Mitch McConnell (R-Ky.) blasted his Democratic challenger, Alison Lundergan Grimes, for accepting $2,000 in donations from NRDC President Frances Beinecke and her husband, Paul Elston, given the NRDC’s support for carbon limits.

Grimes’s camp shot back, asking McConnell if he will return the $2,000 from Texas Business for Clean Air founder David Litman, whose group opposes building new coal-fired power plants in Texas on grounds that they would exacerbate air pollution and c*****e c****e.

1. Hawaii – It may be one of America's favorite vacation destinations, but that doesn't mean everyone living there has it easy. Hawaii's cost of living is 50% higher than the national average, and its average salary isn't nearly enough to compensate.

2. New York – Even though New Yorkers enjoy a higher average salary than usual, there too many other dings that push it to the bottom ten. The cost of living in New York is much higher than average and state income tax is very high. To make matters worse, New York's unemployment rate is nothing to be proud of.

3. Mississippi – Mississippi has the lowest workplace conditions rating out of all fifty states, but that's just the start of its problems. Even though the cost of living is low, wages lower than the national average are not enough to compensate.

4. Rhode Island – Rhode Island enjoys a high average income and low state income tax, but its cost of living is high enough to negate both. Furthermore, the unemployment rate is the lowest in the nation.

5. Connecticut – Workplace conditions in Connecticut are barely rate higher than Mississippi's, and that's not all. The average income doesn't compensate for the higher than average cost of living, and unemployment in the state is high.

6. Alaska – Although Alaska has no state income tax, the high cost of living overburdens most Alaskans. Unemployment is higher than average, and Alaskans on average do not like the jobs available in their state.

7. Alabama – Similar to Mississippi's problems, Alabama has a low cost of living but wages are too low to benefit from them on average. Unemployment rates are high, and workplace conditions are rated lower than average.

8. Arkansas – Arkansas is slightly higher in the totem pole created by Mississippi and Alabama. Wages are too low to balance the below-average cost of living. Workplace conditions are below average, and unemployment is high.

9. New Jersey – Similar to New York, New Jersey's high average wages aren't enough to compensate for its high cost of living. Unemployment is higher than average, and workplace conditions are below average.

10. South Carolina – South Carolina sits at the top of the Southeastern string of living-related issues. Cost of living is low, but wages aren't high enough. However, an average South Carolina rated higher than Mississippi, Alabama, and Arkansas.