AAPS News February 2014 – Equality and Fairness

AAPS News February 2014 - Equality and Fairness

AAPS News February 2014 – Equality and Fairness
Jan 25, 2014
Volume 70, no. 2.

Economic “disparity” and income inequality are set to be the Democrats’ defining issue of 2014. Obama referenced Pope Francis in a Dec 4 speech and plans to meet with him at the Vatican in March for an “inequality summit” (Guardian 1/23/14).

“The president looks forward to discussing with Pope Francis their shared commitment to fighting poverty and growing inequality,” said White House spokesman Jeb Carney.

Poverty and citizens’ well-being are not, however, Obama’s main concern. During the 2008 election, Obama was asked whether he would favor a higher capital gains tax rate, even if it brought in less revenue. Yes, he answered. Yet everyone would be worse off, including the poor who depend on government, notes John Goodman.

The American public is responding. Gallup’s Jan 5-8 Mood of the Nation survey included a question asking Americans how satisfied they are with income and wealth distribution in the U.S. Few, 7%, report that they are “very satisfied” with the distribution, while 39% of Americans say they are “very dissatisfied,” and a total of 67% are dissatisfied.

The Pope, like many others, “falls into the trap of conflating inequality and poverty,” writes Ben Domenech. “Some countries enjoy income parity because most citizens are rich and others because most citizens are poor…. Egypt, Pakistan, and Mongolia all enjoy more economic equality than the United States. The GDP per capita here is $49,800. In a country like Argentina, the Pope’s homeland, a place where wealth is more fairly distributed, it’s $18,200” (The Transom 12/3/14).

“Equality”: the Socialist Obsession
Exploiting the politics of envy to promote income equality (for the masses, not the ruling elite), as opposed to equality under the law, is the signature tactic of Marxism. The abolition of private property, central to The Communist Manifesto, had consequences unforeseen by its promoters: the death of tens of millions of people. Now the goals are masked: “if you like your private life [your individual mind, your private property], you can keep it,” while your rights are constantly eroded (Daren Jonescu, American Thinker 11/26/13).

Socialism began as a Christian heresy, writes Tom Bethell, citing the 1980 book The Socialist Phenomenon by Soviet mathematician Igor Shafarevich (American Spectator, July/August 2013). “It is shocking…how many intellectuals in the West supported the overall socialist mission.”

Although the Catholic Church has “officially condemned socialism, communism, and Marxism by name,” writes Jonescu, members of the church hierarchy have been “deeply invested in progressive collectivism” for generations. Marxist vocabulary has been baptized in the Christian faith. “Justice” in this parlance means “economic equality achieved through redistribution, i.e. the universal annihilation of profit, property, and prosperity” (American Thinker 12/3/13).

The Pope attacks free-market capitalism because it takes too long for the poor to get rich, writes Judge Andrew Napolitano. But “without capitalism, which rewards hard work and sacrifice, they will wait forever” (James Cook Market Update 12/13).

ObamaCare “Equality”
The Affordable Care Act (ACA) mandates huge disparities in what Americans are obligated to pay for plans. A healthy, single, 54-year-old man in San Francisco, earning more than $45,959/yr, would have to pay $5,436/yr in premiums for the least expensive Bronze plan that covers 60% of costs after a $5,000 deductible. A 54-year-old obese, frequently unemployed alcoholic, on the other hand, who earns a little too much to qualify for Medicaid ($15,860), would pay a premium of only $12/yr. The monthly premium for a Platinum plan would be $843 and $258, respectively. This is “redistribution…on a scale never before seen in this country” (Frontpage Mag 1/6/13).

The huge unfair tax on young men to subsidize others has been called a “war on bros.” The modified community rating means that they are effectively paying a 34.8% sales tax on their expected medical expenses. New taxes, plus the 2% premium tax embedded in historic rates, amount to a 9.4% tax on Exchange premiums (Forbes 1/13/14).

Constant waivers and exemptions compound inequities and lead to chaos (Forbes 12/10/13).

Then there is the definition of income, observes Craig Cantoni. Many cannot earn enough after-tax income to compete with untaxed entitlements like food stamps and Medicaid.

Widening the Gap
The main force that concentrates wealth in fewer hands is big government, writes David Malpass (WSJ 1/16/14). The “War on Poverty,” which spends $1 trillion/yr on 126 means-tested welfare programs, is a war on the poor, writes John Goodman. Without it, economic growth should have mostly eliminated poverty by now: an American would have a 3 in 100 chance of being born into poverty, instead of nearly a 1 in 2 chance of a birth paid for by Medicaid. This is not likely to be on the summit agenda.

ObamaCare Fallout

  • Hospital Can’t Meet Payroll. According to a local Houston TV station, ABC-KTRK, more than 150 hospital employees have not been paid in a nearly a month. Novitas Solutions, the contractor building the financial management system for Healthcare.gov, is being blamed for delayed Medicare payments.
  • CGI Group Denied Payment. The ObamaCare website designer is being denied payment on its $69 million contract for Massachusetts and Vermont websites because of dysfunctional Exchange sites that haven’t been fixed (ibid.)
  • Cancer Treatment on Hold. When a patient’s insurance rolled over into an Exchange plan, she lost access to her cancer surgeon and is having trouble finding comparable doctors in the new plan.
  • Marriage Penalty. Adding to penalties in the tax code and welfare system, ACA’s preferential treatment of cohabiting couples in calculating subsidies can cost a couple who marry more than $7,000/yr.
  • No Coverage for Travelers. Unlike their former plans, many find that their Exchange plans have local networks only. In a winter or summer home, all medical treatment may have to be paid out of pocket—and expenses will not count toward the deductible.
  • Patients Leave ER without Treatment. On Jan 2, a Virginia hospital told patients they would be billed for full cost if they could not prove they were insured after they thought they had signed up with an Exchange. One declined a chest xray (>$500!). One declined admission for chest pain ($3,000 for a day) (Mail Online [UK]). A Gallup survey showed that 59% of Americans had had a negative experience with ACA (ibid.).

ObamaCare Landmines

  • 1 in 7 Navigators in Crime Database. According to an investigation by National Review, the names of 38 New Mexico certified Navigators showed up in the FBI’s National Crime Information Center database. But an official in the state’s ACA implementation project says this does not mean they pose any risk to consumers.
  • Data Security Worse. Cyber warfare expert David Kennedy, who in 4 minutes wrote a program to extract 70,000 users’ data from Healthcare.gov, says website security is still worse today), despite congressional testimony to the contrary. The claim not to have detected attacks is “deeply disingenuous,” Kennedy said. They haven’t because they can’t. Unlike Target, the government is not required to notify you if your information is breached.
  • Telephonic Signatures. To create a “streamlined application process,” the Obama Administration mandates that states accept voice signatures on ACA applications that must be signed under penalty of perjury. Such signatures are accepted for collecting benefits or voter registration—but not for tax forms. Security is not assured, and perjury prosecutions are hindered.


Reach out to medical students. Invite them to a meeting and recommend them for a scholarship. Contribute to the AAPS Educational Foundation. Sponsor an open house at your office.

New Student Chapter at Creighton

AAPS thanks medical student Alyssen Bell for setting up an official student chapter at Creighton University School of Medicine, with the help of AAPS past president Lee Hieb, M.D. Please contact us at [email protected] if you would like to help with a student chapter in your area.

AMA Selling out Doctors and Students

According to reports from AMA delegates at state medical society meetings, the AMA, to keep its “seat at the table,” is planning to accept a “voluntary” fee freeze for 10 years in return for repeal of the Clinton-Gingrich Sustained Growth Rate (SGR) formula. Physician fees have already been essentially frozen for more than 10 years. With continuing debasement of the dollar, frozen revenue with constantly increasing expenses is a formula for bankruptcy. At the same time, the AMA says nothing about the fact that fees for nurse practitioners and physician assistants are set at 85% of physicians’ fees. Why should medical students incur huge debts? AMA policy would sentence them to a lifetime of indentured servitude, writes AAPS past president Kenneth Christman, M.D. Students need to join AAPS to learn of the perils of government medicine, and of the path to a private alternative.

Hospice Industry Answers Obama’s Call

A multi-million dollar, year-long ad campaign will begin in January, encouraging people to seek hospice services 3-6 months before the anticipated end of life. The industry’s stake in ObamaCare is that 5.3 million Medicare beneficiaries will be in Accountable Care Organizations (ACOs). As Obama noted in 2009, sometimes elderly people will be “better off not having the surgery, but taking painkillers”

Transparency Too Burdensome for Government

The White House opposes the Health Exchange Security and Transparency Act (H.R. 3811) introduced by Rep. Joe Pitts (R-PA), which would require notifying individuals of security breaches by ACA Exchanges. It also objects to weekly reporting on enrollment and operations of Healthcare.gov. It called the requirements “unfunded, unprecedented, and unnecessary.” Notifying individuals of data breaches in a timely manner would “create unrealistic and costly paperwork requirements.”

AAPS Calendar

Jan 31-Feb 1. Workshop, board meeting, Louisville, KY.

Feb 12, 19. CME by Webinar; (details coming soon).

May 9-10. Workshop, board meeting, Minneapolis/St. Paul.

Sept. 2-6. 71st annual meeting, Charleston, SC.

AAPS, MSSNY Support Petition for Dr. Natale

The Medical Society for the State of New York joined with AAPS in filing an amicus brief supporting the petition for writ of certiorari to the U.S. Supreme Court on behalf of Dr. John Natale. Dr. Natale served 10 months in federal prison for making “false statements,” and his conviction was upheld by the Seventh Circuit Court of Appeals (AAPS News, July 2013).

Amici oppose elimination of the longstanding requirement for proof of criminal intent in connection with the federal prosecution of physicians.” The jury found that Dr. Natale did not defraud anyone, but merely made mistakes in his dictation of reports of complex operations.

“Federal incarceration should not hinge on an academic inquiry into whether terminology used by a physician…is the same wording that most other physicians might use.”

The Seventh Circuit acknowledged the chilling effect on medical practice, but declared that only Congress could rectify it. Amici argue that Congress did not dispense with the mens rea requirement, nor could it within the bounds of the Constitution.

“Poor Quality” = “False Claim”

The HHS Office of Inspector General (OIG) is placing top priority on “high quality” of care. It will review events that cause patient harm and refer providers for prosecution “when necessary,” according to the strategic plan released in November. Another key focus is access to and use of preventive care and quality improvement programs. It is difficult for physicians who do not use electronic medical records to assess performance, as by determining what percentage of patients received tobacco cessation counseling. Additionally, private payers are likely to terminate contracts with physicians who do not meet quality and outcomes metrics (Medical Practice Compliance Alert 1/20/14).

New Fraud Penalties; More Enforcement

Proposed Senate legislation to reform the SGR would also “strengthen” penalties for Medicare and Medicaid fraud. One anti-fraud provision would require all prescription drug plan sponsors to require a valid prescriber identifier for all Medicare Part D pharmacy claims.

In 2014, physicians enrolled in federal insurance programs will face increased scrutiny from integrity contractors. ACA and ICD-10 implementation also impose increased compliance burdens to avoid violating fraud provisions.

The authority to exclude providers has previously focused on executives at large companies, but attorney Laurence Freedman said “I think CMS is poised to seek some high-level individual exclusions, and DOJ is poised to pursue more individuals under the FCA [False Claims Act] and criminally.”

In fiscal year 2013, the HHS OIG excluded 3,214 individuals and corporations from participation in federal health-care programs, worked on 960 criminal actions, was involved in 472 civil actions including FCA cases, and expects to recover $5.8 billion.

A proposed CMS rule would require Medicare Advantage plans and Part D sponsors to identify and return any overpayments received during the past 6 payment years, and would allow seeking information from any contractors (HCFR 1/8/14).

More Limits on Prescribing

A 678-page rule proposed by CMS on Jan 6 would require that all prescribers of drugs covered under Part D Medicare be enrolled in Medicare. At present, prescribers only need to have an active state license that permits prescribing. The proposed rule would also allow CMS to revoke the enrollment of any provider who overprescribes drugs such as opioids or acetaminophen—or “has a pattern of prescribing Part D drugs that…represents a threat to the health or safety of Medicare beneficiaries or otherwise fails to meet Medicare requirements.” Comments are due by Mar 7.

CMS is in effect restricting Medicare beneficiaries’ ability to use their benefits if they see a physician outside the system. This rule would close the loophole for prescription medications, to which the current “ordering and referring” rule does not apply, writes Lawrence Huntoon, M.D., Ph.D. Pharmacies may incorrectly interpret this rule to mean they should refuse to fill prescriptions written by non-PECOS physicians. They should be required to fill valid prescriptions written by independent physicians as long as the patient agrees to pay out of pocket.

“The apparent goal is to totally destroy the ability of independent physicians to practice medicine. Yes, you can see patients, but you can’t order anything for them. This is like telling an auto mechanic he can fix cars but he can’t use tools.”

Tip of the Month: Physicians lose rights in a settlement negotiated by medical societies in a class action suit against Aetna. Ignoring the settlement results in a waiver of 10 years of claims. The deadline for action is Feb 26. Out-of-network physicians who accepted assignment on claims were underpaid because of Aetna’s use of the Ingenix database to determine usual and customary fees. Patients of out-of-network physicians who did not accept assignment were underpaid; physicians may wish to notify them of systematic underpayment and of the deadline for filing a claim. By accepting Option 1, physicians may receive up a maximum of $40/yr ($400). Option 2 might return more but requires extensive acceptable documentation of underpaid claims. To preserve the right to sue, physicians must ask to be excluded.

Huge HIPAA Fines Expected

A dermatology practice will pay $150,000 because an unencrypted thumb drive containing protected health information on about 2,200 patients was stolen from an employee’s vehicle in 2011. The practice had not conducted a risk analysis of security vulnerabilities as required by the Health Insurance Portability and Accountability Act. The Office of Civil Rights (OCR) is sending a message that it will not allow covered entities, even small physicians’ offices, to ignore fundamentals such as training personnel and adopting policies and procedures (MPCA 1/20/14).

Of 115 entities audited during a pilot program, only 11% were in good compliance. So far, settlement agreements have been for only a “fraction” of what could have been imposed. More than 700 large breaches are posted on the HHS “wall of shame.”

Under a new provision of HIPAA courtesy of the HITECH Act, OCR has the right to request restrictions on treatment to patients who pay in full out of pocket (MPCA 1/6/14).


Opt-out Renewal. I finally won the battle with CMS that I have been fighting since August 2013. To avoid problems with not having a valid opt-out if I saw a Medicare patient, I submitted my opt-out renewal 90 days before it expired, just as I have before. Medicare regulation 42 CFR §405.445(a), cited in CMS Transmittal 160 Pub 100-02 in the CMS Manual, states that a physician can renew the opt out as long as it is filed within 30 days after the current opt-opt period expires. In its instructions to contractors, CMS absurdly interpreted this to mean the renewal could be filed only within the 30 days after expiration. Therefore, the carrier refused to process my renewal. I was repeatedly instructed to wait until expiration before filing. I submitted opt-out affidavits nearly every day for 3 months, and each time the carrier adamantly refused to process it. I wrote about 100 letters to NGS and CMS during this period., asking why one would wait until the opt out expires if one wanted to maintain a continuous opted-out status.

How many CMS bureaucrats does it take to interpret a regulation that CMS itself wrote? Apparently, quite a few. The CMS Division of Financial Management and Fee for Service Operations sent the concern to the Provider Enrollment Operations Group (PEOG), which referred it to CM (Centers for Medicare), which agreed with my logical, plain-English interpretation. A letter from CMS posted on the AAPS website should be helpful to other physicians facing this problem.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

Will ObamaCare Collapse? The ACA is all about increasing federal control over medicine and decreasing the freedom of patients and physicians. It is designed to happen slowly and insidiously. It will take months to years for patients to realize what has happened, and by then it may be too late. Because of waivers and delays only 5 percent are now affected. And the Obama Administration has launched a $685 million public relations campaign to disguise the impending disaster.
Stanley Feld, M.D., Dallas, TX

Burdens. A Harvard study of families enrolled in “high-deductible” plans from the Massachusetts Connector considered burdens to include having a discussion with a doctor about costs, setting up a payment plan, or difficulty paying for other needs because of a medical bill. The additional premium cost to avoid a “burden” of a $3,500 family deductible was $7,190. High premiums or taxes, however, don’t count as burdens, even though they must be paid yearly regardless of the use of medical services.
Greg Scandlen, Consumers for Health Care Choices

Rights. The U.S. Declaration of Independence states: “That all men are created equal, that they are endowed by their Creator with certain unalienable rights.” The UN Declaration of Human Rights states: “Rights and freedoms may in no case be exercised contrary to the purpose and principles of the United Nations.”
Jim Vanne, Aurora, IL

Why Such High Unemployment? One of our top labor economists, Casey Mulligan of the University of Chicago, estimates that roughly half of the excess unemployment we are now experiencing is due to the lure of entitlement benefits—such as food stamps, unemployment compensation, and disability benefits. In other words, we are paying people not to work.
John Goodman, Ph.D., National Center for Policy Analysis

Two Strategies. We can be like Gandhi and refuse to participate and comply. Or we can be like Rosa Parks, occupy what is rightfully ours, and refuse to give up our seat. Both exercised their rights—defined by what the government cannot do to you.
Michael Riesberg, M.D., Pensacola, FL

In Hospital? Read Fine Print. Medicare patients can be subject to exorbitant hospital bills if they don’t carefully check their patient status. Some patients are unknowingly kept in the hospital under a different category called “observation status.” When this happens their admission is not covered by Medicare Part A. Also, while hospitalized they can be subject to multiple co-payments for various medications, procedures, and tests. Medicare currently requires that patients have at least three consecutive days of “inpatient status” in the hospital to qualify for recovery time in a skilled-nursing facility.
Joseph M. Scherzer, M.D., Scottsdale, AZ

HHS Objects to “Premium Charity.” HHS is worried about charitable payments for patients’ premiums. Some hospitals want to do this for their most frequent patients, not out of charity but so that they can get paid by the insurers. This makes the “affordable” premiums look bad, and it “skews the insurance pool and creates an unlevel field in the Marketplaces,” according to HHS. “Help from nonprofits or hospitals could speed the arrival of less healthy customers into the exchanges, outpacing the arrival of younger, healthier people who might not cross paths with hospitals” (WSJ 12/17/13). The Obama Administration is focused on the healthy, not the poor and the sick.
Twila Brase, R.N., Citizens’ Council for Health Freedom

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