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Govtrackus Is Taking A New Focus On Civic Education
Help us develop the tools to bring real-time legislative data into the classroom.
If youve visited a bill page on GovTrack.us recently, you may have noticed a new study guide tab located just below the bill title. This is part of a new project to develop better tools for bringing real-time legislative data into the classroom. We hope to enable educators to build lesson plans centered around any bill or vote in Congress, even those as recent as yesterday.
Were looking for feedback from educators about how GovTrack can be used and improved for your classroom. If you teach United States government and would like to speak with us about bringing legislative data into your classroom, please reach out!
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Progressive Lawmakers Demand Fraud Probe Into Medicare Privatization Scheme
A group of progressive lawmakers led by Sen. Elizabeth Warren and Rep. Pramila Jayapal is calling on Biden health officials to immediately launch a fraud probe into the organizations taking part in ACO REACH, a slightly reformed version of a Medicare privatization scheme that the Trump administration set in motion during its final months in power.
In a Thursday letter to Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services , 21 members of Congress voiced alarm that the ACO REACH pilot “provides an opportunity for healthcare insurers with a history of defrauding and abusing Medicare and ripping off taxpayers to further encroach on the Medicare system.”
“No matter the name, these systems are designed to create profit for private insurers by delaying or denying care.”
The newest version of the program, which entails shifting some traditional Medicare recipients onto privately run insurance plans without their knowledge or consent, is scheduled to formally begin on January 1, months after CMS announced largely cosmetic changes to the Trump-era Global and Professional Direct Contracting model.
The lawmakers noted in their letter that Physicians for a National Health Program a doctor-led group pushing for the complete termination of ACO REACHhas identified at least 10 GPDC Direct Contracting Entities with records of “healthcare fraud, abuse, and violations of healthcare laws prior to 2021.”
Other Criminal Statutes Applicable To Health Care Providers
Although there are a large number of criminal laws that can affect a health care provider, the laws addressing fraud are perhaps most likely to spawn a criminal investigation. In the area of health care, criminal fraud often concerns either billing or referrals. The more commonly used statutes briefly described below will in many situations overlap with each other as well as with statutes not described here.
Health Care Fraud, 18 U.S.C. § 1347
Mail and Wire Fraud, 18 U.S.C. §§ 1341,1343
The mail and wire fraud statutes are similar to the health care fraud statute, but broader in that they do not require the fraudulent conduct to have occurred in connection with the delivery of or payment for health care benefits, items, or services. Rather, a violation of the mail and wire fraud statutes requires that a person have devised or intended to devise a scheme to defraud and used the interstate mails or wires for purposes of executing the scheme. In practice, the mail and wire fraud statutes can be used to prosecute almost any form of fraud or white collar crime. Conduct in violation of the health care fraud statutes often violates the mail and/or wire fraud statutes as well. Each use of the mails or wires constitutes a separate violation of the statute. Each violation can be punished by a fine of up to $500,000, twice the gross gain from the offense, or twice the gross loss caused by the offense, as well as imprisonment for up to twenty years, or both.
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Stories Chosen For You
Abby Zimet, Common Dreams ruled one more time foundtally
Still, until that latest string of debacles, he’d been getting away with a lot for a guy who’d been long digging a brazenly illegal hole – or more accurately warren – that should have landed him in prison decades ago. Maintaining the delusion he and his cult followers are above the law, he just made a video for a “Patriot Freedom Project Holiday Open House” – yes, MTG named it – to support those poor people in jail for trying to overthrow the government on Jan. 6. “It’s a very unfair situation, and we’re going to looking about it and talking about it very, very strongly,” he babbled, playing his air accordion. He escaped unscathed from the Dining-With-Nazis-and-Urging-We-Terminate-the-Constitution fiasco thanks to reptilian Republicans who could only stammer out alimp “the question is how we move forward” and people will “take into consideration a statement like this.” Mainstream media wasn’t much better: Two days later, on Page 13, the New York Times reported his call for terminating the Constitution “draws rebukes.” Twitter: “Hitler’s plan to exterminate the Jews draws rebukes.” And the frantic rants of HOAX AND SCAM AND FRAUD! kept coming.
Hundreds of Oath Keepers
“Extremism within our government is always alarming, but even more so in a department with a law enforcement and national security nexus like DHS.”
According to the report:
Where Can I Learn More
The MFCU operates pursuant to a federal grant program operated by the Medicaid Fraud Unit Oversight Division located in the Office of Evaluations and Inspections of the United States Department of Health and Human Services Office of Inspector General . Additional information on the Units jurisdiction and performance may be found at OIG.HHS.gov.
Information on the South Carolina Medicaid program and its commitment to maintaining program integrity may be found at SCDHHS.gov.
The MFCU is a member of the Adult Protection Coordinating Council . The APCC is comprised of numerous public and private entities whose mission is to foster coordination and cooperation in a combined effort to protect South Carolinas Vulnerable Adults. Information on the APCCs structure and services may be found at SCDHHS.gov.
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Federal Funding For State Medicaid Fraud Control Units Still Needed
HRD-81-2Skip to Highlights
Medicaid fraud costs American taxpayers millions of dollars annually. To help reduce the losses, Congress enacted the Medicare-Medicaid Anti-Fraud and Abuse Amendments authorizing 90 percent Federal matching payments for fiscal years 1978-80 as an incentive for States to establish Medicaid fraud control units. It was expected that this financial relief would enable many State Governments to establish new units or expand existing ones and that, after the units had been in operation a few years, they would begin to recover from prosecutions amounts equal to or exceeding their operating costs. The Department of Health and Human Services Office of the Inspector General is responsible for certifying, funding, and monitoring the fraud control units. GAO reviewed 7 of the 30 existing State certified fraud units.
Red Flags For Fca Fraud
FCA fraud is usually committed in order to receive higher Medicare reimbursements. To achieve the highest possible reimbursement, offenders often create complex schemes to falsify claims. These schemes can involve the collection of Medicare information through patient recruiters or fraudulent billing practices like upcoding.
Other Medicare abuses may be unintentional, the result of an organizational or individual failure to properly record services. This can happen when healthcare facilities do not adequately allocate their resources to ensure that invoices are meticulously completed.
It is important that healthcare providers report any discrepancies on previous claims and reimburse Medicare accordingly, but infrequent, unintentional errors are unlikely to be considered FCA violations.
The government is largely disinterested in prosecuting cases based upon mistakes or miscalculations, explains Morgan & Morgan Complex Litigation Group attorney James D. Young. The purpose of the False Claims Act is to root out fraud, not billing errors. There are numerous other regulatory mechanisms to hold providers accountable for their mistakes.
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Civil Monetary Penalties Law
OIG may seek civil monetary penalties and sometimes exclusion for a wide variety of conduct and is authorized to seek different amounts of penalties and assessments based on the type of violation at issue. Penalties range from $10,000 to $50,000 per violation. Some examples of CMPL violations include:
- presenting a claim that the person knows or should know is for an item or service that was not provided as claimed or is false or fraudulent
- presenting a claim that the person knows or should know is for an item or service for which payment may not be made
- violating the AKS
