Dear Dr. David R.,
The National Association of Drug Diversion Investigators (NADDI) is pleased to announce a brand new grant program for law enforcement agencies across the country. Thanks to Endo Pharmaceuticals, NADDI has obtained funding to provide 100 prescription drug take back boxes to distribute nationally. The boxes will be provided free to those agencies that are successful in their grant application.
The boxes, which are pictured in this release, are designed to be secured inside law enforcement facilities that will provide a depository for unwanted prescription drugs from households. NADDI continues to strongly support law enforcement-backed prescription take back programs but realizes that unwanted pharmaceuticals may remain in the household for months before those programs are available. Every day those remain in the households they become a potential target for those who would abuse the drugs, in particular our nation’s youth.
The law enforcement agency must agree to certain guidelines to ensure that the boxes are not tampered with in any way, and to provide a regular schedule for removing the prescription drugs that are deposited by their citizens. These drugs will then be handled in the same manner that other licit and illicit drugs are handled by law enforcement, likely with a court order to destroy the unwanted medications, leading to the ultimate proper destruction.
In addition, those agencies that are interested in additional boxes, or are not successful in the grant process, can purchase the boxes directly from NADDI and shipped to their agency. The same guidelines apply to those purchased as to those which are awarded through the grant. NADDI is also interested in the location of existing prescription drop boxes already in place by other law enforcement agencies for inclusion on our website.
Additional information can be gained by going to www.rxdrugdropbox.org
Charlie Cichon, Executive Director
John Burke, President
Posted on Wed, Apr. 20, 2011
More senior citizens are dying at home
By John Dorschner
jdorschner@MiamiHerald.com
After years of experts and patients saying people at the end of life might be more comfortable dying at home, a new study says that may finally be happening: fewer seniors in the United States and South Florida are dying in hospitals.
But the same survey finds that in the last months of life for seniors throughout the United States and especially in Miami, the trend is for more of them to see large numbers of specialists and to spend more time in expensive intensive care units.
Those are the results of the latest study from the Dartmouth Atlas, a project of the Dartmouth Medical School. The project for years has been using Medicare data to expose anomalies in healthcare costs and wide geographic disparities in expenses.
“Miami is practically off the charts,” says David Goodman, a Dartmouth researcher who was the lead author of the study. “It really continues to stand out” for having the highest costs and most extensive treatments in the last months of life, even when adjusted for age, ethnicity, race and severity of illness.
In particular, the study shows Miami leads the nation in seniors’ time spent in intensive care during the last six months of life – 10.7 days for the average Miami senior — compared with 0.7 days in Minot, N.D., the area with the least use of intensive care. In the Fort Lauderdale area, it was 7.2 days. The national average is 3.8 days, making Miami’s length of stay three times as long and Fort Lauderdale’s twice as long.
Disparities also exist by hospitals in the region. Mount Sinai Medical Center leads South Florida, with patients averaging 15.6 days in intensive care during their last six months. Aventura, Hialeah, Palmetto General and Metropolitan average more than 14 days. At the bottom: Cleveland Clinic in Weston (5.8), Mercy in Miami (6.1) and Homestead (7.7).
On Wednesday, Mount Sinai issued a brief statement that it’s not the hospital that makes the decisions: “We respect our patient’s preferences.”
The numbers are important for several reasons, researchers say. Intensive care often involves aggressive procedures, and surveys show that “patients have a strong tendency to want to avoid unpleasant procedures near the end of life,’’ says Goodman. Studies also show that three-quarters of Americans prefer to die in a “home or home-like environment” such as a hospice.
What’s more, “three clinical trials show that patients with advanced illness who received palliative and hospice care actually live longer than patients who receive aggressive treatment, which makes a lot of sense when you think of how fragile are the elderly when that treatments that purport to be life-sustaining, such as chemotherapy,” says Goodman.
Another crucial reason why these numbers are important: Medicare spending is a major reason for the nation’s crushing debt. Though this study doesn’t deal with costs, Goodman says earlier Dartmouth work has found that 32 percent of Medicare’s budget goes for care in the last two years of a senior’s life — expenses that often do little or nothing to postpone death.
The latest study, released last week, measures changes in the end-of-life treatment of chronically ill Medicare patients between 2003 and 2007. Delays in publishing the data are caused by the Atlas’ adjusting its figures for various factors, such as age and race. Other studies have consistently confirmed that other patients show the same treatment patterns as Dartmouth finds for seniors.
Over the five-year period, the study found the rates of deaths in hospitals dropped 12.8 percent nationwide. Locally, the rates dropped 13 percent in Miami and 19.9 percent in Fort Lauderdale.
Days in hospice increased 47 percent nationally, 50.6 percent in Broward and 15.5 percent in Miami over that time frame.
Once again, the differences between hospitals are major. At Mount Sinai, 43.5 percent of its longtime patients died there. The lowest figures in the region come from Memorial Pembroke and Cleveland Clinic hospitals, where 25.9 percent died in the facilities. The national average is 28 percent.
Goodman says Miami’s high costs are generally attributed to the area having a large number of hospital beds and a high number of physician specialists, causing both doctors and doctors to find ways of boosting business.
One reason patients may not get their wish to die at home could be “flaws in communications between physicians and patients,’’ says Goodman. Many doctors are trained to discuss treatments, not whether it is time to all end treatment, he said.
At Dartmouth’s medical center, an office has been set up specifically to counsel patients and families on end-of-life choices, often with specially trained nurses leading the discussions.
One puzzling aspect of the report: Fewer seniors dying in hospitals seems to indicate less aggressive care, but increased time in intensive care and more trips to specialists in the final months seem to indicate more aggressive care.
The Dartmouth data found that over the five-year period, the percentage of patients seeing 10 or more specialists in the last six months of life rose 17.2 percent nationally. In Broward, it increased 5.8 percent and in Miami 8.6 percent. Steven Ullmann, a health policy professor at the University of Miami, says there are several explanations for conflicting trends. One is that Medicare and other organizations are closely watching hospital mortality rates, and a high rate “is not a good thing,” meaning hospitals are motivated to push those in their final days into hospices.
Still, Ullmann says, hospitals and physicians might continue to seek ways to get more money from Medicare and related insurance. That, and technology improvements, could cause patients to be steered to intensive care until almost the end of their lives, he said: “So the motivations are complicated.”
© 2011 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com
Read more: http://www.miamiherald.com/2011/04/20/v-print/2177714/more-seniors-are-dying-at-home.html#ixzz1KXQevDQi
Medicare fraud-busters’ Star Trek turn
By: Brett Coughlin
January 24, 2011 11:39 PM EST
The words “Medicare fraud” conjure up pictures of shady doctors, forged paperwork and unwitting little old ladies — not Armenian mobsters, illegal guns and Klingon swords. A raid on the New Jersey mansion of a suspected Armenian-American mobster, however, uncovered the sword and was part of the $4 billion Medicare fraud crackdown Obama administration officials touted Monday.
The Justice Department estimated that the suspected ring of Armenian-American mobsters fraudulently billed Medicare for $163 million. A joint federal task force busted the ring last October, arresting 53 individuals in what the DOJ called the largest fraud scheme perpetrated by one criminal enterprise.
Justice officials said at the time that the group operated 118 phony clinics in 25 states using the stolen identities of doctors and “thousands of Medicare beneficiaries.” Officials also seized a cache of weapons during the bust that included many guns and a Bat’leth, a vicious-looking double-sided Klingon longsword inspired by “Star Trek.”
“This is a good example of organized crime [figuring out a way to] make quick money, one they think they can get away with. It involved multiple FBI and inspector general offices scattered across the country,” Kevin Perkins, assistant director of the FBI, told POLITICO, referring to the high-profile case.
“It was the use of intelligence and analysts to connect these different cities. Instead of having individual cases, we were able to determine a network that was hitting cities across the country. We’ve got more of those cases,” Perkins said.
A new regulation issued Monday will allow Medicare officials to stop payment on suspected fraudsters, but will also give law enforcement new tools to mine claims and other data to identify the really bad guys. Health and Human Services Secretary Kathleen Sebelius, CMS Administrator Don Berwick, and Associate Attorney General Thomas Perrelli held a joint press conference on Monday to discuss the new rule and the fraud prevention efforts.
Taken together, the rule will give the agency and law enforcement further tools to prevent fraud and abuse from happening and stop the “pay and chase” mentality that has frustrated federal fraud fighters for years.
It establishes procedures for screening new enrollees that will hopefully catch criminals before they can begin billing the program. It also allows Medicaid and CHIP plans to bar from participation any provider that has been banned by Medicare. It allows Medicare and Medicaid officials to freeze enrollment into either program if they identify trends suggesting fraud in a given region or by benefit category. CMS will also charge new “application fees” on “institutional providers” — nursing home and hospital care givers — under a provision of the rule.
One area, however, that is giving legitimate providers pause is a provision of the rule that allows the agency to stop payment when there are “credible allegations of fraud.”
Peter Budetti, the CMS Deputy Administrator for Program Integrity, said decisions about this provision will be carefully vetted, but it “allows the Secretary –in consultation with the Inspector General – to suspend payments when there is a credible allegation of fraud, so the key is defining what is sufficiently credible and warrants suspension of payments.”
Budetti said the sources of the allegations can vary, but must be “sufficiently solid to merit attention.”
The allegations could come from law enforcement investigations or “tips of various kinds.” Traditional techniques like screening of claims and data will also be used.
“Whatever it is that generates an allegation of fraud, if the secretary – in consultation with the inspector general – determines that it is credible, and sufficiently so to warrant suspension of payments, that is how the provision will be implemented,” he said.
Budetti said that screenings for fraud will be done, according to the statute, by “the level of risk of fraud, by category of providers.” Screening will also take into account information from law enforcement, and reports by the Inspector General and the Government Accountability Office, Budetti said.
Perkins said that the way the FBI determines risk is whether a patient’s life or health is in jeopardy.
Among the highest risk areas, according Perkins, are durable medical equipment suppliers, home health agencies, independent diagnostic testing facilities and HIV infusion clinics.
Although many at the press conference to discuss the Obama administration’s fraud-fighting efforts talked about the money it will return to the Medicare trust fund, a federal score of the bill does not estimate savings from these provisions.
The high return on investment that Medicare fraud generates apparently was not enough for the Congressional Budget Office to score savings from the provisions. HHS officials said that the ROI is as high as $4.9 returned for every $1 invested since 1997 and an ROI of $6.8 to $1.0 for the last three years.
Under the ACA, Section 6401(a) codified the HHS authority to issue requirements on screening, application fees, and a moratorium on payment to suspected fraudulent providers. The law [Section 6402(h)] set forth the payment suspension requirements discussed above, while Section 6501 allows for the mutual termination requirements for Medicaid and Medicare.
An HHS official, however, questioned the official score, saying that the Congressional Budget Office did not estimate any savings for sections 6401 and 6501 “despite the fact it is well established there are good ROIs with all our fraud prevention activities.”
The CMS final rule with comment was published in the Federal Register Monday afternoon. CMS is seeking comment only on a narrow provision of the rule that would allow the agency to use a fingerprint-based criminal history report for certain providers and suppliers.
© 2011 Capitol News Company, LLC
Martha Deaver - FBI Director’s Community Leadership Award
Senior Justice Student Intern Stephen Garner recently helped make a presentation to the Arkansas Department of Health (ADH). Below are some pictures of Stephen Garner and Dr. Montague following the presentation.
By Harris Meyer
Apr 15, 2010
Millie Toda of Toledo, Ohio, takes cares of her husband Richard, 83, who is severely disabled from Parkinson’s Disease. She’s grateful that with the help of government-paid home health aides and adult day care, he’s able to continue living at home rather than move to a nursing home.
Even with that aid, Toda, 75, says extra money would be a big help. She could use the cash to help replace the broken lift on the front porch so she wouldn’t have to pull and push him up and down the front steps of their trailer home to get to his wheelchair.
A provision in the health care overhaul law signed by President Barack Obama last month could bring some help in the future to people like the Todas. The law establishes a voluntary, long-term care program that will provide cash to enrollees who suffer at least two limitations in daily activities, such as eating, bathing and dressing. The help could begin five years after people enroll in the program.
Supporters say the program, known as the Community Living Assistance Services and Supports (CLASS) Act, will give families greater means to care for disabled relatives. There are about 10 million Americans who need long-term care services, including 4 million under age 65.
“This will empower consumers by putting money in their hands. Then entrepreneurial organizations will come to them and ask, ‘What can we do to help you?’ ” said Larry Minnix, president of the American Association of Homes and Services for the Aging, which lobbied for the CLASS Act.
But some business and insurance groups argue that the CLASS program won’t be financially sustainable. The key is getting enough Americans to sign up for CLASS, advocates respond.
James Gelfand, senior manager of health policy at the U.S. Chamber of Commerce, which opposed the CLASS Act, doubts that participation will be adequate. Only about 5 percent of eligible employees choose to participate in employers’ private long-term care insurance benefit programs and about 7 million Americans own private long-term care policies.
The CLASS program will be run by the U.S. Department of Health and Human Services (HHS). After contributing for five years, participants who are disabled and meet criteria set by HHS will be eligible for a cash benefit of at least $50 a day. There will be no screening for preexisting conditions and no lifetime benefit limit.
The CLASS cash benefit will be flexible. It can be used to pay for a home health aide, transportation, assistive technology such as wheelchairs, lifts, text telephones and sensors with alarms, adult day care, respite care to give the family caregiver a break, household modifications to accommodate the disabled person – or even to pay a family member to provide the care. Alternatively, it can be used to help pay for assisted living or a nursing home.
The new health law has an insurance policy that would provide about $75 a day to help people like the Toda’s pay for long term care. (JD Pooley)
Such care, of course, can be extremely expensive. Nursing homes costs average more than $70,000 a year and home health expenses average just under $30 an hour. But Nancy King, chief operating officer of Senior Independence, a nonprofit service agency in Columbus, Ohio, said that even $50 a day — $18,250 a year — would help people trying to pay for a home health aide, adult day care, or assisted living.
HHS has to write the rules for the program, including setting the premium and benefit levels and the disability triggers for receiving benefits. That process will determine when the program can begin.
Under the law, premiums will vary based on initial enrollment age, with younger people paying less; students and people below the poverty level will pay only $5 a month. While HHS has authority to adjust premiums to keep the program financially viable, it’s expected that participants will pay the same premium amount as long as they remain continuously enrolled.
In an evaluation of the proposal last fall, the nonpartisan Congressional Budget Office estimated that monthly premiums would average $123 at the start. It also projected that benefits would average $75 a day, with annual inflation adjustments. In its analysis, the CBO estimated the program would reduce net federal spending for the first 20 years – particularly because no claims would be paid in the first five years – then boost net outlays by tens of billions in subsequent decades.
Under the terms of the health law, the CLASS program has to pay for itself through premiums and cannot be subsidized by the government. Keeping the program solvent, CBO said, hinges on enrollment of healthy individuals. If fewer Americans were to sign up, and many of them were in poor health, the program would face financial trouble, the CBO concluded.
In an effort to attract healthy Americans, the CLASS Act hopes to interest employers and their workers by streamlining the sign-up and premium payments. Employers can offer workers the opportunity to pay their premiums through a payroll deduction. If an employer does that, all employees must be automatically enrolled in the program, except those who notify their employer that they want to opt out. The CBO said that this automatic enrollment feature could boost participation among healthier people.
The law also allows workers to pay premiums on their own if their employer doesn’t participate or they are self-employed.
Many hope the CLASS Act will further increase public awareness of long-term care needs and boost sales of private policies to cover more expensive care like nursing homes. In a written statement, John Hancock Financial, a major seller of long-term care insurance, said the CLASS act “sends a powerful message about the importance of long-term care preparedness” that should motivate Americans. “It will not replace the need for private long-term care insurance for many Americans.”
© 2010 Henry J. Kaiser Family Foundation. All rights reserved.
The Missouri SMP reported that in the St. Charles area in Missouri, insurance agents are showing up at the homes of seniors explaining that they are with ObamaCare, representing the Federal Government, and trying to sell insurance policies. This has been reported to the Missouri Attorney General’s office as well as to CMS and HHS Public Affairs during HHS-level Health Care Reform meeting that was going on. HHS Public Affairs forwarded the information on to the White House!
The Senior Justice Interns have, separately and/or collectively, attended at least one of the re-entry programs for the inmates at Wrightsville prison. At the program, the interns had the opportunity to hear Dr. Montague speak to the inmates. The interns also interacted with the inmates by answering questions about how “insiders” are often categorized while incarcerated and even more so once they are released. The interns had the chance to meet several of the inmates during a short break. They talked about their some of their experiences as inmates and what they hope to accomplish when released. Each of the interns enjoyed the time they spent at the re-entry program and look forward to attending programs in the future. The following is a schedule of the Pine Bluff Re-entry Programs.
class 014 pine bluff reentry schedule-1.pdf