Medicare's second-highest paid doc accepts three-year exclusion

One of the country’s highest paid physicians agreed to a three-year exclusion to settle claims that he billed Medicare for medically unnecessary cardiac procedures, according tothe Department of Justice.

Last year, the DOJ joined two whistleblower lawsuits against Asad Qamar, who owned the Institute of Cardiovascular Excellence in Ocala, Florida. The lawsuits alleged that he regularly billed for unnecessary procedures and violated the Anti-Kickback Statute by waiving Medicare copayments. Months later, the Centers for Medicare & Medicaid Services banned Qamar from the Medicare program, prompting support from a Super PAC of former patients who were “disgusted and distressed” by the government’s portrayal of Qamar.

In addition to a three-year exclusion from Medicare, Qamar will pay $2 million and forgo an additional $5.3 million in suspended claims.

One thing to remember is that these occurences are rare. The real question is how medicare waits so long to act on these suspicious billings. The claims should be suspended pending adequate analysis.  The system needs to be proactive to avoid fraud and theft from the public tillers.

Fraud such as this is inexcusable, and the alleged perpetrator should have his medical license suspended  pending further analysis.  With this volume of surgery  his records also should be thoroughly examined. No doubt he owned his own surgery center and had no peer review. Were the procedures even indicated ?

These issues brought forth by the DOJ on behalf of CMS are difficult to analyze at times. There were a number of providers in this group and it may be that all were included under his billing identifications. No other providers were named in the action.

Here is the doctors letter of response to his patients. Bottom line...pay a fine, make retitution and you are still in business...all about money for the feds....not a real moral or ethical issue for them. Was he guilty.  I present.... you decide.  

Patients are easily fooled, especially if complication rates are low. Examine the Facebook pages of grateful happy patients. PR and marketing can be clever camouflage for deception and fraud

WebMD reports multiple physicians in this group. Dr Qamar may have been the only interventional cardiologists receiving referrals from the other cardiologists. The devil is in the details. It is a standard practice for cardiologists, and other interventional providers who no longer operate to see and diagnose patients with serious cardiac problems and refer them to someone who performs PCCT. It is also a proven fact that 'high volume' surgeons have fewer complications... We do not know all of the details which become murky and obscured by what is published by others. Either that or the doctor is a sociopath. Case closed.

Digital Health Space neither agrees or disagrees with any stipulated legal settlement between Dr Assad Qamar with CMS and/or HHS.  This is only opinion..

Dropout by Dartmouth Raises Questions on Health Law Cost-Savings Effort - The New York Times

 In its quest to remake the nation’s health care system, the Obama administration has urged doctors and hospitals to band together to improve care and cut costs, using a model devised by researchers atDartmouth College.

But Dartmouth itself, facing mounting financial losses in the federal program, has dropped out, raising questions about the future of the new entities known as accountable care organizations, created under the Affordable Care Act.

The entities are in the vanguard of efforts under the health law to moveMedicare away from a disjointed fee-for-service system to a new model that rewards doctors who collaborate and coordinate care.

Medicare now has more than 400 accountable care organizations, serving eight million of the 57 million Medicare beneficiaries. Obama administration officials say the new entities are saving money while improving care, but some independent experts have questioned those claims.

“There’s little in the way of analysis or data about how A.C.O.s did in 2015,” said Dr. Ashish K. Jha, a professor at the Harvard School of Public Health. “The results have not been a home run.”

In addition, he said, “there is little reason to think that A.C.O.s will bend the cost curve in a meaningful way” unless they bear more financial risk, sharing losses as well as savings with the government.

An evaluation for the federal government found that Dartmouth’s accountable care organization had reduced Medicare spending on hospital stays, medical procedures, imaging and tests. And it achieved goals for the quality of care. But it was still subject to financial penalties because it did not meet money-saving benchmarks set by federal officials.

“We were cutting costs and saving money and then paying a penalty on top of that,” said Dr. Robert A. Greene, an executive vice president of the Dartmouth-Hitchcock health system. “We would have loved to stay in the federal program, but it was just not sustainable.”

Dr. Elliott S. Fisher, the director of the Dartmouth Institute for Health Policy and Clinical Practice, said: “It’s hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with. I helped design the model of accountable care organizations. So it’s sad that we could not make it work here.”

The idea of accountable care organizations and the name are generally traced back to a paper in 2006 by Dr. Fisher and colleagues at Dartmouth and its medical school. Writing in the journal Health Affairs, they reported that Medicare beneficiaries received most of their care from doctors who were directly or indirectly affiliated with a local hospital.

Rather than trying to measure the performance of individual doctors, they said, Medicare should assess the hospital and the doctors together and hold them jointly accountable for the cost and quality of care provided to a defined group of Medicare patients.

In effect, this was an effort to overcome the fragmented nature of most American health care and to replicate some of the benefits of managed care while still allowing Medicare patients to visit any doctors they wanted.

The new entities, unlike health maintenance organizations, “can’t tell you which health care providers to see” and “can’t limit your Medicare benefits,” the Obama administration tells beneficiaries. But, it says, doctors and hospitals working together in an accountable care organization can share information, including test results and prescription drug data, so it is easier for them to coordinate care for patients.

This result is the outcome of muddled thinking. True cost savings and reductions in fees would not be known for some time.  They also exclude the organizational costs and information technology (software development) to administer the new organization.

Accountable care organizations are one of many demonstration projects being conducted by the Center for Medicare and Medicaid Innovation, an office created by the Affordable Care Act to test new ways of financing and delivering care. Under the law, the secretary of health and human services has sweeping power to expand such projects nationwide if she finds that they would reduce Medicare spending without harming the quality of care.

The center is testing new ways to pay for prescription drugs, medical devices, cancer care, hip replacement surgery and many other services.

The Congressional Budget Office predicts that the center’s activities will save $34 billion over the next 10 years, although it does not know which projects will save money.

Bottom line:

We want you to reorganize to save money, and we will penalize you if you don't or cannot.  (CMS Center for Innovation)

Dropout by Dartmouth Raises Questions on Health Law Cost-Savings Effort - The New York Times

8 Tips for Healthier Eyes

Report: Hungry Teens Often Feel Responsibility To Help Feed The Family | California Healthline

A report today from the California Healthline reveals a disturbing fact. Many adolescents are required to help feed their families.  Many are not aware of public assistance programs such as Cal or Medicaid programs.



At the same time it is heartening that young people are devoted to their family and attempt to remain independent from government programs.  What would be good would be a public employment (part time) for youth who could be active in rebuilding community, such as improvements in housing, or neighborhood cleanup programs.  Rather than having a rather meaningless job at a fast food restaurant, or worse, dealing in controlled substances they would contribute a real need for their community, and  gain self esteem.  By using unemployed needy youth it could offset increasing public budgets for community services. The effort should be coordinated with official agencies for public service as to optimize the program(s) without unduly effecting the job market.

Teenagers as young as 13  often play an active role in feeding their families,  taking jobs when they can or selling their possessions to help raise money for food, researchers found in a detailed look at hunger among adolescents.

In extreme cases, teens resorted to crime and sexual favors in exchange for nourishment.

Yet, according to the research, many cringed at the thought of using a local food bank.

“I will go without a meal if that’s the case,” said one girl in Chicago. “As long as my two young siblings is good, that’s all that really matters to me.”

The report, published Monday, is from the Urban Institute, an economic and social policy research group, and Feeding America, a national network of food banks. It is based on interviews of 193 teenagers in 20 focus groups across the country.

Researchers asked teens how they coped with hunger in their communities and what barriers prevented them from accessing food assistance programs. They discovered many teens shrink from seeking help for fear of being stigmatized.

Susan Popkin, senior fellow at the Urban Institute and co-author of the report, said teens engaging in risky behavior are often treated with disdain instead of being recognized as victims of sexual exploitation and the cycle of hunger.

“We need to be thinking about getting assistance to families with teens,” she said. We need to stop thinking about teens as the problem and start helping them.”

The federal Department of Agriculture last week released the latest government estimate of household hunger, finding 13 million children and 29 million adults did not have sufficient food at some point in 2015. That is nearly 13 percent of the U.S. population.

In 13 of the 20 focus groups, participants in the Urban Institute study mentioned “selling their body” or “sex for money” as a viable strategy. While participants in nearly every focus group preferred finding a job to make ends meet, many had trouble finding work and school commitments made working more difficult, the teens noted.

Others simply went hungry so their siblings could eat.

The report also found teens didn’t know many of the resources available to them. In addition to feeling stigma, some participants perceived local food pantries as inaccessible and believed summer programs targeted small children, not adolescents.

Despite that progress, teens reported that Supplemental Nutrition Assistance Program SNAP benefits — federal food assistance —do not provide enough food for the month

Teachers and other program directors for adolescent programs should learn to evaluate adolescent behavior stemming from hunger....irritability,  lethargy, depression, stealing food, or money, selling personal possessions or other family items.

Publc schools should display articles about adolescent and child hunger on their bulletin boards. PTAs should discuss these needs with parents.

Other sources of information can be found:

Foods Available
Feed The Children
Facebook Feed the Children
Twitter Feed the Children

Report: Hungry Teens Often Feel Responsibility To Help Feed The Family | California Healthline

Under Obamacare, Health Care Costs Unlikely to Ever Drop - Opportunity Lives

As reported extensively at Opportunity Lives, the cost of health care is skyrocketing nationwide, with insurance companies raising premiums or even pulling out of the Obamacare exchanges due to enormous profit losses over the past few years.  Liberals have long argued this was merely a temporary hiccup as insurers adjusted to the new regulations and mandates of President Obama’s signature law. But experts are now warning that the problems associated with Obamacare are only compounding and show no hope for improvement.

In an ideal world, President Obama would recognize the pain American families are feeling under the rule of his law and collaborate with Republicans, several of whom are physicians, to put together a plan that works for the country. But that seems unlikely in a hyper-politicized environment.

According to Megan McArdle of Bloomberg, the Obama administration has found itself in a difficult position. Regulators, who place significant controls on premium prices, have an interest in keeping costs low for policyholders. But with insurers posting record losses, these bureaucrats don’t want to drive them out of the exchange program, either, and thus, must permit rates that allow them to yield a modest profit.

“They are not going to approve rates they believe will cause insurers to lose large sums of money,” McArdle explained.

“A BIG PART OF IT IS SIMPLY THAT THE INSURERS CANNOT MAKE A PROFIT AT CURRENT PRICES”

Insurers are hemorrhaging money because Obamacare requires the guaranteed issue of policies, even when patients pose extreme financial risks to the provider. Further, Obamacare mandates that insurers cover a bevy of new procedures and treatments, tacking on additional costs to doing business for these companies.

These goals are all well and good, but intentions often go astray when market forces are not understood.  

Obamacare attempts to camouflage an insurance company by calling it  a health plan. The obvious point about insurers using risk to appraise premiums has been totally ignored.

“THEY ARE NOT GOING TO APPROVE RATES THEY BELIEVE WILL CAUSE INSURERS TO LOSE LARGE SUMS OF MONEY”

To compensate for the financial strain imposed by Obamacare, insurers have raised rates. For millions of Americans, this means premiums and out-of-pocket expenses doubling, tripling or even quadrupling. As a result, healthier patients, many of whom are young and pose virtually no risk to insurers, have opted to drop their coverage, pay out of pocket for medical costs they incur and endure a tax penalty for their failure to maintain insurance. The plans based their income on the number of young and healthy patients who have little medical expenses. Most of these people did not carry health insurance in the first place. The sudden impact of paying $200 dollars a month did not compute, especially when their out of pocket and deductible expenses would also add to their monthly costs.  Why pay a premium when the $ 200 premium could go directly to direct payment expense?   Well, the HSA or MSA was invented. Patients could place money in a tax deductible savings account, before taxes.  It is all about cash flow. Most of these young people do not have discretionary income to save $ 200.00 each month

This is because of the aforementioned healthy-sick ratio of patients, nicknamed the adverse-selection death spiral. As prices go up to compensate for the rising number of sick Americans covered, healthy consumers are forced out of the market, exacerbating the risk insurers already face in covering those who cost more to insure.

As typical of most government programs it does not happen. It was an illusion foisted upon all of  us.  Perhaps for older adults and those with substantial income it might be work.

Obamacare advocates insist that this is a temporary problem, but as McArdle points out, the problems are far more systemic than the law’s defenders like to admit.

The worse news, McArdle writes, is that, “unbeknownst to most people, the subsidies are actually capped at a little over 0.5 percent of gross domestic product. We’re nowhere near that level yet — the Congressional Budget Office expects us to spend about $43 billion in 2017 on premium tax credits, while 0.5 percent of GDP would be a hair over $90 billion — but it doesn’t take too many years of 10 percent increases to get there.”

Perhaps the most realistic view, cynical though it may be, is that the impending death spiral was always the point of Obamacare. Conservatives are accused of engaging in hyperbole for even bringing up the accusation, but all evidence points to this being the actual motivation.  

Liberals have always desired a government-run health care system. They knew the public would never accept it. So they concocted a scheme they knew would succeed by failing. With the collapse of Obamacare, they figured, most Americans would have no choice but to embrace some amped-up iteration of Medicaid or a single-payer system that puts most private insurers out of business. Private coverage would remain only for the affluent who could purchase it to supplement their state-sponsored care, just as it’s done in many European countries — the same countries whose “universal” health care systems have been lauded by Democrats but left patients with long lines and little hope.

At the worst it looks like a conspiracy. At the least it was a stupid bungling. Our government is so disorganized it would be hard pressed to conjure up this plan. Nevertheless, it may happen.  I have always suspected as much. Make the system so chaotic and  unworkable that we all give up and sue for a single payer system. "Just go away"

In an ideal world, President Obama would recognize the pain American families are feeling under the rule of his law and collaborate with Republicans, several of whom are physicians, to put together a plan that works for the country. But that seems unlikely in a hyper-politicized environment.

Ellen Carmichael is a senior writer for Opportunity Lives. Follow her on Twitter @ellencarmichael.

Under Obamacare, Health Care Costs Unlikely to Ever Drop - Opportunity Lives

You Break it, You fix it. Ownership

The rhetoric is stuck. If you are a Democrat you are pleased that Obamacare is now law. If  you are a Republican you are devoted to major amendments and even complete repeal.

There does not seem to be any middle ground. No DMZ.

The Democrats must own up to the failures of the ACA. It is not a total  failure however the intricacies and secondary effects are huge, some which  providers hospitals and insurers predicted. And then some that were a surprise.

Health providers not only want it corrected, it must be corrected and soon. It is time to tweak the law. Some changes are not tweaks. The past two years have exposed the weaknesses.  When you build a program and it does not work well it is time to study the negative aspects and make corrections.

Over the next three years more cracks will appear in the ACA. Expect it and also fix it. The cement has not yet hardened and there is still time to mold the ACA.

Health reform is such a huge undertaking that no one should expect immediately gratifying effect, except those who measure sucess by how many millions of people now carry an insurance ID.  In some cases the ticket is not worth very much due to high  deductibles, limited provider access, and prremium still beyond affordability except in the government's table of allowable expenses for medicaid. The figures based upon the FPL are obsolete and do not account for geographic location.  It costs much more to live in Los Angeles  than Topeka Kansas.

The amplitude of the argument is increasing without any serious introspection on the part of the democratic party.

DFLers say they're ready to get loud about federal health law,

Democrats in Minnesota are ramping  up their arguments, on the defensive and with little positive conter-argument, other than the number count.

Republicans have been criticizing the federal health care law for years, and Democrats have been on the defensive. But as the 2014 election approaches, Democrats are starting to push back.

They now say the Affordable Care Act is making a positive difference in people's lives and that Republican efforts to repeal it will take health insurance away from thousands of Minnesotans.

Views on the law are likely to get lots of airtime up to Election Day. On Thursday, the Minnesota Jobs Coalition, a group working to help Republicans defeat DFL Gov. Mark Dayton, announced it will air a TV ad linking Dayton to MNsure, Minnesota's online health care exchange.

But after taking some early lumps on MNsure — the rollout of the state website led to botched applications and the resignation of MNsure's executive director in December — Democrats are becoming more aggressive about promoting what they say are the program's benefits. What are they ?

Knowing how controversial the law has been, most democrats have kept their head down not responding to the many criticisms, and not just from Republicans. Now the pendulum has swung and democrats are ready to swing. Republicans have been criticizing the federal health care law for years, and Democrats have been on the defensive. But as the 2014 election approaches, Democrats are starting to push back.

They now say the Affordable Care Act is making a positive difference in people's lives and that Republican efforts to repeal it will take health insurance away from thousands of Minnesotans.

Views on the law are likely to get lots of airtime up to Election Day. On Thursday, the Minnesota Jobs Coalition, a group working to help Republicans defeat DFL Gov. Mark Dayton, announced it will air a TV ad linking Dayton to MNsure, Minnesota's online health care exchange.

But after taking some early lumps on MNsure — the rollout of the state website led to botched applications and the resignation of MNsure's executive director in December — Democrats are becoming more aggressive about promoting what they say are the program's benefits.
What is apparent is that the ACA is a misfire, creating so much chaos that many are now crying for a 'single payer' solution, as stated succinctly on Care2's web site:

"Then what should be done?

The solution has been staring us in the face for a long time now: A single-payer healthcare option for all Americans. Why? Because before the Affordable Care Act, it was clear that it is not acceptable to leave the basic human right to healthcare access to profit-driven corporations.

The Affordable Care Act should be seen as an attempt at something of a compromise between the public and private health sectors; unfortunately, this is showing itself to be wishful thinking, at best.

At least one state, Colorado, will be voting on the creation of single-payer healthcare this fall; however, for such a program to truly work, it would need to be instituted on a national level. Regardless, if Colorado does pass the ballot measure, it would certainly be a major step in the right direction."

Is it Time to Occupy Health Care ?

The occupy movement has become embedded in many protests. It culminated with Occupy Wall Street, followed by many others.

During the past four years we have witnessed an internal breakdown of the health care financing system. In spite of the affordable care act and perhaps because of it, many insurers are withdrawing from the Obamacare Exchanges. The  Walmart model for health care is failing. The reason it has not worked is the health system is on the verge of a meltdown.  Walmart meets the demand with adequate inventory. Health Care has no inventory. In spite of this some large insurance companies are recording large profit margins. This despite the ACA's rule regarding the percentage of the health care premium which must go to patient care.

At each step of increasing regulation designed to improve quality decrease cost the effects have been paradoxical. This is true for many reasons. Our market system adjusts rapidly to barriers for care and the results are often counter productive and counterintuitive.  As Nancy Pelosi said 'We won't know what the ACA is until it is passed.  That is like throwing the dice, or spinning a roulette wheel.  Chances are very good you will lose. That is what has happened.

While the roster of patients who carry an insurance card has grown by millions since 2012 many cannot access care due to high deductibles for outpatient services, high premiums, a lack of providers and overcrowded emergency rooms.  The ACA which was supposed to make health care affordable and accessible has caused many patients to go to emergency rooms where they cannot be refused examination.  The quality of care has decreased due to overcrowding, exhausted health care personell and has increase professional burnout and exits from the health system.

The insurance card patients carry may not be worth the ink and paper upon which it is printed. l The addition of EHR created enormous expense for providers. The incentives came out of  your pockets.

Occupy Health is a nationwide movement scheduled the last week of October 2016 just prior to the Election.  The goals are to bring attention about the sad state of health care in the U.S. The situation was made much worse by the Affordable Care Act.  Well intentioned or not, it has evolved into a disaster. The outcome has resulted in millions of Americans who now have a mostly meaningless card...doctors are not accessble, deductibles are very high, as well as premiums for many people. The people were promised  health care. This was a vacuous statement.  The bottom effect was to decrease losses for hospitals to ensure they were paid. The result is more crowded emergency rooms, dangerously overworked health personell  and a lowering of quality for the insured.  Please comment on the Occupy Health facebook page. Share widely in your social network. And most important plan or join a movement in  your city. This will be a national demonstration including Alaska, Hawaii, and the U.S. territories.

Occupy groups are no longer splinter groups.  It has become mainstream, because our system has not worked and our leaders are lame. Every increase in federal regulation has not decreased costs. The bureaucracy, inefficiency and mandates have the opposite effects.

Our goal is to have several million demonstrators across the country. Having a march on the national mall is meaningless. It is a useless protest for television and the media.

Occupy your city, town, village, or intersection. Take it to city hall, town center, hospital, pharmacies, and medical clinics.

Participants will include patients, providers, health insurance companies, hospitals, and congressional representatives as well as administrators of CMS, and HHS.

We are recruitng leaders in all 50 states, and many cities throughout our nation. The ACA has brought attention to the plight of our system. It is not yet completed and must be amended or repealed. It won't happen unless the people demand it with overwhelming demonstrations.

This effects every American and our Health Care Matters.