In a famous comment, Supreme Court Justice Potter Stewart said, “I shall not today attempt further to define the kinds of material I understand to be embraced [by the word obscene] . . . but I know it when I see it . . . ” Well, we may all feel we know what fraud and abuse are when it comes to Medicare payments . . . or do we? One person’s fraud and abuse may be another person’s essential benefit. The problem is WE REALLY DO know what constitutes fraud and abuse but we REALLY DO NOT know what constitutes essential benefits. So, with this conundrum in play, the Senate was able to vote today to cut some $43 billion in Medicare payments for home health care benefits for seniors over the next 10 years, as part of the attempt to pay for the health care reform package now being debated in Congress. The prevailing side, mostly Democratic, argues that the $43 billion in cuts are cuts only for overspending, fraud and abuse. The dissenting side, mostly Republican argues that cutting these funds will affect real people and have real consequences. In some sense, both are correct. There is fraud and abuse in home health care. It should be rooted out and prosecuted. However, a blanket cut in payments to providers is not rooting out fraud and abuse. It is taking an axe to the home health budget when a scalpel is what is needed. If this is the blueprint for health care reform as offered by the Democratic majority, we should be increasingly afraid of it. If the Senate believes that there is this much overpayment, fraud and abuse, where is their concern for the oversight of these payments. Why do they not have a hearing and investigate the actions, or lack of actions, of CMS and the administrative agencies resonsible for preventing overspending, fraud and abuse in federal programs? The action taken today is tacit admission that the executive branch cannot effectively administer federal tax dollars being spent in the Medicare program. It is also an admission that Congress is unable to effectively oversee this spending. As such, why would we want to give these same people even greater control over spending and an ever greater amount of dollars to administer? It is hard to understand the reasoning in play here. We can only hope that members of Congress will hear from their consitutants and that the people will ask why the government is not doing its job right now, instead of inacting wholesale cuts which will surely fall hard on seniors in America . . . obi jo
http://library.findlaw.com/2003/May/15/132747.html
http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=378&invol=184
By a vote of 53 to 41, the Senate on Saturday rejected a Republican effort to block cutbacks in payments to home health agencies that provide nursing care and therapy to homebound Medicare beneficiaries. Republicans voted against the cuts, saying they would hurt some of the nation’s most vulnerable citizens. Most Democrats supported the cutbacks, saying they would eliminate waste and inefficiency in home care. The Democrats’ health care bill would reduce projected Medicare spending on home care by $43 billion, or 13 percent, over the next 10 years. The savings would help offset the cost of subsidizing coverage for the uninsured. Four Democratic senators joined 37 Republicans in voting to block the home health cuts. The four were Evan Bayh of Indiana, Blanche Lincoln of Arkansas, Ben Nelson of Nebraska and Jim Webb of Virginia.
Senate Clears Way for Home Health Care Cuts – http://www.nytimes.com/2009/12/06/health/policy/06health.html?_r=1&emc=tnt&tntemail0=y
Senate Republicans forced Democrats to vote in favor of cutting billions from providers of home care for older people as partisan debate flared Saturday during a rare weekend session on President Barack Obama’s health care overhaul. Obama planned to travel to Capitol Hill on Sunday to help Democrats resolve internal disputes that stand in the way of Majority Leader Harry Reid bringing the 10-year, nearly $1 trillion legislation to a vote. Ahead of his visit, Republicans, bent on making Democrats cast politically risky votes, offered their third amendment in the debate so far showcasing more than $400 billion in cuts to projected Medicare spending that would pay for the bill, mostly for subsidies to help extend coverage to millions of uninsured. Like the other two, this one went down to defeat, on a vote of 53 to 41. The measure by Sen. Mike Johanns, R-Neb., would have eliminated $42 billion in cuts over 10 years to agencies that provide home health care to seniors under Medicare.
Medicare cuts focus of Senate health care debate – http://news.yahoo.com/s/ap/20091205/ap_on_bi_ge/us_health_care_overhaul
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