Friday, January 31, 2014

Private Dancer

As I no longer own or drive a car I have relied solely on public transportation and the occasional taxi for those days when getting up at 4 am to go to work as it rains or even not. just seems too challenging. Even that service has changed with more flat fee taxis offering better rates and service. And when the time comes I will go toward using the car sharing services that are also providing another alternative to rentals. So why own basically an appliance when the money could be better used?

But as I frequently point out there are trade offs with anything. There is the convenience and the speed and that is pretty much it. As the costs continue to rise to keep, insure, fuel and maintain a vehicle and the ever increasing distractions, risk but add just another issue to your privacy being violated with the "black box" installation in cars, the cameras that film you from a multitude of sources, just having one sense of control of a world where we are under constant surveillance and observation gets to a point of where anonymity is a precious commodity.

And right now here in King County we find ourselves having formed a "transit riders union" to fight the budget cuts that are threatening routes and schedules in time where overall ridership is up. Of course the largest cuts are to the areas most reliant on buses while some areas have double decker buses with outstanding seats and wi fi.  Yet the City itself is funding the construction of bike lanes and new trolley lines designated to accommodate the Amazonians and those "others" who live in work in area that they "coincidentally" serve.  While it offers more choice what it  has further demonstrated that even in this supposed liveable city we have a distinct difference even when it comes to the idea of pubic transport.

Even in San Francisco they are realizing that private buses using public transportation infrastructure without paying for the privilege is now coming to an end. It is of course still debatable and this is the issue that will become another one here in Seattle  as we too have the same problem with our own Tech giants and others (Hospitals/Medical) and their private services and subsidies to their workers that use the same public access facilities without compensation.

And of course there are other "penalties" that are exclusive taxes on types of vehicles that is here in Washington and will undoubtedly grow across the country as more alternative vehicles take hold in our fossil fuel nation.

Sate electric car tax going into effect in 2013
A new tax on electric cars is going into effect in Washington State, to collect road use fees normally collected at the gasoline pumps electric car owners never visit.

How do we collectively pay for construction and maintenance of "free" highways and other roads? Fuel taxes. In light of the inability to collect fuel taxes from electric car drivers, the State of Washington has passed a law requiring a yearly $100 fee to own an electric car. The fee goes into effect early in 2013, and has criticism from an electric vehicle advocacy group.

The existing fuel tax system is an extremely fair and anonymous way to collect road maintenance dollars from road users. The amount of fees paid by each individual is directly related to how much they use the road system. The fee is anonymously collected at the gasoline pump, which means the fuel tax can't be used by the government as a sneaky way to track all our movements. The flaw is that because the fee is on the sale of fuel, owners of cars that consume a fuel delivered through an alternative mechanism do not pay any fees for road use. For more information see Nicholas Zart's article at Washington State Taxes Electric Car Drivers For loss of Gasoline Tax

The phrase for "fuel tax" is probably not the best way of describing this fee. Because the purpose of gasoline taxes is to pay for road maintenance, a better phrase would be "road use fee".

That is, the homebrew biodiesel maker does not fuel their vehicle at a diesel pump, skipping paying any road use fee (fuel tax) they'd pay at the pump. Likewise, the electric vehicle owner is not refueling their vehicle at a gasoline or diesel pump, and also skips paying road use fees (fuel taxes). So long as the total number of electric vehicles is small, the amount of road use fees lost by the government isn't enough to worry about. But as electric vehicle adoption grows the lost road use fees grows, and if the adoption of electric vehicles successfully results in millions of electrified vehicles on the roads, there will be significant wear and tear on the highways caused by vehicles whose owners are not paying road use fees.

The fee in Washington State was included in House Bill 2660, and goes into effect on Feb 1, 2013. Electric vehicle owners must pay the fee at the time of their annual vehicle registration renewal. The $100 fee is in addition to the standard vehicle registration fees owed each year.

So when was discussing the crisis in funding and asking what alternatives there are to simply slashing and burning service, I have been asking my drivers about the options and their opinions. And like always I get a multitude of thoughts and some not so thought.

My favorites are the idiots and yes I know they are bus drivers but honestly you don't have to be an idiot when you drive a bus, collect garbage or wait tables, yet that is what we have become a nation of - idiots - when not in positions of financial largess. And frankly that number of zeros on the payroll check have no monopoly on the smart factor.

But the one thing that we all agree is eliminating our transfer system and ensuring payment on routes, not just having fare checks on the "special" routes. We all agree that would also ensure security overall for both drivers and passengers in a year where drivers and riders are being assaulted and robbed at an increasing rate. And there is the need to debate about fare costs and fees that need to be re-examined with relation to income. There are already Senior and disabled fares and we need to see what that means with regards to the working poor who use the service exclusively.

And of course that means looking at driver licensing and use fees. And on that note that too is coming and frankly as they use the roads it means looking at who uses it and how often and that is now coming. It can't come too soon. 
Washington, Oregon Consider Mileage-Based Road Tax

PORTLAND - Washington and Oregon are getting serious about finding a replacement for the gas tax. Steadily improving fuel efficiency in cars is eroding the primary source of road funding in the Northwest. A new report to the 2013 Washington Legislature finds it "feasible" to have drivers pay by the mile instead. In Oregon, lawmakers have actually drafted legislation to do just that.

Suburban Portland SUV owner Mary Olson has possibly glimpsed the future of how we'll pay for roads, although it's tricky to spot.

"There's a plug-in underneath my dash," she says pointing to a small, square transmitter that records Olson's mileage for monthly billing. She is a state transportation commissioner and has volunteered to test a newfangled tracking device.

"It has GPS capability, so it knows somehow whether I am traveling on state, county, or city roads or if I am traveling on private property," Olson explains.

You can imagine that if some drivers were offered a GPS-enabled device they would not just say no, but maybe "Hell no!" So why did Olson choose this option?

"Because I don't care if people know where I'm driving," she says. "I don't have a problem with that. But more importantly, I drive out of state from time to time. This way, I don't have to think about that because the device automatically tells them that I am not in Oregon, so I am not charged for those miles."

Olson is one of about 100 volunteer participants from Oregon, Washington and Nevada testing pay-per-mile as an alternative to the gas tax. She shows me her December bill from a state transportation contractor.

"They're charging me a penny and a half per mile. So that was $5.21."

It turns out, that's just about exactly what gas taxes would've cost her. Road trial participants get a credit for the estimated state gas taxes they pay at the pump.

Oregon Department of Transportation project manager Jim Whitty says the experiment shows how a new approach to pay for roads could work. He argues it's important to get moving on a mileage-based road tax because average fuel economy keeps improving, not to mention those electric cars which generate no gas tax at all.

"As more and more people move into that segment, into the high fuel efficiency vehicles, essentially our financial system for the roads collapses."

Whitty says Oregon's real-world experiments have also demonstrated that drivers want choices for how their mileage is tracked. They want the option to pay a flat rate too. Consultants hired by Washington's Department of Transportation came to the same conclusions.

"If you give people one way to do things, it might be satisfactory to some people," Whitty says. "But most people will say, I wish they had done it a different way. Especially if that choice was GPS. They say, 'Aha, the government is getting my coordinates.' You want to avoid that because we don't want their coordinates. We have no reason to have them. All we want is the taxes from their driving."

Once the Oregon Legislature gets down to business this winter, lawmakers will consider whether to implement pay-by-the-mile starting two years from now. The proposed legislation says metered road use would apply only to new cars that average 55 miles per gallon or better.

In Washington state, lawmakers will need more convincing to go down this road says state Senator Ann Rivers, a Republican from Clark County.

"I think that this idea is so new, it's going to take quite a bit of time to get the public comfortable with it."

As Rivers puts it, having "Big Brother" ride along in your car is big issue to overcome. She also predicts her constituents will perceive the mileage tax to be additive rather than a replacement for an existing tax. Finally, Rivers mentions one more speed bump ... both Oregon and Washington have supermajority requirements to pass new taxes through their respective legislatures.

In Salem, the Oregon House Revenue Committee will be the first legislative panel to consider pay-by-the-mile this winter. Committee chairman, Rep. Phil Barnhart, acknowledges a need "to come up with another way" to pay for road maintenance and construction. But the veteran Democrat is noncommittal about requiring high-MPG car owners to pay a mileage-based road use charge.

"What the legislature is going to do with the proposal this time, I do not know. We have yet to study the proposal in detail," said Barnhart.

Now the issue of private roads and toll roads are not new and in California and other cities they use the EZ pass system to expedite some of the traffic issues and ostensibly build new highway infrastructure.  But often they are built to accommodate the residents of the area.  The first one I ever encountered was in Orange County but they are elsewhere with even a Wikipedia page dedicated to them.  

And there is an ever increasing debate over the private road system and that they are going to have to pay now for services they haven't to maintain and keep what only they use.  I have no problem with that either.

We have to re-evaluate how we commute, how we drive, and more importantly maintain and keep the infrastructure in place for EVERYONE to use.  There can be no privacy in what is a public reality.


Wednesday, January 29, 2014

The States of this Union

I think I watched some of the SOTU speech but I kept waiting for Jacqueline Bisset to arrive and ask for dinner. But instead it resembled the Oscar death announcements with rising applause for each dead celebrity that was more famous than the prior who died that year only in this case it was for policies that may or may not have happened, will never happen nor were accurately explained what happened.

So instead I caught up on the Blacklist, with James Spader as the most amazing anti hero since Walter White only without a decent and talented sidekick which this show desperately needs.

So avoiding all the unreal recaps, highlights, speculation and endless debate, discussion and digression over what is tantamount to an Oscar speech, I flipped to Radley Balko's column in the Washington Post and was not disappointed by his highlight reel.

As always there is one standout and this is my favorite, the DUI training cop once again not charged with a DUI, irony or consistency? The other two stories he mentions are equally amusing as they are very consistent with stories that have happened here in my State of the Union. If anything is consistent is Police absurdity and hypocrisy.

And of course no mention by the President about our hideous police nation and the ever increasing pursuit of the death penalty despite the fact that even big Pharma wants nothing to do with it.

And once again the passing mention of gun violence is ignored and yet when you look to the amount of children killing children, inadvertently or not, the role of Education and support systems gets an F. Here are just some stories about children with guns.

Teen Charged
Boy With a Gun
Case for Hawaii 5 O
Best Friends Forever
Teen Shot
Un-Graduated
Teen Hero Shot
Sentenced for Life
Maryland Mall

Google the phrase "teen shooting" and it is a never ending resource of teen agers who have been the victim of gun violence as either a victim or perpetrator and they will end up with a "life sentence" be it in prison or with their life.

But you will not hear that in a State of the Union, the toll that gun violence has had on our communities and the citizens of this union.

There have been so many shootings of late that the social media histrionics that used to accompany every one has withered on the vine, much like the debate over gun licensing. I recall the shooting of Gabrielle Giffords and the Twitteronics about how they were sure it was a "tea party" member or the endless hysteria over Travoyn Martin while other shootings were utterly ignored. Guess not "liking" something is not on Facebook?

Nor was there any discussion of the current "project" of Joe Biden and his talks to the college youth about sexual violence or in fact the long standing struggle of our military with the same issue. Maybe he should address prison guards who seem to be accountable for a large majority of sexual assaults

And there was no discussion about the cutting of food stamp benefits for over 8 million people or the fact that across the nation we will have a food crisis with regards to costs associated with production due to the energy and in turn climate crisis.

And no discussion about the real problems with the Affordable Care Act, the rising costs of Medical care or the fraud associated with our Medical Industrial Complex with regards to Medicare/Medicaid. Pro Publica did an amazing investigation with regards to this issue and others about Obamacare which makes their work worth a look.

Really the SOTU should have the Bankers, like Jamie Dimon, have a chance to accept an award or accolade or one of the many Billionaires, like Bill Gates who is working to privatize and in turn corporatize our public Education system. They could be the "dates" to accompany the appropriate Cabinet Secretary's.

And I am not ignoring but the endless cycle of observation and data collection by the NSA was however.

It would be far more entertaining to serve food and booze and have the truly ignored and yet truly influential take a stand at the mic and take the credit or blame for our largely ineffectual Government.

Today it will be business as usual which means no business as usual.

Well at least they are job creators giving more work to the endless talking heads and panel discussion on cable news. That will be the only discussion or action with regards to the states of our union.

Tuesday, January 28, 2014



The Prescribers

Inside the Government's Drug Data
‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan

Dr. Ernest Bagner III stands outside his former office tucked in the back corner of a strip mall in Hollywood, Calif., where he says he was the victim of Medicare fraud. (Jonathan Alcorn for ProPublica)

by Tracy Weber and Charles Ornstein
ProPublica, Dec. 19, 2013, 10:57 p.m.

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This story was co-produced with NPR. Tune into Morning Edition Friday morning for more on this story.

With just a handful of prescriptions to his name, psychiatrist Ernest Bagner III was barely a blip in Medicare's vast drug program in 2009.

But the next year he began churning them out at a furious rate. Not just the psych drugs expected in his specialty, but expensive pills for asthma and high cholesterol, heartburn and blood clots.

By the end of 2010, Medicare had paid $3.8 million for Bagner's drugs — one of the highest tallies in the country. His prescriptions cost the program another $2.6 million the following year, records analyzed by ProPublica show.

Bagner, 46, says there's just one problem with this accounting: The prescriptions aren't his. "All of that stuff you have is false," he said.

By his telling, someone stole his identity while he worked at a strip-mall clinic in Hollywood, Calif., then forged his signature on prescriptions for hundreds of Medicare patients he'd never seen. Whoever did it, he’s been told, likely pilfered those drugs and resold them.

"These people make more money off my name than I do," said Bagner, who now works as a disability evaluator and says he no longer prescribes medications.

Today, credit card companies routinely scan their records for fraud, flagging or blocking suspicious charges as they happen. Yet Medicare’s massive drug program has a process so convoluted and poorly managed that fraud flourishes, giving rise to elaborate schemes that quickly siphon away millions of dollars.

Frustrated investigators for law enforcement, insurers and pharmacy chains say they don’t see evidence that Medicare officials are doing much to stop it.

“It’s kind of a black hole,” said Alanna Lavelle, director of investigations for WellPoint Inc., which provides drug coverage to about 1.4 million people in the program, known as Part D.

Lavelle said her team routinely refers doctors and pharmacies to the contractor Medicare hires to pursue fraud. "Oftentimes we never hear back, positive or negative."

Since it started in 2006, Part D has been lauded for its success in getting needed medications to more than 36 million seniors and disabled enrollees.
Takeaways

ProPublica identified scores of doctors whose prescribing in Medicare’s drug program bore the hallmarks of fraud
Medicare’s failure to follow up on unusual prescribing patterns has allowed fraud to flourish
The cost of one Miami doctor’s medications jumped from $282,000 to $4 million in one year , but her lawyer said Medicare didn’t ask any questions
Scammers sometimes charge Medicare for drugs they don’t dispense and then resell them to pharmacies and wholesales
Investigators say Medicare fails to block doctors’ IDs when there’s a suspicion of fraud
In Medicare’s convoluted fraud-fighting system most cases are dropped without referral to prosecutors

Link

But over the past year, ProPublica has detailed how Part D is beset by weak oversight. Medicare doesn’t analyze its prescribing data to root out doctors whose inappropriate drug choices endanger patients. Nor has it flagged those whose unchecked devotion to name-brand drugs, instead of generics, adds billions in needless expense.

For this story, ProPublica again scrutinized Medicare’s data, this time to identify scores of doctors whose prescription patterns bore the hallmarks of fraud. The cost of their prescribing spiked dramatically from one year to the next — in some cases by millions of dollars — as they chose brand-name drugs that scammers can easily resell.

Sometimes the doctors claimed they were unwitting victims of identity theft. In other cases they were paid for writing bogus or inappropriate prescriptions.

A reporter initially contacted Bagner to ask about the high cost of his prescribing, then learned that his flood of prescriptions had already drawn the attention of law enforcement, the fraud units of at least two insurers and Medicare's fraud contractor by as early as mid-2010.

All these entities knew that Bagner claimed his identity had been stolen, documents and interviews show. Some of the investigators suspected he was not being wholly truthful about his involvement. Still, Medicare never blocked his national provider ID, which is used to fill prescriptions, Bagner said. The same was true with other physicians ProPublica identified.

The Centers for Medicare and Medicaid Services, which runs Part D, declined to make an official available for comment and would not answer specific questions. Instead, a spokesman sent a brief statement saying the agency “actively works to detect and prevent provider fraud” and refers cases to law enforcement if appropriate.

Law enforcement investigators and insurers say a marked increase in tips, complaints and cases suggests that Part D fraud is rising, but because pursuit of it is scattershot, gauging the extent is impossible.

Criminals are "coming up with new schemes, and drugs that are being diverted every day,” said Michael Cohen, an investigator with the inspector general of the Department of Health and Human Services (HHS).

Bagner’s case and others like it show how fast a single doctor can be used to run up a staggering tab.

Part D is vulnerable because it requires insurance companies to pay for prescriptions issued by any licensed prescriber and filled by any willing pharmacy within 14 days. Insurers generally must cover even suspicious claims before investigating, an approach called "pay and chase." By comparison, these same insurers have more time to review questionable medication claims for patients in their non-Medicare plans.

Fraud rings use an ever-evolving variety of schemes to plunder the program.

In one of the most popular, elderly, broke, disgraced or foreign-trained doctors are recruited for jobs at small clinics. Their provider IDs are used to write thousands of Medicare prescriptions for patients whose identities also may have been bought or stolen. Once dispensed, the drugs are then resold, sometimes with new labels, to pharmacies or drug wholesalers.

In other schemes, investigators say, pharmacies are active participants, billing Medicare multiple times for prescriptions they never fill.

Doctors can readily disavow the prescriptions as forged, investigators say. And because the schemes don't always involve painkillers, a law enforcement focus, they can escape notice.

Stymied by Medicare’s inaction, the task of pursuing such cases sometimes falls to local agencies such as Los Angeles County's Health Authority Law Enforcement Task Force.

Sheriff's Sgt. Steve Opferman, who heads that task force, said he doesn’t understand why Medicare does not make fraud more of a priority. Part D is “icing on the cake" for crooks, he said.

“Why is the government so reluctant to stop this?” he asked.
‘A Deal With the Devil’

In September 2006, federal officials called a meeting in Los Angeles to brief law enforcement on Medicare’s freshly launched prescription drug program.

When it was over, Opferman announced to a colleague: “Let the crime spree begin.”

Sure enough, Opferman said, it did.

From a beat-up office in a county building in downtown Los Angeles, his team now spends about half its time chasing down Part D scams in one of the country’s Medicare fraud hot spots.

Opferman has the pony tail, tattoos and scruffiness that go with working undercover and an impressive ability to recall the intricacies of dozens of such scams. He said it didn’t take long for local organized crime rings to suss out Part D’s weaknesses.

The scams he works are usually tied to Armenian organized crime rings. They depend, in large part, on a steady supply of doctors who are either oblivious or corrupt enough to look the other way.

“These people aren’t very bright,” Opferman said. “They’ve made a deal with the devil.”

Some doctors get hooked in after answering Craigslist ads seeking “Medical Director for clinic.” One doctor who did so got suspicious, but by the time she backed out, prescriptions already were being billed in her name, one of Opferman's team members recalled.

In some cases, Opferman and others say, the doctors are paid a flat fee to review a small percentage of patient charts once a week, while dozens, even thousands of prescriptions, are churned out under their names and filled at local pharmacies.

When one doctor's identification becomes "hot," the scammers simply find another.

A box of pill bottles in a locked room deep inside the building that houses the Los Angeles County's Health Authority Law Enforcement Task Force. (Tracy Weber/ProPublica)

In a locked room deep in the bowels of Opferman's building, boxes of drugs seized in raids are stacked to the ceiling. Gallon-sized plastic bags of pills. Piles of bottles with labels soaked off with nail polish remover, ready for new ones. Even a baby stroller used to peddle pills in a local park.

The painkillers, including such drugs as Oxycontin and Vicodin, are sold on the street to addicts, Opferman said. Expensive drugs for other conditions are resold back into the supply chain — to other patients, pharmacies or drug wholesalers.

Among the most popular are drugs such as the antipsychotic Abilify, which costs upward of $750 or more for a 30-day supply, or the heartburn pill Nexium, which runs at least $240.

In some cases, drug wholesalers repackage expired medications, which are ultimately dispensed to unsuspecting patients.

Opferman said Medicare is of scant help to local agencies trying to combat Part D fraud. It can take "months or years," he said, to get basic information, such as a physician’s prescribing or billing data, from the program.

“It’s like pulling teeth,” he said.

In contrast, Opferman said, Medi-Cal, the state-run insurance program for the poor, is quick to share its data. Medi-Cal can move to restrict a doctor’s ability to prescribe certain drugs if fraud is suspected and, in some cases, it suspends them from the program, state officials said.

Opferman and other investigators say Medicare could stanch much of the fraud by ensuring that doctors and pharmacies are legitimate and by quickly shutting off provider IDs associated with fraud. In many cases, the doctors' clinics turn out to be little more than rooms with a telephone, while the pharmacies are simply storefront pill mills, they said.

At the very least, WellPoint’s Lavelle suggests, Medicare or its fraud contractor could use Google Earth to see if the pharmacies even exist.

In the years since his first meeting about Part D, Opferman has come up with his own presentation about the program for his fellow fraud investigators. One slide is titled “An Invitation to Steal $$.”
His Dream Went South
Ernest Bagner
Cost of Prescription Claims by Year

$0
$3,777,000
$2,571,000

2009 2010 2011

Note: 2009 figures only include drugs for which at least 11 prescriptions were written. 2010 and 2011 include all prescriptions.
Top Drugs
2009
2010
2011
Drug Type Claims Cost
Namenda
Treats Alzheimer's disease Brand 1,065 $217
Singulair
Treats asthma and allergies Brand 743 $156
Crestor
Treats high cholesterol Brand 603 $155
Cymbalta
Treats depression, anxiety, nerve pain Brand 527 $180
Zetia
Treats high cholesterol Brand 506 $137
Twitter Link

At the beginning, when an Armenian woman offered to open a clinic for him, Bagner said he could see no down side. She'd set up the site, find the patients, handle the billing. And when the Medicare reimbursements rolled in, he'd get paid.

“My office. I risk no money. I see patients," Bagner recalled thinking. "Sounds good. Something I dreamed about as a kid.”

At first, all was well, Bagner said. He’d see about 10 patients a day, usually older Armenians and Hispanics, at an office on an overstuffed stretch of Hollywood Boulevard. About three months in, he said, his dream went south. Two investigators — he can't recall from which agency — showed up with a stack of prescriptions and patient records. They said he'd ordered more than $3 million worth of wheelchairs, neck braces and drugs since the clinic had opened.

They brought medical records that were copies of his actual files, Bagner said, but with different patient names written in. The prescriptions bore a fake signature that closely resembled his, he said, and they were written to patients he didn’t know.

“I wrote my signature. I showed them," he said. "They saw the difference.”

The investigators told him he was likely a victim of a scam, Bagner said, and promised to get back to him.

About a month later, the woman who ran the clinic abruptly closed it before he’d ever been paid, Bagner said. He never had a contract, he said, and couldn’t recall her last name. Soon after, an investigator from CVS Caremark began calling.

“He was insinuating I was getting kickbacks for writing expensive drugs,” Bagner said. “I called him back and said those patients were not mine.”

At that point, Bagner said he didn’t know how he could prove he hadn’t been party to the fraud. “Theoretically, hypothetically, I could sign my name a weird way and say, ‘No, it’s not mine,’” he said. “I could give my charts to the Russian mob.”

Bagner blames horrible business sense for falling prey to the scam. He rose from a childhood in gritty East Oakland to attend UCLA for his undergraduate degree and medical school. Nowhere in his training, he said, did anyone teach him how to run a business. He said he had previously lost $30,000 that he loaned to another clinic.

“I've never talked about this because it’s embarrassing,” he said. “I know medicine. I know psychology. When it comes to business, I'm like a retarded person.”

Bagner said he doesn’t even know what Part D is or how much drugs cost. “If you told me you’d give me a million dollars right now if I could tell you how much a month of Prozac costs under that program,” he said, “I have no idea what Part A or B or C or G is.” (There is no Part G.)

Over the course of several interviews, Bagner’s story changed somewhat. He initially insisted that no one had asked about his prescribing other than the CVS staffer and the investigators who visited him. But later he recalled that he had also been contacted by at least one other insurer and by a detective with Opferman’s task force.

Opferman said he came across Bagner in January 2011, when a pharmacist called about suspicious prescriptions someone had dropped off. When a driver brought patients to pick up the drugs, officers met them. They found that the “patients” were not the people named on the prescriptions, and the driver had been paid by a woman working at a strip-mall pill mill, according to a search warrant affidavit.

A follow-up search turned up a stack of prescriptions supposedly signed by Bagner in the woman’s purse, Opferman said. The case is still under investigation, but at this point Bagner is considered a victim, Opferman said.

Bagner plays in poker tournaments and fancies himself good at reading his opponents. He said he still doesn't know why the scammer chose him.

“I’m grateful and amazed that I haven’t gotten in trouble with this,” he said.
How Most Cases Die

When criminals plunder Part D, justice is rarely swift. Investigators from so many agencies are involved that chasing down fraud often seems like a relay race in which someone fumbles the baton—or stops well short of the finish line.

Unlike other parts of Medicare, Part D is entirely run by private insurance companies, which are paid by the government to process the bills. According to their contracts, the insurers are supposed to look out for fraud.

Cases typically begin when insurers notice spikes in a doctor’s prescribing or are tipped off by a patient, pharmacy or disgruntled employee.

If insurers suspect fraud, Medicare encourages — but does not require — them to notify its Part D fraud contractor, a private firm hired to review complaints and recommend cases for investigation. The insurers, however, are not allowed to block a suspect doctor's prescriptions.

Moreover, insurers can see only the fraction of a doctor’s prescribing record that involves their members — they have no insight as to whether the pattern extends to other companies. Only Medicare and its fraud contractor can see that information.

When tips from insurers reach the contractor, they join those coming in from patients and others. But the contractor can’t directly access patient medical charts to assess whether the patient actually saw the doctor or had a condition that warranted the medication. It must go back to the insurers, which then request the records from doctors or pharmacies.

Most cases die at this level. Between April 2010 and March 2011, the contractor started 1,800 Part D reviews, but forwarded only about 220 for further investigation, according to a report released earlier this year. Nearly all of those cases went to the Health and Human Services inspector general, which has a team of special agents that investigate fraud.

There, the Part D cases compete for attention with an array of other Medicare frauds, from kickbacks for lab referrals to unnecessary spinal surgeries. Of the 7,800 entities investigated for health care fraud — not just Part D — by the inspector general in 2010, just 14 percent were referred for prosecution.

The rest were dropped, "mainly due to lack of resources or insufficient evidence," a 2012 report from the Government Accountability Office found.

Even when the inspector general believes cases merit criminal charges, prosecutors don’t always pursue them. Each U.S. attorney’s office around the country sets its own priorities, which may not include health-care fraud.

At every stage, Medicare continues to allow prescriptions written by suspect doctors to be paid for by Part D. It only blocks them after a doctor is formally excluded from Medicare by the inspector general, an action that can take months, even after a conviction and sentencing.

In interviews, investigators at various levels deflected blame to others or cited a lack of funding to explain why so few cases are pursued.

Regardless of who is at fault, inattention to fraud has a steep price, they acknowledged.

“It costs the nation, beneficiaries and plan sponsors hundreds of millions of dollars — if not billions — each year,” said Jo-Ellen Abou Nader, who runs the waste, fraud and abuse program at Express Scripts, a pharmacy benefit manager that runs its own Part D insurance plans and manages those of 50 others.

She said Express Scripts prowls its claims for fraud on a daily basis using dozens of indicators that include a physician's prescribing history and drug mix.

But not all insurers do this, and some have been faulted for failing to alert Medicare to suspected fraud.

Abou Nader said every entity in the chain lacks the resources to get the job done. “You try to get as much through as you can,” she said.

There are ways to change the system.

Congress could, at Medicare's urging, change laws to give insurers more time to weed out fraud before paying claims. It could also give them more discretion to suspend doctors and pharmacies.

Currently, insurers must pay Part D pharmacy claims electronically within 14 days. Private plans have up to 30 days. Congress added the quicker turnaround in 2008 at the urging of pharmacies, which complained of payment delays. The change took effect in 2010.

“They’re public policies that actually promote fraud,” said Mark Merritt, CEO of the Pharmaceutical Care Management Association, which represents pharmacy benefit managers. “There’s zero upside for consumers.”
‘The Case Really Blew Up’

In early 2011, federal investigators wiretapped the phones of Babubhai Patel, the owner of several Detroit-area pharmacies. They suspected him of improperly dispensing narcotics and other controlled drugs.

The investigators learned that Patel wasn’t just peddling painkillers.

The 51-year-old pharmacist had a stable of doctors willing to write Part D prescriptions for any drug he wanted, any time he wanted. In return, the doctors got cash, a flock of new patients and, in at least one case, a down payment for an office building, federal prosecutors claim.

“The case really blew up,” said John Neal, an assistant U.S. attorney who prosecutes health care fraud in Detroit.

Over several months, investigators unraveled one of the largest prescription drug scams ever prosecuted -- and much of the fraud came at Medicare’s expense.

According to court records, Patel’s pharmacies billed Medicare and other insurers for the doctors’ prescriptions, then got paid a second time when the drugs were resold. Some patients who allowed Patel to process phony prescriptions in their names received painkillers as kickbacks, as did people who recruited patients for the scheme.

In all, Patel’s 26 pharmacies billed Medicare for more than $37 million from January 2006 to August 2011. They billed another $23.1 million to Michigan’s Medicaid program, court records show.

Unlike other jurisdictions, the U.S. attorney’s office in Detroit has made Part D fraud — and the doctors who play a role in it — a priority. The office ranks among the country’s leaders in prosecuting Medicare fraud.

“I think as a general matter, that Part D fraud is a significant problem here,” said Neal. “And billing for medically unnecessary and/or never dispensed Part D drugs is a problem here.”

So far, 39 people have been indicted in the Patel scheme, including eight doctors, a podiatrist and a psychologist. Of those, 31 have pleaded guilty or have been convicted by a jury, and two more are scheduled to enter guilty pleas. Two doctors are set to go on trial early 2014. A jury found Patel guilty in 2012; he is serving a 17-year prison sentence.

Mark Greenbain (WDIV Detroit)Among those who pleaded guilty is psychiatrist Mark Greenbain, now 71, to whom Patel allegedly paid $500 every week for prescribing expensive antipsychotics. Witnesses said the two would sit together in Greenbain’s house. “Patel would direct Greenbain what medications to write, and Greenbain would demand cash in exchange,” prosecutors wrote in their sentencing memo.

Greenbain’s prescriptions cost Medicare $2.3 million in 2011, ProPublica’s analysis of Part D data shows. He was recently sentenced to four years in prison. He still has a clear license, according to Michigan’s medical board website.

Anmy Tran (WDIV Detroit)A jury found another medical professional, podiatrist Anmy Tran, guilty of steering patients and prescriptions to a Patel-owned pharmacy in her building. Tran, 42, was caught on wiretap discussing her prescriptions with Patel, who said: “Your end is tremendously OK, excellent,” court records show.

When Tran was arrested in 2011, she told an investigator for the HHS inspector general that in return for referring patients, Patel helped cover the down payment on her office building, paid her tax bill and provided support to the Vietnamese community, according to court testimony.

Years before she caught the attention of prosecutors, Tran’s prescribing stood out starkly from that of her peers, data obtained by ProPublica show. In 2011, her Part D spending was higher than any other podiatrist’s in the country, costing Medicare $756,000.

Neither Medicare nor state regulators have taken any action against Tran, who still has the ability to write prescriptions.

Tran’s lawyer is seeking to overturn her conviction, calling it a “miscarriage of justice.” All her prescriptions were written for legitimate medical reasons, and she didn’t know Patel was corrupt, attorney David Steingold wrote in a motion to the U.S. District Court in Detroit. Tran is scheduled to be sentenced in January 2014.

Neal said it’s important to pursue doctors involved in these schemes to alert the community that this kind of behavior has consequences.

“Patel’s empire could not have existed or certainly sustained itself for as long as it did without the active cooperation of doctors,” he said.
Hiding in Plain Sight
Carmen Ortiz-Butcher
Cost of Prescription Claims by Year

$181,000
$282,000
$4,006,000

2009 2010 2011

Note: 2009 figures only include drugs for which at least 11 prescriptions were written. 2010 and 2011 include all prescriptions.
Top Drugs
2009
2010
2011
Drug Type Claims Cost
Advair Diskus
Treats asthma and COPD Brand 960 $246
Dovonex
Treats psoriasis Brand 643 $513
Singulair
Treats asthma and allergies Brand 624 $15
Lidoderm
Treats post-shingles pain Brand 612 $229
Zyprexa
Treats schizophrenia and bipolar disorder Brand 595 $1,076
Twitter Link

A misdirected fanny pack alerted Dr. Carmen Ortiz-Butcher that something was wrong. She'd asked a staffer to mail it to her brother a couple months ago, but it never arrived. Instead, he got a bunch of prescriptions ostensibly signed by Ortiz-Butcher, said her attorney, Robert Mayer.

Ortiz-Butcher, a Florida kidney specialist, suspended one of her employees and alerted authorities. But it wasn’t until ProPublica contacted Ortiz-Butcher, 59, for this story that she learned just how extensive the fraud was, Mayer said.

According to Medicare data, the scam appears to have started two years earlier. In 2011, the number of prescriptions Ortiz-Butcher wrote more than quadrupled from the previous year, to 16,000. And the cost of her drugs to Medicare spiked from $282,000 to $4 million.

The cases of Ortiz-Butcher and other doctors identified by ProPublica show how easy it is to spot potential fraud in Medicare’s own data.

“At no time had anyone contacted her about the frankly amazing increase in her prescriptions in the last two years,” Mayer said.

In some instances, when ProPublica asked doctors about the huge spikes in their prescribing, they recounted multiple situations in which someone appeared to be using their identity for suspicious activity.

It isn’t hard to spot Miami physician Aurelio Ortiz in Medicare’s Part D prescribing data. He’s the one whose prescription tab ballooned from $2.1 million in 2010 to $8.7 million the next year — the fourth-most in the country.

The 70-year-old doctor’s most-prescribed drugs read like a shopping list of the pills that are most valued in scams.

When ProPublica called him up, Ortiz (no relation to Ortiz-Butcher) couldn’t recall whether the prescriptions were his: “Right off the bat, I couldn’t say yes I did or I did not.”

He later said he’d been aware that some bogus prescriptions had been written using his name. At one clinic, “I found two or three prescriptions forged,” he said. “I resigned from the clinic, and I didn’t go there anymore.”

At another clinic, he said, “They had a gentleman who said he was a physician assistant … but this guy also forged my signature for medications.”

“If something has been going on,” Ortiz said, “no one has called me like you to tell me that there’s over-prescription of medications.”

Often doctors caught up in such scams have records of disciplinary action or financial difficulty. In 2006, Ortiz was placed on probation for three years by the Texas medical board, and he was subsequently disciplined by the Florida board, for falsely claiming to have examined a patient. Ortiz said he has resolved these issues and has had no problems since.

Another doctor whose prescriptions spiked one year, then virtually disappeared the next, maintained that she had fallen victim to more than one fraud.

Anesthesiologist Ruth Fontaine said she was “bankrupt and bereft” after her holistic medicine practice failed. Then a colleague told her about an Armenian man who ran an outpatient clinic near Los Angeles, she said.

It was the first of three clinics Fontaine, 64, would work at during the next three years, each entangling her in suspicious activity or fraud.

The first closed abruptly in 2007 after the owner declared he was out of money then disappeared, Fontaine said. The next morning, she found the lock sawed out of the clinic’s front door, she said.

Undeterred, Fontaine joined a second clinic. There she was visited by fraud investigators who asked about her prescriptions for motorized wheelchairs, Fontaine said. Half of them, she said, were not for her patients. Then pharmacists began calling about prescriptions for Oxycontin she hadn’t written, she said.

When Fontaine refused to write any more prescriptions for pain pills, the second office also suddenly closed, she said.

Nonetheless, Fontaine joined a third in 2010. This one was open for less than a month. Fontaine said she wasn’t hired to see patients, but rather to oversee the work of a physician assistant, who could prescribe under her name. But she said she never met the assistant and later discovered prescriptions were being attributed to her before she even learned the clinic’s address.

“I started asking too many questions,” Fontaine said. And then one day, the clinic’s phone was turned off.

The FBI later visited Fontaine and said she’d likely been the victim of identity theft, she said. The FBI declined to verify her claim.

Medicare data show her short stint at the final clinic in 2010 resulted in prescriptions worth more than $520,000.

Not So Fast

As we often wonder what makes a community and how that is defined, I think the coffee shop is the most prevalent one in almost any one's description. Perhaps it was the diner/coffee shop that Seinfeld and friends hung out or Central Perk where the Friends gathered to discuss the events du jour, or there was Flo's Diner or later Luke's (a diner for every generation)and let us not forget to include Cafe Nervosa where a Seattle dweller Fraiser analyzed his life. Wherever and whenever the time period the local watering hole for whatever beverage served it has a resonance that many of us identify.

For many, Starbucks the ubiquitous Seattle association with coffee, came and is the coffee equivalent of the fast food chain is now the hang out spot. Instead of a Big Mac you order a Grande Latte, add free wi-fi and the faux urban feel of the local java joint, it is for many a place of work or of respite.

That does not mean the fast food chains are not included in this as we have learned of late that for many Seniors, McDonald's holds that same appeal and their menu includes now Lattes and other beverages that are for many in the not-broken-hip crowd.

And sadly that has also been the source of ire for many of those who work there. Funny you think they would spend more time organizing about wages and working conditions than the Seniors congregating over bad coffee. But not all and in the article here, you read that not everyone agrees.

I am a lover of coffee and I do have my favorites, my personal is Cupcake Royale, I love the coffee (and yes the cupcakes but get real not every day) but I love the people who work there and the owner's politics actually matter and it is why I started going there but its not what keeps me there. And like the kids who loved the Peach Pit or Arnold's I go to my local pizza joint not for the coffee or the pizza but the for the camaraderie. I have met many great and not-so-great people there, but hey I need material for my ongoing tome, Conversation with Idiots. And yes they seem to have a lot there and yet I have never met the one I wish to, soon to be retiring Senator Adam Kline who represents the district in which it is located. I cannot wait!

I am sure I have offended people there as well and that is what it means to be in public, you will encounter those you don't like and those you do but it is the latter that teaches you more about tolerance and understanding more than many life lessons can provide.

But this is a nation that doesn't talk to people unless online or on phone. So many times I hear that having a conversation is hard and I wonder why that is unless you are stupid and then cognitive functioning takes more time but that is why I have conversations with even idiots to see if I have something in common and find that common ground and in turn something on which to learn. But wait! Learn you say? Yes even I queen of the snark learn something from idiots. What is exactly is unclear but I am fine with that.

I do worry when we are not able to have spontaneous conversations and encounters without pre planning or thought of as "asking for trouble." I still go back to belief that if you are robbed, raped, assaulted you somehow participated in that happening and then if that is the case, we should all become hermits and never leave our homes. Since most jobs will be done by robots soon that should solve that. Having an income I guess would be from programming and operating the robots from a satellite location like the drone program or NSA surveillance.

I think we could do excellent surveillance well in public, fascinating I can assure you. Funny some idiot/acquaintance told one of the many idiots that handled my medical case that I lived in isolation. I only wish that was true but this person actually never spoke to me in years and has never spoken to me since so I find that fascinating as well. People are assholes and idiots they can be mutually exclusive and I know this from personal experience but you won't know that unless you actually speak to them. Then you can actually tell them that as well!

Get out and have a coffee just don't stay long or tip well as for many in the food service industry they make shit for wages and they deserve respect even when they don't necessarily give it, this might explain why.

Monday, January 27, 2014

Hungry? Get a Cow

Or  have a cow. something like that. The article in the Wire  today was about the infamous WSJ letter by Tom Perkins, the Octogenarian founder of the Venture Capital firm Kleiner Perkins;  the same firm that lists Al Gore on the letterhead,  who has once again inserted his Gucci/Ferragamo clad foot into his mouth.

Apologizing, if that is what the rich call it, on the network of the rich and the beleaguered, Bloomberg News  (vs CNBC the network of the rich and arrogant) for comparing class warfare to Kristillnacht.  Instead his apology was either for using German or the idea of the word and its reference  or the whole Nazi thing, whatever, but not the message itself.   So in other words it's the non apology apology or as  I call it pissed for getting called out;  Mr. Perkins then informed the listeners that like Mitt Romney mistakenly did and his 47% remark said he was not wrong in his message.  Then ironically while unaware he was still on mic commented, "I could buy a six pack of Rolexes" Okay then.

Perkins speaks well off the plutocratic script and that means he at least is not senile, an asshole but not senile. When asked by the interviewer  if he was divorced from reality I thought since his foot was still promptly in his mouth, let me answer for him - yes he is that - unreal man!

He also mentions Paul Krugman's column which I thought addresses this rather well, shame Mr. Krugman did not hear his bizarre ramblings in response. Frankly as we now face massive cuts to food stamps the irony is not lost. 

Bart Simpson would say don't have a cow man so we can now add this elderly idiot on the level of a cartoon child. But Bart would never go to Harvard right? And this elderly man did as did Mitt Romney. Is there something in the curriculum or the water?

Paranoia of the Plutocrats

JAN. 26, 2014
Paul Krugman

Rising inequality has obvious economic costs: stagnant wages despite rising productivity, rising debt that makes us more vulnerable to financial crisis. It also has big social and human costs. There is, for example, strong evidence that high inequality leads to worse health and higher mortality.

But there’s more. Extreme inequality, it turns out, creates a class of people who are alarmingly detached from reality — and simultaneously gives these people great power.

The example many are buzzing about right now is the billionaire investor Tom Perkins, a founding member of the venture capital firm Kleiner Perkins Caufield & Byers. In a letter to the editor of The Wall Street Journal, Mr. Perkins lamented public criticism of the “one percent” — and compared such criticism to Nazi attacks on the Jews, suggesting that we are on the road to another Kristallnacht.

You may say that this is just one crazy guy and wonder why The Journal would publish such a thing. But Mr. Perkins isn’t that much of an outlier. He isn’t even the first finance titan to compare advocates of progressive taxation to Nazis. Back in 2010 Stephen Schwarzman, the chairman and chief executive of the Blackstone Group, declared that proposals to eliminate tax loopholes for hedge fund and private-equity managers were “like when Hitler invaded Poland in 1939.”

And there are a number of other plutocrats who manage to keep Hitler out of their remarks but who nonetheless hold, and loudly express, political and economic views that combine paranoia and megalomania in equal measure.

I know that sounds strong. But look at all the speeches and opinion pieces by Wall Streeters accusing President Obama — who has never done anything more than say the obvious, that some bankers behaved badly — of demonizing and persecuting the rich. And look at how many of those making these accusations also made the ludicrously self-centered claim that their hurt feelings (as opposed to things like household debt and premature fiscal austerity) were the main thing holding the economy back.

Now, just to be clear, the very rich, and those on Wall Street in particular, are in fact doing worse under Mr. Obama than they would have if Mitt Romney had won in 2012. Between the partial rollback of the Bush tax cuts and the tax hike that partly pays for health reform, tax rates on the 1 percent have gone more or less back to pre-Reagan levels. Also, financial reformers have won some surprising victories over the past year, and this is bad news for wheeler-dealers whose wealth comes largely from exploiting weak regulation. So you can make the case that the 1 percent have lost some important policy battles.

But every group finds itself facing criticism, and ends up on the losing side of policy disputes, somewhere along the way; that’s democracy. The question is what happens next. Normal people take it in stride; even if they’re angry and bitter over political setbacks, they don’t cry persecution, compare their critics to Nazis and insist that the world revolves around their hurt feelings. But the rich are different from you and me.

And yes, that’s partly because they have more money, and the power that goes with it. They can and all too often do surround themselves with courtiers who tell them what they want to hear and never, ever, tell them they’re being foolish. They’re accustomed to being treated with deference, not just by the people they hire but by politicians who want their campaign contributions. And so they are shocked to discover that money can’t buy everything, can’t insulate them from all adversity.

I also suspect that today’s Masters of the Universe are insecure about the nature of their success. We’re not talking captains of industry here, men who make stuff. We are, instead, talking about wheeler-dealers, men who push money around and get rich by skimming some off the top as it sloshes by. They may boast that they are job creators, the people who make the economy work, but are they really adding value? Many of us doubt it — and so, I suspect, do some of the wealthy themselves, a form of self-doubt that causes them to lash out even more furiously at their critics.

Anyway, we’ve been here before. It’s impossible to read screeds like those of Mr. Perkins or Mr. Schwarzman without thinking of F.D.R.’s famous 1936 Madison Square Garden speech, in which he spoke of the hatred he faced from the forces of “organized money,” and declared, “I welcome their hatred.”

President Obama has not, unfortunately, done nearly as much as F.D.R. to earn the hatred of the undeserving rich. But he has done more than many progressives give him credit for — and like F.D.R., both he and progressives in general should welcome that hatred, because it’s a sign that they’re doing something right.


What's That Smell

As we move to the eve of legal marijuana sales here in Washington State I suspect that the rise in DUI while high will increase (they already have). Given Kat Williams problems here a couple of years ago I think he should bypass the city of Seattle. I wonder if that bench warrant issued by Judge Gregory has been resolved?

As in DUI with alcohol the smell test is the big factor in determining if you will be charged with a crime. And with marijuana there is a distinct smell, the unfortunate part is that it is transferable. So good thing Kat Williams isn't coming here just being in the near vicinity should be enough to warrant a stop and frisk and subsequent blood test. And let's not forget the bill for that as well. As I am sure without any THC in my blood there would be the hospital costs and some convoluted charge they would devise to validate the stop. Ah yes admitting one is wrong is not something the Police do willingly let alone ever. So that concert ticket could end up costing a few thousand by the time the evening is done. So tell your seat mates this is non smoking zone and let me know how well that works out.

And the irony on top of hiliarity one of the Representatives, Roger Goodman, who has said drunk driving is the greatest scourge on society today (really it is?) and an agressive advocate to make domestic violence something akin to a felony crime such as murder or rape, was accused by his former wife of smoking a joint with the kids. Is this domestic violence issue or a DUI? The next Trey Redel maybe? Or just a classic hypocritical Politician?

And with this comes the idea of the drug sniffing dog. And today Radley Balko's column in the Washington Post is about another fraud in science and in police tactics - the drug sniffing dog. Studies have found that surprisingly it is not the dog but the handler.

Even the perhaps worst Editor in the history of the New York Times, Bill Keller, wrote an editorial today about our prison happy nation. And while it was short on any actual ideas and plans to resolve this crisis, he made some salient points with regards to the ever increasing prison nation.

We are adding more penalties and laws to enhance said penalties. We have ensured convictions by removing any flexibility in local courts including even writing jury instructions to ensure convictions. We use dogs and junk science to convict and aided by an ever increasing hysterical media and the subsequent victim lobbying faux non profit advocate groups that suddenly appear with appropriate indignation and checks in hand. Yes the system of Justice is swift and unwavering in its quest to ensure cooperation and compliance. What it does beyond that is any one's guess.



Sunday, January 26, 2014

Time for the "Talk"

For many that was the first time they discussed sex be it with one's Parent's or in School. When I was a kid it was both.

I went to Catholic school and in 7th grade the official request to begin a sexual education class was sent home and many parents either to circumvent or avoid the subject began to address the ubiquitous "birds and bees" issue.

As my mother was an immigrant and my father the product of immigrant and both much older than average parents of a child, I had been subjected to the subject matter of sex and sexuality early on.  Add to that that many of my family's friends were Gay, Lesbian, Transgender and also foreign there was no subterfuge with regards to what the bigger picture was.  I don't ever recall the biological aspect and that was gladly handed over to school to fill in that missing data but the more complicated issue of sexuality was not something hidden in our home.

My Mother was raped when I was 6.  I am not sure if I should be writing about it but I recall waking up that morning and the screaming, the Police and the hysteria of the event that transpired that day.  She was raped in our home when a gentleman whom she knew from work drove her home and then came into the home threatened her and raped her in our living room as I lay sleeping in my bed.

I thought for sure that sins of the mother happened to me the night of February 8 and I still have never come to terms with the idea that I was raped that night.  Something in my core says he was going to do that in my home exactly as my mother was and the car accident is what saved my life in some perverse act.

Denial is a big part of rape and frankly given the patriarchal system of Justice is that not shocking.

And to hear that President Obama is assigned the big doofus Joe Biden in charge of educating young men about the issues surrounding rape, I wonder why he didn't finish it back when this was assigned to him in 2011.  That was when Biden was going to go to Ivy League schools to discuss the issue there, state colleges are on their own as the progeny of the esteemed Harvard Yard and Yale are by far more important than the women of Missoula or other red state youth.

But to be frank, I seriously doubt young men of this generation will listen to a representative of the "greatest generation" about sex and sexuality.   Deaf and ears will meet and this may go along with former Defense Secretary Gates assessment of VP Biden and it is just wrong on all counts. 

And again I am neither a Republican nor Democrat so spare me your insults. I am a Green Party member and first and foremost a Humanist and the issue surrounding sexual assaults has nothing to do with politics or party... I hope.

So now the issue is back as it appears that the message was buried, lost or forgotten with all the other PR or other "assignments" given to Vice President Biden.  I am sure this time there will be some positive affect or not.  Let's be honest our young men are a deeply troubled lot, from gun violence to sexual violence, we clearly are not providing any messages they want, wish or need to hear.



The New York Times op ed had this...

Talking Sexual Violence Without Giving Offense

THE EDITORIAL BOARD
JAN. 25, 2014

It’s rare to hear politicians discuss rape and assault with real sensitivity, but that’s just what President Obama and Vice President Biden did."

It’s rare to hear politicians at the national level discuss sexual violence. It’s even rarer to hear them discuss it with real sensitivity. Yet President Obama and Vice President Joseph Biden Jr. managed exactly that last Wednesday, when they announced a task force on campus rape — an area of particular concern. A 2007 study found that one in five women had been sexually assaulted in college

The administration has addressed this issue before. In 2011, the Department of Education’s Office for Civil Rights sent a letter to colleges explaining that sexual violence is a form of sex discrimination prohibited by Title IX. And Mr. Biden’s dedication to combating sexual assault is well established; he drafted the Violence Against Women Act in 1994. On Wednesday, though, the president and vice president distinguished themselves not just by what they said but by how they said it.


“Our daughters, our sisters, our wives, our mothers, our grandmothers have every single right to expect to be free from violence and sexual abuse,” Mr. Biden said. “No matter what she’s wearing, no matter whether she’s in a bar, in a dormitory, in the back seat of a car, on a street, drunk or sober — no man has a right to go beyond the word ‘no.’ And if she can’t consent, it also means no.”

He added: “Men have to step up to the bar here. Men have to take more responsibility. Men have to intervene.”
Mr. Obama also emphasized male accountability: “We’ve got to keep teaching young men in particular to show women the respect they deserve and to recognize sexual violence and be outraged by it, and to do their part to stop it from happening in the first place.”

Cynics might dismiss these remarks as focus-group pablum. But it’s no small thing for two men in power to speak inoffensively on such a delicate topic, avoiding victim-blaming and callousness.

Just over a year ago, Richard Mourdock of Indiana, who was then a Republican candidate for the Senate, described pregnancy resulting from rape as “something that God intended to happen.” And Representative Todd Akin of Missouri, another failed Republican Senate hopeful, said he thought abortion should be illegal even in cases of rape because “if it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

When it comes to sexual violence, tone matters. A new report on rape and sexual assault from the White House Council on Women and Girls notes that if men believe that their peers accept abusive behavior, they’re less likely to intervene. Conversely, “when men speak out against abuse, other men are more likely to step in to neutralize a risky situation and prevent an assault.”

And tonight 60 Minutes had a story on the lack of mental health providers for those families whose children are truly ill and troubled and how ER's are largely filling the bill for care.  And to this I say "SHOCKING."'  I have long been writing about that issue for quite sometime but until it happens to you in America no one gives a shit.

I have lost count on the shootings this past month. Have you?

We have a mental health crisis in this country and yet the solution seems to find another drug to shove, whoops, I mean promote.  My new favorite was the one for "bi-polar depression." Okay please tell me that people who have this are actually watching TV and saying "that's me, that's the ticket"

Now we are actually promoting mental health drugs directly to people with mental health problems.

 Next up.. "suffer from schizophrenia? Try Schizoid, the new med that can have those voices in your head talking to each other rather than you..."

This is our Country, one that has no answers but endless problems and the resources to actually address them but for some reason not.

Be a part of the solution, not the problem.  How? that is the question.  You can talk the talk but you need to walk it as well.



The 51st State

That would not be Puerto Rico.  When Nick Kristof who covers primarily the indignities of third world countries writes of our own you know it is serious.

As you will read the indignities of America and the ever present zeal of our Police to ensure that we are felons of some sort disguised as keeping us safer, the stories below are not ones that are unfamiliar.  I should know.. I do know as it happened to me.

There is no lawsuit, no monies, no apologies that can compensate when you have been violated and raped (yes metaphorically but again the legal definition by the Justice Department is here) by the Police and their accomplices, the Medical professionals, you wonder if it is possible to ever get over that pain.  I have run out of prayers, mantra and cupcakes to assuage that pain.

To the medical staff you are nothing more than evidence and to that you will be billed for that indignity.  They have no dignity as we have also come to see in Texas keeping a dead woman "alive" to be a human incubator for a fetus that is not viable.  Undoubtedly they will bill the family for that as well, as they are only upholding the laws written by legislators who care little about what those laws really mean and what the true affects of those laws are on those enforcing them and those they are enforced upon.

 I have a bill too, I used it wipe my ass.   I will use the Constitution the next time it is about as valuable.

This is America, welcome to the newest state - the Police State.


Enemas Later, Still No Drugs

JAN. 25, 2014
Nicholas Kristof

IF you think that protests about overzealous law enforcement are over the top, listen to what unfolded when the police suspected that David Eckert, 54, was hiding drugs in his rectum.

Eckert is a shy junk dealer struggling to get by in Hidalgo County, N.M. He lives a working-class life, drives a 16-year-old pickup and was convicted in 2008 of methamphetamine possession.

Police officers, suspecting he might still be involved in drugs, asked him to step out of his pickup early last year after stopping him for a supposed traffic violation. No drugs or weapons were found on Eckert or in his truck, but a police dog showed interest in the vehicle and an officer wrote that Eckert’s posture was “erect and he kept his legs together.”

That led the police to speculate that he might be hiding drugs internally, so they took him in handcuffs to a nearby hospital emergency room and asked the doctor, Adam Ash, to conduct a forcible search of his rectum. Dr. Ash refused, saying it would be unethical.

“I was pretty sure it was the wrong thing to do,” Dr. Ash told me. “It was not medically indicated.

Eckert, protesting all the while, says he asked to make a phone call but was told that he had no right to do so because he hadn’t actually been arrested. The police then drove Eckert 50 miles to the emergency room of the Gila Regional Medical Center, where doctors took X-rays of Eckert’s abdomen and performed a rectal examination. No drugs were found, so doctors performed a second rectal exam, again unavailing.

Doctors then gave Eckert an enema and forced him to have a bowel movement in the presence of a nurse and policeman, according to a lawsuit that Eckert filed. When no narcotics were found, a second enema was administered. Then a third.

The police left the privacy curtain open, so that Eckert’s searches were public, the lawsuit says.

After hours of fruitless searches, police and doctors arranged another X-ray and finally anesthetized Eckert and performed a colonoscopy.

“Nothing was found inside of Mr. Eckert,” the police report notes. So after he woke up, he was released — after 13 hours, two rectal exams, three enemas, two X-rays and a colonoscopy

The hospital ended up billing Eckert $6,000.

When I came across this case, it seemed far-fetched to me — more like rape than law enforcement. But the authorities, hospital and doctors all refused to comment, and, a few days ago, the city and county settled the lawsuit by paying Eckert $1.6 million.

This wasn’t a unique case. A few months earlier, a man named Timothy Young who lives nearby says that police officers pulled him over, forcibly strip-searched him in a parking lot and then took him to a hospital for a forced X-ray and rectal examination while he was handcuffed. Nothing was found, so he was released — only to receive a hospital bill.

And a few weeks before Eckert’s ordeal, a 54-year-old American woman crossing from Mexico into El Paso was strip-searched and taken to the University Medical Center of El Paso. She says in a lawsuit that, over six hours, she was shackled to an examination table and subjected to rectal and vaginal examinations — with the door open to compound her humiliation. After a final X-ray and CT scan, all of which turned up nothing, she was released — and billed for the procedures.

Joseph P. Kennedy, Eckert’s lawyer, notes that such abuses are not random but are disproportionately directed at those on the bottom rungs of society. “It’s a socioeconomic issue,” he said. “It’s the indignities forced on people who are not articulate, not educated and don’t have access to legal services.

Police are caught in a difficult balancing act, and obviously the abuse of Eckert isn’t representative. But it is emblematic of something much larger in America, a kind of inequality that isn’t economic and that we don’t much talk about.

It’s the kind of inequality that lies behind police stops for “driving while black,” or unequal implementation of stop-and-frisk policies, or “zero tolerance” school discipline codes that lead many low-income children to be suspended.

This inequality has a racial element to it, but it is also about social class (Eckert is white but struggling financially). This is about Americans living in different worlds. If you’re a middle-class reader, you probably see the justice system as protective. If you’re a young man of color, you may see it as threatening.

So as we discuss inequality in America, let’s remember that the divide is measured in more than dollars. It’s also about something as fundamental as our dignity, our humanity and our access to justice; it’s about the right of working stiffs not to endure forced colonoscopies.

Friday, January 24, 2014

Water Water Everywhere

...and not a drop to drink. The crisis in Virginia, the nuclear meltdown in Japan, the endless climate crisis globally tells us that water will be far more significant than any other energy related one.

It is very telling that suddenly industry is realizing that without water they have no product and without product they have no business. That part of the customers and the world they live in, that too but at least it is a step in the right direction.

WalMart is now encouraging manufacturing in the United States for vendors and undoubtedly the recent disasters in the overseas manufacturing sites have contributed but in reality the costs of doing business overseas is beginning to be offset by costs of wages and in turn costs of transport, eventually the reality sets in that 1+1 is not 2.

Water is the most precious of resource, way more so than oil but don't tell Exxon that. Without water we are not alive. Period. How more clear is that?

Water is what we are made of by land and by sea.


Industry Awakens to Threat of Climate Change

By CORAL DAVENPORT
JAN. 23, 2014


WASHINGTON — Coca-Cola has always been more focused on its economic bottom line than on global warming, but when the company lost a lucrative operating license in India because of a serious water shortage there in 2004, things began to change.

Today, after a decade of increasing damage to Coke’s balance sheet as global droughts dried up the water needed to produce its soda, the company has embraced the idea of climate change as an economically disruptive force.

“Increased droughts, more unpredictable variability, 100-year floods every two years,” said Jeffrey Seabright, Coke’s vice president for environment and water resources, listing the problems that he said were also disrupting the company’s supply of sugar cane and sugar beets, as well as citrus for its fruit juices. “When we look at our most essential ingredients, we see those

Coke reflects a growing view among American business leaders and mainstream economists who see global warming as a force that contributes to lower gross domestic products, higher food and commodity costs, broken supply chains and increased financial risk. Their position is at striking odds with the longstanding argument, advanced by the coal industry and others, that policies to curb carbon emissions are more economically harmful than the impact of climate change.

“The bottom line is that the policies will increase the cost of carbon and electricity,” said Roger Bezdek, an economist who produced a report for the coal lobby that was released this week. “Even the most conservative estimates peg the social benefit of carbon-based fuels as 50 times greater than its supposed social cost.”

Some tycoons are no longer listening.

At the Swiss resort of Davos, corporate leaders and politicians gathered for the annual four-day World Economic Forum will devote all of Friday to panels and talks on the threat of climate change. The emphasis will be less about saving polar bears and more about promoting economic self-interest.

In Philadelphia this month, the American Economic Association inaugurated its new president, William D. Nordhaus, a Yale economist and one of the world’s foremost experts on the economics of climate change.

“There is clearly a growing recognition of this in the broader academic economic community,” said Mr. Nordhaus, who has spent decades researching the economic impacts of both climate change and of policies intended to mitigate climate change.

In Washington, the World Bank president, Jim Yong Kim, has put climate change at the center of the bank’s mission, citing global warming as the chief contributor to rising global poverty rates and falling G.D.P.’s in developing nations. In Europe, the Organization for Economic Cooperation and Development, the Paris-based club of 34 industrialized nations, has begun to warn of the steep costs of increased carbon pollution.

Nike, which has more than 700 factories in 49 countries, many in Southeast Asia, is also speaking out because of extreme weather that is disrupting its supply chain. In 2008, floods temporarily shut down four Nike factories in Thailand, and the company remains concerned about rising droughts in regions that produce cotton, which the company uses in its athletic clothes.

“That puts less cotton on the market, the price goes up, and you have market volatility,” said Hannah Jones, the company’s vice president for sustainability and innovation. Nike has already reported the impact of climate change on water supplies on its financial risk disclosure forms to the Securities and Exchange Commission.

Both Nike and Coke are responding internally: Coke uses water-conservation technologies and Nike is using more synthetic material that is less dependent on weather conditions. At Davos and in global capitals, the companies are also lobbying governments to enact environmentally friendly policies.

But the ideas are a tough sell in countries like China and India, where cheap coal-powered energy is lifting the economies and helping to raise millions of people out of poverty. Even in Europe, officials have begun to balk at the cost of environmental policies: On Wednesday, the European Union scaled back its climate change and renewable energy commitments, as high energy costs, declining industrial competitiveness and a recognition that the economy is unlikely to rebound soon caused European policy makers to question the short-term economic trade-offs of climate policy.


In the United States, the rich can afford to weigh in. The California hedge-fund billionaire Thomas F. Steyer, who has used millions from his own fortune to support political candidates who favor climate policy, is working with Michael R. Bloomberg, the former New York mayor, and Henry M. Paulson Jr., a former Treasury secretary in the George W. Bush administration, to commission an economic study on the financial risks associated with climate change. The study, titled “Risky Business,” aims to assess the potential impacts of climate change by region and by sector across the American economy.

“This study is about one thing, the economics,” Mr. Paulson said in an interview, adding that “business leaders are not adequately focused on the economic impact of climate change.”

Also consulting on the “Risky Business” report is Robert E. Rubin, a former Treasury secretary in the Clinton administration. “There are a lot of really significant, monumental issues facing the global economy, but this supersedes all else,” Mr. Rubin said in an interview. “To make meaningful headway in the economics community and the business community, you’ve got to make it concrete.”

Last fall, the governments of seven countries — Colombia, Ethiopia, Indonesia, South Korea, Norway, Sweden and Britain — created the Global Commission on the Economy and Climate and jointly began another study on how governments and businesses can address climate risks to better achieve economic growth. That study and the one commissioned by Mr. Steyer and others are being published this fall, just before a major United Nations meeting on climate change.

Although many Republicans oppose the idea of a price or tax on carbon pollution, some conservative economists endorse the idea. Among them are Arthur B. Laffer, senior economic adviser to President Ronald Reagan; the Harvard economist N. Gregory Mankiw, who was economic adviser to Mitt Romney’s presidential campaign; and Douglas Holtz-Eakin, the head of the American Action Forum, a conservative think tank, and an economic adviser to the 2008 presidential campaign of Senator John McCain, the Arizona Republican.

“There’s no question that if we get substantial changes in atmospheric temperatures, as all the evidence suggests, that it’s going to contribute to sea-level rise,” Mr. Holtz-Eakin said. “There will be agriculture and economic effects — it’s inescapable.” He added, “I’d be shocked if people supported anything other than a carbon tax — that’s how economists think about it.”

Admit One

Today the cover of the New York Times had the story below about the inflationary practices of the HCA Hospital chain, which of course would be shocking to no one who actually follows the practices of the Medical Industrial Complex and their notion of the word "care."  In that they mean their Executives, Administrators and of course shareholders for those in the profit area of which many medical providers are.  Nothing says wellness more than a nice bonus or dividend on the backs, literally and metaphorically, of the Patients whom they abuse, mistreat and occasionally provide care for (not without substantive costs).

The CEO is long gone that instituted the admission software but really we cannot forget that his legacy lives on while he is on "religious retreat" I am sure asking God for forgiveness of robbing primarily the tax paying citizens of America as most of it centered on the two big Government programs of Medicare and Medicaid. 

This software is going to be the big winner in the Obamacare sweepstakes as this will be the difference between a band aid and a suture and more importantly the costs between them.

Hospital Chain Said to Scheme to Inflate Bills


by JULIE CRESWELL and REED ABELSON
Published January 24, 2014

Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors.

Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.

The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.

This month, the Justice Department said it had joined eight separate whistle-blower lawsuits against H.M.A. in six states. The lawsuits describe a wide-ranging strategy that is said to have relied on a mix of sophisticated software systems, financial incentives and threats in an attempt to inflate the company’s payments from Medicare and Medicaid by admitting patients like an infant whose temperature was a normal 98.7 degrees for a “fever.”

The accusations reach all the way to the former chief executive’s office, whom many of the whistle-blowers point to as driving the strategy.

For H.M.A., the timing could not be worse. Shareholders recently approved the planned $7.6 billion acquisition of the company by Community Health Systems, which will create the nation’s second-largest for-profit hospital chain by revenue, with more than 200 facilities. The deal is expected to be completed by the end of the month.

While the lawsuits against H.M.A. provide a stark look at the pressure being put on doctors and hospital executives to emphasize profits over their patients, similar accusations are being raised at other hospital and medical groups as health care in the United States undergoes sweeping changes.

Federal regulators have multiple investigations into questionable hospital admissions, procedures and billings at many hospital systems, including the country’s largest, HCA. Community Health Systems, the Franklin, Tenn., company from which H.M.A. hired its former chief executive in 2008, faces similar accusations that it inappropriately increased admissions. Community is in discussions with federal regulators over a settlement regarding some of the accusations.

The practice of medicine is moving more rapidly than ever from decision-making by individual doctors toward control by corporate interests. The transformation is being fueled by the emergence of large hospital systems that include groups of physicians employed by hospitals and others, and new technologies that closely monitor care. While the new medicine offers significant benefits, like better coordination of a patient’s treatment and measurements of quality, critics say the same technology, size and power can be used against physicians who do not meet the measures established by companies trying to maximize profits.

“It’s not a doctor in there watching those statistics — it’s the finance people,” said Janet Goldstein, a lawyer representing whistle-blowers in one of the suits, of a type known as qui tam litigation, against H.M.A.

What’s more, like their Wall Street bank counterparts, the mega-hospital systems, with billions of dollars in revenue, are more challenging to regulate, according to experts.< Still, when H.M.A. announced the Justice Department’s involvement in the lawsuits, investors and analysts shrugged, and the stocks for both companies involved in the merger barely budged. Sheryl R. Skolnick, who follows health care for CRT Capital, recently wrote in a note to investors, “Investors seem to think that D.O.J. investigations, qui tam suits and allegations of serious Medicare fraud are simply a cost of doing business.” Many settlements run only into the tens of millions of dollars. That’s a corporate slap on the wrist for companies whose stocks typically soar when executives push the profit envelope. Only if the penalty is at least $500 million, Ms. Skolnick said, are corporations likely to find the cost a deterrent. H.M.A. also faces shareholder lawsuits and a federal securities investigation. A former executive was indicted late last year on an obstruction charge related to these investigations.

The company said it could not comment on pending litigation, but was cooperating with the Justice Department investigation. In a statement, the company defended the quality of its medical care. “H.M.A. associates and physicians who practice at our facilities are focused on providing the highest-quality patient care in all of our hospitals,” it said.

The architect of the strategy to raise admissions, according to several of the lawsuits, brought by an array of physicians, individual hospital administrators and compliance officers, was the company’s former chief executive, Gary D. Newsome.

“Gary vigorously denies the allegations,” according to an email from his lawyer, Barry Sabin of Latham & Watkins.

Mr. Newsome joined H.M.A. in September 2008 from a high-ranking post at Community Health. He left H.M.A. last summer to head a religious mission in Uruguay. His compensation in the three years before his departure totaled $22 million.

Shortly after joining H.M.A., Mr. Newsome traveled to North Carolina to meet with local hospital officials. He informed them he was putting in place new protocols, using customized software, meant to “drive admissions” at hospitals, according to allegations in a federal suit filed by Michael Cowling, a former division vice president and chief executive of an H.M.A.-owned hospital in Mooresville, N.C.

To reach admission goals, administrators were directed to monitor on a daily basis the percentage of patients being admitted, using a customized software program called Pro-Med. The progress of the physicians in meeting their goals was updated daily on the scorecards

When Mr. Cowling confronted Mr. Newsome with physician concerns that the new protocols were clinically inappropriate and would result in unnecessary tests and admissions, and said that his doctors “won’t do it,” Mr. Newsome responded: “Do it anyway,” according to the lawsuit.<


As a result, according to a former physician who cited multiple examples, patients who did not need inpatient treatment often were admitted, which allowed the hospital to bill Medicare and Medicaid more for the care.

In Georgia, a baby whose temperature was 98.7 degrees was admitted to the hospital with “fever,” according to a lawsuit filed in federal court by Dr. Craig Brummer, a former medical director of emergency departments at two H.M.A. hospitals.

In one case, an 18-year-old Medicaid patient with a right-knee laceration was admitted, though he could have been treated and discharged, Dr. Brummer said in his lawsuit.

Executives who raised questions about H.M.A.’s policies and procedures were often fired.

When Jacqueline Meyer, a regional administrator for EmCare, a company that provided emergency room physicians to a number of H.M.A. hospitals, refused to follow H.M.A.’s directives and fire doctors who admitted fewer patients than H.M.A. wanted, she was fired, according to the lawsuit she filed with Mr. Cowling. The Justice Department has not yet decided whether to join her lawsuit against EmCare, which declined to comment.

Likewise, shortly after Ralph D. Williams, an accountant with 30 years’ experience in hospital management, was hired as the chief financial officer for an H.M.A. hospital in Monroe, Ga., he asked an outside consulting firm to review the hospital’s inpatient admission rate.

When Mr. Williams showed the report, which confirmed a higher admission rate, to a higher-level division executive, he was told to “burn it.” Mr. Williams was soon fired, according to a qui tam lawsuit Mr. Williams filed in federal court in Georgia.

The last year has been particularly tumultuous for H.M.A., starting with the announced departure of Mr. Newsome, a battle for control of the board with Glenview Capital Management, the hedge fund founded by Lawrence M. Robbins, and the announcement of the acquisition by Community Health Systems.

The merger — and the fact that Glenview controlled big blocks of stock in both H.M.A. and Community Health — recently drew fire from some critics who questioned whether shareholders knew enough about the whistle-blower lawsuits before they voted on the merger.

H.M.A. has disclosed in regulatory filings dating back almost two years that it was the subject of investigations by attorneys general in numerous states. But the shareholder vote on the merger started before the Justice Department joined the multiple lawsuits and the company disclosed that fact.

“I find it incredibly troubling that a few days after voting had started on the merger that the company announced that the Justice Department was joining a bunch of these suits,” said Randi Weingarten, the president of the American Federation of Teachers. The union represents nurses at some of the company’s hospitals, but also trustees of teacher pension funds that own shares.