Advocates: Disabled take huge hit under GOP health reform

Advocates for the disabled say the House Republican plan to replace the Affordable Care Act seriously threatens some of the most vulnerable Americans.

The website DisabilityScoop reports that advocates say the bill threatens home- and community-based services and other supports that people with developmental disabilities rely upon.

Photo: Joshua Zader/Creative Commons

“The American Health Care Act shows callous and dangerous disregard for the well-being of people with disabilities and their families and erases decades of progress,” said Peter Berns, CEO of The Arc, an organization that service people with intellectual and physical disabilities.

The House passed the bill 217 to 213, allowing President Donald Trump and Republicans to do a victory lap that they had finally succeeded in destroying Obamacare. The measure though was roundly criticized by doctors, hospital and senior groups. It must still pass the U.S. Senate, which gave it a lukewarm response and promised to address its more draconian measures.

While the disabled take a hit, the most wealthiest Americans are big winners with the new legislation as it delivers a big tax cut the would redistribute billions of dollars to the upper tier.

 

How does it hurt the disabled? The many groups who represent them say the bill would institute a per capita cap for Medicaid. This means the federal government would offer a fixed amount of money for each beneficiary.

“These huge cuts and caps will likely put pressure on states to cut home- and community-based waiver services, especially those that are ‘optional,’ like personal care services and therapies,” said Kim Musheno, chair of the Consortium for Citizens with Disabilities, a coalition of disability advocacy groups.

Schools also would be affected by the Medicaid shift because they are currently able to seek reimbursement for a variety of services provided to disabled children to a tune of $4 billion annually. That means money to reimburse schools for speech and occupational therapy, specialized playground equipment, and even wheelchairs is now in jeopardy.

Advocates for the disabled say House Republicans would allow states to no longer consider schools as eligible Medicaid providers.

To read all of the story by DisabilityScoop click here.

 

Indicted Delray Beach doctor is focus of $4.8M whistleblower lawsuit

A newly unsealed whistleblower lawsuit alleges insurance giant Humana knew that a Delray Beach doctor for seven years bilked the government through fraudulent Medicare billing for $4.8 million, according to a report this week by the Center for Public Integrity that was published by NPR.

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A billing practice called a “risk score” is what a Delray Beach doctor used to perpetrate fraud, according to a whistleblower lawsuit.

The lawsuit claims that Humana  – which operates some of the nation’s largest private Medicare health plans –  did little to curb the practice even though it could harm patients.

The Center for Public Integrity is a nonpartisan, nonprofit investigative news organization.

The whistleblower suit was filed by South Florida physician Mario M. Baez and accuses Humana and his former business partner, Dr. Isaac K. Thompson, of Delray Beach, in engaging in a lucrative billing fraud scheme that lasted for years.

In Thompson’s case, Humana paid 80 percent of the money it received to the doctor and retained the rest. Prosecutors charged that fraudulent diagnoses submitted by Thompson between January 2006 and June 2013 generated overpayments of $4.8 million.

Thompson was indicted early last year on health care fraud charges and has indicated he would plead guilty.

The whistleblower suit was filed in October 2012 but remained under a federal court seal until Feb. 26.

Humana, which had no comment, is based out of  Louisville and covers more than 3 million elderly patients in its Medicare Advantage plans nationwide. At question in the whistleblower suit is a billing formula called a risk score that pays higher rates for sicker patients.

To read the whole story by the Center for Public Integrity click here.