Bribery by any other name is still wrong
November 29th 2009 14:28
In the legislative branch of the US Government, they call it logrolling. But in reality, when all is said and done, it is bribery. They use our hard earned money taken at gunpoint from us to bribe other representatives to vote in favor of bad ideas. It costs the American people billions of dollars a year that we could be keeping in our pockets and using to stimulate the economy.
Just wait until the health care bill is finalized. It is already packed full of pork to get the votes for cloture, and everyone who didn't get anything yet is balking at the bill now in order to get some pork for themselves. The Baucus bill has the federal government paying the entire cost for the mandated Medicaid expansion in the following states: Nevada, Oregon, Rhode Island and Michigan. And let's not forget the 100 MILLION dollars for Louisiana's Medicaid system. This is an attempt to bribe or reward the Senators and Representatives from those states using my tax money.
Other states aren't getting this sweet deal. Citizens in the other 46 states will have to pay higher State taxes to fund this scheme. Frankly, I think any Congressional leader who offers a tax-funded benefit for a state or district in order to secure a vote, and any member of Congress who negotiates to gain such a benefit, should be brought up on charges and go to jail for violating the anti-bribery law.
The laws are supposed to treat all of us equally. Any law that treats citizens of some states differently is inherently unjust, and any law passed using tax-funded bribery is inherently unethical. I believe the so called health care bill is both things, unjust and unethical. Any of you who still think that this bill is going solve ANY problems with the health care system are fooling yourselves. It is yet another case of egotistical politicians telling bald faced lies to try and convince us that they can solve the problem with more government CONTROL over our lives. Don't drink the Kool-aid. Less government is the only way to solve the health care problem.
Just wait until the health care bill is finalized. It is already packed full of pork to get the votes for cloture, and everyone who didn't get anything yet is balking at the bill now in order to get some pork for themselves. The Baucus bill has the federal government paying the entire cost for the mandated Medicaid expansion in the following states: Nevada, Oregon, Rhode Island and Michigan. And let's not forget the 100 MILLION dollars for Louisiana's Medicaid system. This is an attempt to bribe or reward the Senators and Representatives from those states using my tax money.
Other states aren't getting this sweet deal. Citizens in the other 46 states will have to pay higher State taxes to fund this scheme. Frankly, I think any Congressional leader who offers a tax-funded benefit for a state or district in order to secure a vote, and any member of Congress who negotiates to gain such a benefit, should be brought up on charges and go to jail for violating the anti-bribery law.
The laws are supposed to treat all of us equally. Any law that treats citizens of some states differently is inherently unjust, and any law passed using tax-funded bribery is inherently unethical. I believe the so called health care bill is both things, unjust and unethical. Any of you who still think that this bill is going solve ANY problems with the health care system are fooling yourselves. It is yet another case of egotistical politicians telling bald faced lies to try and convince us that they can solve the problem with more government CONTROL over our lives. Don't drink the Kool-aid. Less government is the only way to solve the health care problem.
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Comment by Anonymous
Turning next to relators’ claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government's funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’ state law claims and refused to grant relators leave to amend.
MEDICARE FRAUD, MEDICADE FRAUD, AND KICKBACKS AND BRIBES BUSINESS AS USUAL,INSIDER INFORMATION GIVEN. 9B BS ONE THING BUT WHAT ABOUT YOUR "HANDS OFF POLICY" BY THE DOJ AND CMS AND HHS, AND WHY NO INVESTAGATIONS OR AUDITS TO CONFIRM OR HELP? "SELF DISCLOSURE BY CARRIER ANOTHER JOKE".
WHAT ABOUT "TAXPAYERS TO PREVENT AND STOP AND PREVENT FRAUD FOR MEDICARE AND MEDICADE" WHAT ABOUT WILLIS AND WILKINS BEING FIRED FOR NOT WANTING TO BREAK THE HEALTH FRAUD LAWS?
NJ CEPA CLAIM NOW ON FILE.....FALSE CLAIM UNDER APPEAL AND FILED..... WHERE WAS ANY HELP FROM THESE DEPARTMENTS?
The U.S. District Court for the District of New Jersey dismissed May 13 a qui tam action alleging violations of the False Claims Act (FCA) by United Health Group and its subsidiaries. According to the court, the complaint failed to state a claim upon which relief could be granted under the FCA. Relator Charles Wilkins began employment with United Health Group and its subsidiary AmeriChoice in October 2007 as a sales representative. Relator Darryl Willis began employment with United Health Group and AmeriChoice in 2007 as the general manager for Medicare/Medicaid marketing and sales.
In their qui tam complaint, relators allege 11 violations of Medicare and Medicaid regulations. The United States declined to intervene in the case and the relators filed an amended complaint that stated one federal count—violation of 31 U.S.C. § 3729(a)(1)-(3)—and nine state law counts. United Health moved to dismiss under Fed. R. Civ. P. 12(b)(6), arguing relators failed to plead the elements of a "false certification" claim, they failed to plead any anti-kickback violations, and failed to adequately plead a conspiracy. Relators alleged that because United Health entered into a contract expressly certifying that it agreed with all "terms and conditions of payment," they made a false claim when they submitted claims despite any one of the 11 purported regulatory violations alleged in the amended complaint. Rejecting relators' express false certification claim, the court found “[not once in the Amended Complaint have Relators identified even a single claim for payment to the Government.”The court also held relators’ implied false certification claim failed. According to the court, relators argued that because United Health agreed to comply with all CMS regulations when it contracted to become a prescription drug plan sponsor, and because at times it was in violation of some regulations, it therefore committed fraud each time it submitted a claim for payment. The court found such a theory of liability overly broad. “If Relators' theory were correct, the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,” the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government's payment decision. While that argument is true, the court reasoned, “Relators must still show a claim . . . and [t]hey have not done so.” Turning next to relators’ claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government's funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’ state law claims and refused to grant relators leave to amend.
United States ex rel. Wilkins v. United Health Grp. Inc., No. 08-3425 (D.N.J. May 13, 2010).
FCA claim alleging aggressive marketing tactics by health plan provider dismissed
Publication: Health Law Week
Date: Friday, June 4 2010
The U.S. District Court for the District of New Jersey dismissed a qui tam action brought by two former employees of healthcare plan providers alleging violations of the False Claims Act (FCA) arising from excessively aggressive marketing methods. United Health Group Inc., a provider of access to healthcare services, had as its subsidiaries AmeriChoice and AmeriChoice of New Jersey, which each offered Medicare Advantage plans. Charles Wilkins and Darryl Willis (the relators), who were each employed by United Health Group and AmeriChoice, initiated a qui tam claim against United and its two subsidiaries under the FCA alleging numerous violations of Medicare and Medicaid regulations governing administration of the Medicare Advantage plans. The complaint alleged that the defendants engaged in unauthorized and aggressive sales methods in marketing the plans -- including the provision of illegal cash payments to providers to induce them to change beneficiaries to AmeriChoice and the provision of illegal kickbacks to doctors for obtaining the names of patients they could call and approach. The defendants moved to dismiss.
The district court concluded that the complaint failed to identify a single instance in which the defendants submitted a false claim to the government for payment as required to prosecute a qui tam claim as relators under the FCA. Under applicable federal appellate court precedent, the absence of such an allegation was fatal to the relator's false certification claim. The relators' theory of liability at base was that because United Health agreed that it would comply with all Centers for Medicare and Medicaid Services regulations, and because it was at times in violation of some regulations, it committed fraud each time it submitted a claim for payment. The district court concluded that this contention confused the conditions of participation in a Medicare or Medicaid program with the conditions of payment, and would open the door to a flood of tort claims of a type not contemplated by the FCA. Moreover, the complaint failed to allege that the violation of any regulation was actually relevant to any funding decision. As a result, the complaint failed to state a claim on which relief could be granted and, accordingly, the defendants' motion to dismiss was granted.
Source: Health Law Week, 06/04/2010
Copyright © 2010 by Strafford Publications, Inc. http://www.straffordpub.com / All rights reserved. Storage, reproduction or transmission by any means is prohibited except pursuant to a valid license agreement.
Comment by Anonymous
Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools.
These checks came from AmeriChoice Health and on the surface seems like fine gifts.
Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind in order to promote its share of the market place.
This is not allowed as a use of your taxpayers dollars yet it happens.What does it really cost the City of Philadelphia to receive this money?
Americhoice Health has a long history of corruption over the years yet seems to be protected by those who are responsible to over see their actions why is that?
Comment by Anonymous
It's true a licensed Health Agent was fired for his refusal to deliver these checks. It's true this behavior violates all the laws concerning bribes, kickbacks,fraud and Stark laws.
What is Bribery Any Way? a form of corruption,is an act implying money or gift given that alters the behavior of the recipient.
It's also true that the various Government agencies were notified of these frauds as well as a FCA case being filed. It's true this taint's all the business then received from Community health center to AmeriChoice Health Company and should be then held accountable and subject to all the violations of the health laws involved.
Has Bribery has become a normal way of doing business?
It's true that relators argued that because United Health agreed to comply with all those trivial regulations when it contracted to become a prescription drug plan sponsor,as well as sign a formal contract of compliance.
The court found such a theory of liability overly broad. “If Relators' theory were correct,the FCA would become a federal tort fountain, flowing claims for every trivial violation of Medicare/Medicaid regulations,”the court said. Relators next argued that under the recently enacted Fraud Enforcement and Recovery Act of 2009 (FERA) a relator need only show whether compliance with regulations would have a tendency to influence the government's payment decision.
While that argument is true, the court reasoned, “Relators must still show a claim . . . and they have not done so.”Turning next to relators’claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government's funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’state law claims and refused to grant relators leave to amend.
It's true many additional laws were broken and proof furnished but no copy of checks to suppot the bribes etc.
I think the Federal courts have already decided that not only is Honest Fraud OK but Honest Bribes as well as Honest Kicbacks are OK. It's amazing a Federal Judge thinks bribes and kickbacks and fraud etc. are to trivial for the court system to waist their time on.
What should courts spend their time on and since when do you have to certify compliance for non-violation of the Federal And State Kickback laws??
Comment by Anonymous
The Washington Post
May 27, 2002
By Bill Brubaker
Anthony Welters grew up in a one-room tenement in Harlem, sleeping behind a curtain with his three brothers, he says. Today, he lives in a five-bedroom, seven-bathroom house on five acres in McLean. He has a 75-acre farm in the Blue Ridge Mountains. For a change of pace, there is a 5,000-square-foot house in Aspen, Colo., recently assessed at $3 million. Welters, 47, made his fortune in health insurance, serving a specialized market. The market is the poor. Federal and state audits concluded in the early and mid-1990s that ineffective oversight by Pennsylvania officials had enabled Welters and his partners to make too much money from their taxpayer-supported business. The audits said the Welters group had paid itself millions of dollars in management fees -- paid to other companies they controlled -- and millions more in bonuses.
Welters's health-insurance business expanded to New York in 1994 and New Jersey in 1996. In both states, the HMO was known as Managed Healthcare Systems (MHS). In New York, state investigators discovered something was not right about two clinics that MHS retained to serve patients in the borough of Brooklyn.
They determined that from 1995 to 1997 the clinics were being staffed largely by "unsupervised physician assistants or nurse practitioners," New York state Attorney General Eliot Spitzer announced in May 2000. The investigation also found that patients were "consistently complaining that they were having difficulty getting services or being seen by a doctor." MHS "failed to take any corrective action or properly oversee" the clinics. Spitzer announced a settlement in which MHS repaid more than $2 million to the Medicaid program for services the clinics never provided. In October 2000 MHS changed its name to AmeriChoice of New York. Anthony Welters, Chairman of AmeriChoice Corp.: "What [should] a person who takes a $200,000 investment and turns it into a billion-dollar company . . . receive? I don't know. But I know this: I'm not going to apologize for it."
Really Long Link
Comment: Medicaid's chronic under-funding threatens access to care for the low-income individuals covered by this program primarily because many providers will not participate at rates that frequently do not even pay overhead expenses. Several state governments have turned over their Medicaid funds to private corporations to administer these programs. Mr. Welters exemplifies how well these plans fulfill their corporate responsibility to their shareholders and executives.
Comment by Anonymous
John J. Kirchner - Director, Operations
John Kirchner joined Healthfirst in May 2010 with over 25 years experience in health care management. Mr. Kirchner’s background includes responsibility for health plan P&L, strategic planning and operations, and government and regulatory affairs. Mr. Kirchner will be responsible for supporting all aspects of NJ health plan operations.
Prior to joining Healthfirst, Mr. Kirchner held a variety of positions at AmeriChoice of New Jersey serving as President from 2007 through 2009. Mr. Kirchner also held Government Relations positions for Home Life Financial Assurance Corporation and Blue Cross and Blue Shield of New Jersey and served as Legislative Liaison for the New Jersey State Department of Health. Prior to beginning his career in health care, Mr. Kirchner served on the staff of US Senator Bill Bradley.
Mr. Kirchner received his BS Degree in Business Management from Stonehill College, Northeaston, MA.
Comment by History Buff
Most of Bill Thompson's "financial consulting" clients are not revealed on his Board of Ed disclosure forms. The most disturbing one that Thompson did list, however, was Managed Healthcare Systems Inc., where he earned a total of $65,000 in 1997 and 1998, according to his tax returns. A black-owned HMO whose principals worked at the highest levels of the Reagan administration, the company is shrouded in scandal.
Last year, New York Attorney General Eliot Spitzer forced the MHS, which specializes in recruiting Medicaid recipients for its HMO, to repay the state $2 million for Medicaid services that patients never received. Spitzer also put Jean Moise Millien, the director of an MHS clinic, in jail for up to three years after he pled guilty to stealing $275,000 from Medicaid. Spitzer's press release revealed that MHS knew for years that Millien's clinic, Stuyvesant Heights Medical Group, was largely run by "unsupervised physician's assistants and nurse practitioners" and that patients "were consistently complaining that they were having difficulty getting services."
Yet, said Spitzer, the company "failed to take corrective action or properly oversee its subcontractor." MHS portrayed itself as "a victim" of the clinic when they settled with Spitzer.
The State Health Department also revoked Millien's physician's assistant license in November 2000, finding that he'd run the clinic since 1991—four years before the MHS contract began—without on-site supervision by a licensed M.D. The Department also found that the clinic corporation had been dissolved by state officials for tax delinquency reasons in 1994 and that Millien had a prior criminal record. Spitzer said a doctor from Pennsylvania came to the clinic once a week "to sign charts" for a while, but "eventually stopped coming altogether."
An MHS affiliate left a similar trail of complaints in Pennsylvania—where it became the subject of Philadelphia Inquirerexposés in 1996 and 1997, before and during Thompson's employment. According to one study, it was three times as likely to refuse to pay for days of hospital care as the state's next most stingy HMO. The "focus of six special state and federal audits" and a onetime target of a Pennsylvania grand jury, according to the Inquirer,the company took a reported $119 million in profits and executive bonuses from its Pennsylvania Medicaid work alone in the early '90s, making it the "most profitable HMO" in the state.
Anthony Welters, the principal owner of AmeriChoice, the Virginia-based parent of MHS, was a top Reagan transportation official, gave $20,000 to Pennsylvania GOP governor Tom Ridge, and has given over $56,000 in recent years to Republican candidates and committees across the country. Clarence Thomas is the godfather of one of his children. Thelma Duggin, another top executive, worked in the Reagan White House and at the Republican National Committee under Lee Atwater, the engineer of the Willie Horton campaign.
Thompson said he'd known Welters and Duggin since 1992, when they started trying to do business in Brooklyn, and that he "bumped into Tony" in 1997 and Welters offered him a consulting job that started that June. Charged with "reaching out and helping them obtain business," Thompson said he "spoke to community organizations." Though he says he "never visited an MHS clinic"—including the Stuyvesant Heights one near his home—he insists that MHS is "a good company." While Thompson's tax returns indicate that AmeriChoice paid him $35,000 in 1998, his disclosure forms report no income from the company.
Thompson is quick to point out that he wasn't the only prominent Brooklyn Democrat to wind up on the MHS payroll. Assemblyman Al Vann was hired, as was DeCosta Headley, a Democratic district leader, Ed Miller, a campaign aide of Congressman Ed Towns, and Chris Owens, the son of Congressman Major Owens. "I don't think Al and Chris are getting involved in anything that's not 100 percent benefit to the community," said Thompson, apparently oblivious to the higher standard demanded of a candidate for so powerful a citywide post as comptroller.
Comment by Anonymous
Clarence Thomas (born June 23, 1948) is an Associate Justice of the Supreme Court of the United States since being appointed in 1991. Thomas is the second African American to serve on the Court, after Thurgood Marshall, whom he succeeded.
Thomas grew up in Georgia and was educated at the College of the Holy Cross and at Yale Law School. In 1974, he was appointed an Assistant Attorney General in Missouri and subsequently practiced law there in the private sector. In 1979, he became a legislative assistant to Missouri Senator John Danforth and in 1981 was appointed Assistant Secretary for Civil Rights at the U.S. Department of Education. In 1982, President Ronald Reagan appointed Thomas Chairman of the Equal Employment Opportunity Commission (EEOC) and he served in that position until 1990, when President George H. W. Bush nominated him for a seat on the United States Court of Appeals for the District of Columbia Circuit.
After one year and four months of service on the D.C. Circuit Court of Appeals, Bush nominated Thomas to fill the seat on the United States Supreme Court being vacated by Thurgood Marshall. Thomas's confirmation hearings were bitter and intensely fought, centering on an accusation that he had made unwelcome sexual comments to attorney Anita Hill, a subordinate at the Department of Education and subsequently at the EEOC. The U.S. Senate ultimately confirmed Thomas by a vote of 52–48.
Since joining the Court, Thomas has taken a textualist approach to judging, seeking to uphold what he sees as the original meaning of the United States Constitution and statutes. He is generally viewed as among the most conservative members of the Court. Thomas has often approached federalism issues in a way that limits the power of the federal government and expands power of state and local governments. At the same time, Thomas's opinions have generally supported a strong executive branch within the federal government.
Comment by Anonymous
“United's AmeriChoice unit is the largest government contractor administering state Medicaid programs for the poor and federally sponsored plans for children. AmeriChoice's revenue rose 34 percent last year, to $6 billion, and it has 2.7 million people enrolled.
Those numbers should continue rising under reform since congressional Democrats are proposing an expansion of Medicaid to help achieve universal coverage.
More of the working poor would qualify for Medicaid, and AmeriChoice can sell itself to states as the leading service provider
I have a question when you pay Doctors Commissions (kickbacks) or Clinics/Mayors Gifts (bribes) what accounting columns are these items placed in?
Certainly not bribes/kickbacks as a heading maybe sales expenses or some other type of cost of doing business heading, about loss? well, even that has a write off aspect to it.
So lets think about this as a outsider here we have a Medicaid contractor who receives all its money from the government / taxpayors and uses it for kickbacks and bribes then can turn around and write off that usage.
Well. One would have to say hats off to Ameri-Choice Health who is by far the most successful taxpayer story there is.... Where are all the Government /Taxpayor watch dog groups at that allowed this to happen?
How many companies who are not involved in oil can say they are enjoying the good life from this tax view point?
Government success story? Political success story? Taxpayor success story? its up to you to decide.