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VOR MEMBER TO DO LIST:
1. Return Proxy Today
2. Register for the VOR Annual Meeting and
Washington Initiative - see
http://vor.net/AnnualMeeting2006.html for
details (nonmembers are welcome)
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VOR Weekly E-Mail Update
April 14, 2006
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HOUSEKEEPING
1. PROXIES SENT - Please Respond!!!
2. VOR Annual Meeting and Washington Initiative
Coming Up Quickly -
Register Today!!
BUDGET UPDATE and FOCUS ON FRAUD
3. THANK YOU FOR RESPONDING TO VOR's ACTION
ALERT -- WE HAVE GOOD NEWS
4. More on Medicaid: Congress looks into
Medicaid Fraud
5. The Deficit Reduction Act establishes new
Medicaid Integrity Program;
GAO gives thumbs up
6. Lawmakers Hit Deadlock on False Medicaid
Claims
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1. PROXIES SENT - Please Respond!!
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All VOR members in good standing recently
received the VOR proxy to elect
VOR Board Members. We are required to have
official voting completed by the
Annual Meeting, which means we need a quorum. To
achieve that quorum
members have to respond!
Please send in your proxy today! Doing so will
save VOR the time and money
needed to follow-up with members to achieve a
quorum. Thanks for your help!
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2. VOR Annual Meeting and Washington Initiative
Coming Up Quickly -
Register Today!!
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Time is running short! Please register today.
Visit
http://www.vor.net for
complete agenda details, hotel information and a
registration form. The
deadline for hotel rate and availability is May
8!
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3. THANK YOU FOR RESPONDING TO VOR's ACTION
ALERT -- WE HAVE GOOD NEWS
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From Families USA:
Good news this morning! Leaders in the House
acknowledged last night they
do not have the votes to pass their Fiscal 2007
budget resolution.
The deal fell apart when moderate Republicans
demanded more discretionary
funding, conservatives wanted more assurances
about changes to the budget
process to limit future spending, and
appropriators became concerned that
budget process changes would limit their power.
Majority Leader Boehner may try to revive a deal
after the two-week recess,
but it won't be easy.
The House budget resolution is $10 billion below
the level needed to
maintain current services and does not include
the funds necessary to
extend TMA or fill in the next year's SCHIP
shortfall. In addition, the
resolution includes reconciliation instructions
requiring committees to cut
$6.7 billion. The Ways and Means Committee is
instructed to cut $4 billion
from programs under its jurisdiction. Budget
Chairman Nussle has said
Medicare is not the target of this cut. However,
the Ways and Means
Committee has the power to determine how those
cuts will be made.
What happens if there is no resolution? There is
no legal requirement
Congress have a budget resolution. Without one,
by mid-May the House and
the Senate will vote on a "deeming resolution"
that will simply set the
overall discretionary amount. (The House and
Senate may differ on that
number). Then the appropriators will start
working off that number and
begin passing bills. The same disagreements in
play during this week's
budget struggle will resurface again in the fall
at the end of the
appropriations process.
THANKS TO ALL WHO CALLED, FAXED AND E-MAILED!!
OUR VOICES WERE HEARD!
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4. More on Medicaid: Congress looks into
Medicaid Fraud
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On Tuesday, March 28, 2006, the Subcommittee on
Federal Financial
Management, Government Information, and
International Security held a
hearing entitled, "Bolstering the Safety Net:
Eliminating Medicaid Fraud."
The hearing was convened to examine the current
infrastructure for Medicaid
program integrity at the state and federal
level. Recent challenges to the
current system, as well as some recent progress
in these areas,
necessitates a review of the current system for
tracking improper spending
and fraud at the state and federal levels.
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5. The Deficit Reduction Act establishes new
Medicaid Integrity Program;
GAO gives thumbs up
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The Deficit Reduction Act created the Medicaid
Integrity program that
included specific appropriations that CMS can
use to fund anti-fraud
efforts, including enhanced CMS staffing for
this purpose. CMS is to
develop a comprehensive plan to address Medicaid
fraud, abuse and waste.
The Government Accountability Office (GAO)
concluded that the program is a
unique opportunity to apply federal resources to
the problem of state-
level abuses and waste in the Medicaid program.
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6. Lawmakers Hit Deadlock on False Medicaid
Claims
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Summary: The March 28 New York Times describes
the political machinations
going on in New York about Medicaid fraud.
Experts estimate that abuse of
New York's $44 billion Medicaid program, from
outright fraud to heedless
waste, costs the state billions of dollars a
year, and Gov. George E.
Pataki and legislative leaders say that
combating it is one of their top
priorities..
Lawmakers Hit Deadlock on False Medicaid Claims
March 28, 2006
By Richard Pyrez - Pyra and Danny Hakim
The New York Times
Eight months after promising action against
Medicaid fraud, state lawmakers
have deadlocked on two pivotal issues: whether
to allow individuals to file
whistle-blower lawsuits over abuses, and whether
New York's next governor
will get to choose the chief Medicaid
enforcement official.
Experts estimate that abuse of New York's $44
billion Medicaid program,
from outright fraud to heedless waste, costs the
state billions of dollars
a year, and Gov. George E. Pataki and
legislative leaders say that
combating it is one of their top priorities..
Attorney General Eliot Spitzer and the Democrats
who control the Assembly
insist that whistle-blower suits would bring
many more fraud cases to
light. That view is supported by officials from
both parties in states that
have laws authorizing such suits, and in
Congress, which has urged all
states to adopt them.
The Republicans who run the State Senate do not
want to allow the suits,
saying that the Assembly's proposal would lead
to a flood of litigation
brought by prospecting lawyers, whom they
likened to bounty hunters, and
could actually cost the state money. "They're
really just doing it for the
trial lawyers," said Senator Kemp Hannon, a
Republican from Nassau County
and chairman of the Health Committee.
Assemblywoman Helene E. Weinstein, a Brooklyn
Democrat who is chairwoman of
the Judiciary Committee, contended that "under
the Senate's position, a lot
of fraud would go undiscovered, people would get
away with it, and the
state would miss out on a huge amount of
money.".
The plan to hire an inspector general to
investigate Medicaid fraud has
similarly hit a major roadblock. The governor
and Senate Republicans want
to give Mr. Pataki, who is not running for
re-election, the power to
appoint the inspector general for a five-year
term. The Assembly Democrats
have cried foul, mindful that a Democrat ? Mr.
Spitzer ? is the
front-runner in November's election for
governor, and that a five-year
appointment made this year would outlast the
next governor's term.
"I think it's very important to have a dedicated
individual and team that
have one focus," Mr. Pataki said.
Assembly Speaker Sheldon Silver said, "They just
want George Pataki and his
appointee to be able to make policy for the next
administration."
The two sides also disagree on the powers that
should be given to the
inspector general; Republican leaders want the
post to have sweeping
authority; top Democrats say that that amounts
to making Medicaid policy
that should be left to lawmakers and the
Department of Health.
The dispute reflects the age-old difficulty in
getting much of anything
done in Albany, where partisan division and the
clash of powerful interest
groups can make the machinery of governing lurch
to a halt. In this case,
the hospital industry opposes the whistle-blower
suits and the trial
lawyers' lobby favors them.
The Medicaid stalemate has become a serious
obstacle in negotiations over a
state budget, occupying much of the time in
legislative meetings over the
last two days. In their budget proposals, both
houses of the Legislature
have banked on $325 million in savings over the
next year from combating
Medicaid fraud ? a number that experts call
highly unrealistic for an
effort that has yet to take shape.
"I believe unless we get an agreement, there
will be a $325 million hole in
the budget, and quite frankly, with that type of
hole I don't know how we
go forward," Senator Dean G. Skelos, a
Republican from Nassau County, said
during an unusual Sunday meeting of the budget
committee of each house.
The fiscal year ends Friday night, and lawmakers
are intent on replicating
their feat of passing an on-time budget,
something they did last year for
the first time in 21 years.
The Assembly and Senate are intent on concluding
their own negotiations by
today, and legislators are optimistic they are
on track. Yesterday, they
reached an agreement on higher education,
rejecting Mr. Pataki's proposed
tuition increases at SUNY and CUNY and most of
his cuts to tuition
assistance programs. Negotiations over public
school financing and tax cut
proposals were not resolved last night.
The disagreement over whistle-blower lawsuits
has also created a curious
disagreement between Republicans in Washington,
who favor the provisions,
and Republicans in Albany. And as the two houses
of the Legislature fight
over the issue, Mr. Pataki has not taken a
position on it.
A 1986 federal law, the False Claims Act,
provides that anyone who gets
federal money through fraud or knowingly misuses
the money can be forced to
repay triple that amount. The law also made
every American a potential
watchdog over federal spending not only can the
government sue when it
spots abuses, so can any citizen, acting, in
effect, for the government, or
"qui tam" in legal terms.
Those citizen suits produce about $1 billion a
year in judgments and
settlements ? about two-thirds of all the money
recovered under the False
Claims Act and most of those cases deal with
Medicaid and Medicare. The law
lets the plaintiff keep a share of the damages
the defendant pays to the
government typically about one-sixth so a
successful whistle-blower can
reap millions of dollars.
The Department of Justice can join citizen suits
as a plaintiff, but with
limited resources, it usually takes on only the
biggest cases. Most of the
400 or so whistle-blowers who sue each year are
left to handle the cases
without government help.
For years, Senator Charles E. Grassley, an Iowa
Republican who was the
primary author of the law, has urged states to
adopt similar laws so that
people can sue for triple damages in state
courts. But only 15 states and
the District of Columbia have done so, according
to Taxpayers Against
Fraud, a group run
primarily by lawyers who handle false claims
cases.
"This whistle-blower incentive is the key to
state False Claims Acts," said
Mr. Grassley, who is chairman of the Finance
Committee. "When fighting
fraud, the more deputies you have, the more
crooks you can catch."
He and other advocates of citizen suits say that
the most important thing
they do is generate many more cases precisely
the outcome New York's Senate
Republicans say they fear. Senator Hannon said
that in such cases, money
that should go to the government goes instead to
lawyers.
"We have bounty hunters and we're going to give
them 25 percent, 30 percent
of the recoveries," he said.
But officials in states that have laws like the
federal one say that
whistle-blower suits are a powerful weapon
against fraud. Patrick
O'Connell, chief of the Civil Medicaid Fraud
Section in the Texas attorney
general's office, said that "probably 98
percent" of the Medicaid fraud
claims his office receives arrive via such
suits, and that "it's the
extreme minority of cases so far that I have
found to be baseless."
Senator Grassley inserted a provision into a
federal budget bill, enacted
in December, to offer a financial incentive for
states to adopt their own
Medicaid false claims laws. States and the
federal government share the
costs of Medicaid, so they also share the money
recovered in fraud cases.
The new law can increase the states' share of
those damages ? to 60 percent
from 50 percent in New York's case, a difference
of tens of millions of
dollars a year.
Republicans in the New York State Senate say
their proposal complies with
Senator Grassley's provision.
Senator Grassley and his aides declined to take
issue with New York
officials directly, but they clearly disagree.
They pointed to a passage in
the new federal law about what a state must do
to qualify for a larger
share of Medicaid fraud damages. It says that a
state law must contain
"provisions that are at least as effective in
rewarding and facilitating
qui tam actions" as the federal law.
Senator Skelos, a leading opponent of
whistle-blower suits, said, "In terms
of Senator Grassley, he's one of a hundred
senators."
"Like in Albany, with 212 legislators, we can
all have our opinions."
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vor@compuserve.com or 605-399-1624 with any
questions.
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