News in brief - Nov. 28, 2011

House panel votes to repeal long-term-care program

The House Energy and Commerce health subcommittee on Nov. 15 approved a measure to repeal a long-term-care program authorized by the health system reform law. Health subcommittee Chair Joe Pitts (R, Pa.) said the goal of the Community Living Assistance Services and Supports program was laudable, but that the program is financially unsustainable.

Health and Human Services Secretary Kathleen Sebelius announced on Oct. 14 that the department is suspending its efforts to implement the CLASS Act. The health reform law required the secretary to launch a program that is actuarially viable for 75 years, is fully paid for by enrollee premiums, and offers lifetime and cash benefits, but HHS decided that is not feasible.

Health subcommittee member Rep. John Dingell (D, Mich.) said voting to repeal the CLASS Act without suggesting a replacement for it is irresponsible. "We have no viable alternative for affordable long-term care," he said. Ten million Americans need such care today, and 15 million will need it by 2020, he said.

Pitts said his subcommittee will revisit the issue of long-term care.

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House members target Medicare and Medicaid fraud

A bipartisan House bill would shift Medicare anti-fraud efforts to utilizing prevention tactics employed by the credit card industry, sponsors of the legislation said.

Reps. Peter Roskam (R, Ill.) and John Carney (D, Del.) introduced the Medicare and Medicaid FAST Act on Nov. 10. The bill would authorize the adoption of new technologies to reduce an estimated $50 billion in Medicare improper payments each year.

"Stopping Medicare fraud won't be a cure-all of our country's fiscal woes, but it is a common-sense bipartisan solution to save taxpayers billions and help strengthen Medicare," Roskam said.

The legislation would increase the use of predictive modeling technology to prevent fraudulent payments from being made. The act also would curtail physician identity theft and levy tougher penalties on those defrauding health programs.

The Roskam-Carney bill is similar to a Senate bill introduced by Sens. Tom Coburn, MD (R, Okla.), and Tom Carper (D, Del.) in June.

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Doctors among 12 charged in N.Y. health fraud scheme

The U.S. Justice Dept has charged 12 health professionals, including four doctors, with operating a health fraud scheme in New York.

The defendants were charged Nov. 2 with a variety of health care fraud and money laundering offenses in indictments filed in Brooklyn federal court, according to a release by the Justice Dept.

The medical doctors allegedly submitted $11.7 million in false claims to the Medicare program for physical therapy, electric stimulation treatments and other services while working at URI Medical Center and Sarang Medical PC, two medical clinics in Flushing, N.Y.

The indictment alleges that the defendants also recruited Medicare beneficiaries to their clinic by offering lunches and dancing classes, in exchange for the beneficiaries providing their Medicare numbers to be billed for medical services that they did not need and never received.

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Government should largely exit health care, says presidential hopeful Ron Paul

Republican presidential candidate Rep. Ron Paul, MD (R, Texas), said the federal government has an obligation to provide health care to veterans, but otherwise it should not be involved in health care.

"Delivering health care to the whole society is a mistake," Dr. Paul said. "The market is the only compassionate system."

On Nov. 16, the obstetrician-gynecologist became the latest GOP presidential candidate to speak in front of the Congressional Health Care Caucus, which was organized by Rep. Michael Burgess, MD, (R, Texas).

Dr. Paul would allow people to opt out of paying taxes that support Medicare. Americans would be more engaged in their health spending -- and spending would decrease -- if citizens could place $3,000 to $4,000 a year in medical savings accounts and pay physicians in cash, Dr. Paul said. He doesn't want to cut health benefits for the elderly or the poor, but said the existing funding for such programs is not sustainable.

Dr. Paul said he is not concerned about private businesses gaining monopolies in health care. "Nobody has ever been able to prove that a free-market monopoly exists," he said. But he is concerned about businesses' ability to manipulate government to pad their profits. A good example is the Medicare prescription drug benefit, which generously reimbursed pharmaceutical companies, he said, showing that big health care businesses and government are in bed together. "We're on the road to a corporate state."

Dr. Paul said the Food and Drug Administration unnecessarily restricts access to quality drugs and does much more harm than good. Americans should have more access to natural remedies, he said.

"Define one instance where the FDA was helpful," he asked the audience.

A video of Dr. Paul's speech is available online (health.burgess.house.gov/blog/?postid=268678).

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