Category Archives: Planned Parenthood

DoJ: National Healthcare Fraud Takedown

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In what the Justice Department is calling the largest takedown of healthcare fraud in U.S. history, federal authorities on Wednesday brought charges against 301 people for $900 million in false billings.

Among those charged includes 61 doctors, nurses, and other licensed medical professionals who, among other crimes, allegedly committed money laundering, identity theft, and Medicare Part D pharmacy fraud. Across the country, 23 states and 36 federal districts coordinated with the Justice Department and the Department of Health and Human Services to go after the alleged fraud schemes.

The defendants allegedly submitted Medicare and Medicaid claims the Justice Department said “were medically unnecessary and often never provided.” Some of the defendants were paid kickbacks for providing information for fraudulent bills. At least 28 doctors were among those charged on Wednesday. More from Atlantic.

 

Lynch/Justice Department: Good morning everyone and thank you all for being here.  I am joined by several key leaders in our nation’s efforts to address health care fraud: Department of Health and Human Services Secretary [Sylvia] Burwell; Assistant Attorney General for the Criminal Division [Leslie] Caldwell; United States Attorney [Wifredo] Ferrer of the Southern District of Florida; FBI Associate Deputy Director [David] Bowdich; HHS Deputy Inspector General for Investigations [Gary] Cantrell; DCIS Acting Director [Dermot] O’Reilly; and [Shantanu] Agrawal, Deputy Administrator and Director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services.

We are here today to announce a significant step in the federal government’s ongoing work to keep our nation’s health care system free of fraud and exploitation and to ensure that taxpayer dollars are used lawfully and appropriately.  Over the last three days, the Medicare Fraud Strike Force – a joint effort between the Department of Justice and the Department of Health and Human Services – executed a significant nationwide health care fraud takedown.  This action involved charging or unveiling charges against  approximately 300 defendants in 36 federal districts for their alleged participation in a variety of schemes involving more than $900 million in fraudulent billings, making this the largest takedown in the Strike Force’s nine-year history.

The defendants named in these charges include doctors, nurses, pharmacists, physical therapists and home health care providers.  They are accused of a wide range of serious crimes, from conspiring to commit health care fraud to making false statements and from bribery to money laundering.  They submitted dishonest claims, charged excessive fees and prescribed unnecessary drugs.  One group of defendants controlled a network of clinics in Brooklyn that they filled with patients through bribes and kickbacks.  These patients then received medically unnecessary treatment, for which the clinic received over $38 million from Medicare and Medicaid – money that the conspirators subsequently laundered through more than 15 shell companies.  In another case, a Detroit clinic billed Medicare for more than $36 million, even though it was actually a front for a narcotics diversion scheme.  And yet another defendant took advantage of his position in a state agency in Georgia by accepting bribes and recommending the approval of unqualified health providers.  These are just a few examples of the criminals that we targeted in this operation and although the specific nature of their wrongdoing varied from case to case, all of them betrayed the basic principles of their professions.

In addition to the usual patterns of fraud and deception that we’ve encountered in the past, we also saw new trends emerging in this year’s charges.  For instance, in a number of cases involving the Medicare prescription drug benefit program known as Part D, we saw new evidence of identity theft, including the use of stolen doctors’ IDs to prepare fake prescriptions.  We have also seen a growing number of cases involving compounded medications, which are combinations of two or more drugs prepared by a licensed professional.  In recent years, the cost of these drugs has grown exponentially, making them a more attractive target for criminals looking to exploit them for profit.

As this takedown should make clear, health care fraud is not an abstract violation or benign offense.  It is a serious crime.  The wrongdoers that we pursue in these operations seek to use public funds for private enrichment.  They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.  The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.

In tackling these challenges, the Medicare Fraud Strike Force relies on close cooperation between the federal, state and local, governments.  Since 2014, the Justice Department’s Criminal Division has organized an annual National Health Care Fraud Training Conference for Assistant U.S. Attorneys and state and federal law enforcement officers, which has substantially expanded the reach of our actions.  More than 20 non-Strike Force U.S. Attorney’s Offices participated in this year’s takedown, helping us to combat health care fraud in a total of 30 federal districts nationwide, from Alaska to Florida.  We were also assisted by approximately 20 state Medicaid Fraud Control Units, a reflection of the close partnership between state and federal authorities in combatting health care fraud – a partnership that we will continue to strengthen in the days ahead.

I want to thank my colleagues in the FBI, the Criminal Division and U.S. Attorneys’ Offices for their ongoing efforts to combat health care fraud.  I want to thank all of the state and local law enforcement officers across the country who participated in this complex and fast-moving takedown.  And I look forward to continuing our work together in the days ahead.

At this time, I’d like to turn things over to Secretary Burwell, who has been a dedicated leader and indispensable partner in this critical work and who will provide additional details on today’s announcement.

DOJ: Lawyers Behind the N. Carolina Bathroom Lawsuit

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Radicals….throughout the whole Justice Department but here are the backgrounds of those who Loretta Lynch has assigned to sue North Carolina on the bathroom (genderless) lawsuit. Terrifying….

The Justice Department sent out the guidance letter to public schools in several languages and that document is here.

This is a matter placed under Title IX, Sex Discrimination.

By the way, make sure you use proper words as you could be sued in this regard as well.

A sign marks the entrance to a gender-neutral restroom at the University of Vermont in Burlington, Vt.

These Are the Radical DOJ Lawyers Suing North Carolina Over Transgender Bathroom Use

By J. Christian Adams

PJ Media published the Every Single One series in 2011. The series documented the Obama administration’s hiring of radical lawyers to fill the career ranks in the Department of Justice’s Civil Rights Division.

Every single one of the new attorney hires were radical leftists or partisans.

Since 2011, the situation has only gotten worse. Much worse.

The Civil Rights Division exercises enormous power over the everyday lives of Americans: they are involved in employment, education, housing, religious liberty, abortion, prisons, policing, and much, much more.

The radical beliefs of these radical lawyers have turned into radical administration policies.

The most recent example? The lawsuits aimed at North Carolina intended to create a federal civil right for men to use women’s bathrooms and locker rooms.

We have already provided the resumes of the new lawyers who will oversee the 2016 elections. Now let’s meet the ones who want to oversee bathrooms.

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The complaint filed by North Carolina had Justice Department lawyers from the Employment Litigation section as well as other DOJ Civil Rights Division sections.

Chief Delora Kennebrew

The Employment Section is headed by Delora Kennebrew.

Kennebrew hails from Savannah, Georgia. She was president of the Black Law Student Association at Mercer University’s law school in Macon.

Under Kennebrew, the Employment Section has pursued case after case against fire departments and other municipal entities, forcing them to abandon qualification tests where blacks and Hispanics scored lower than whites. Other settlements have forced municipalities to pay tens of thousands of dollars for using qualification tests for fire and police jobs.

One case she oversaw against Austin, Texas, forced the city to set aside 30 jobs for black and Hispanic applicants.

Kennebrew is listed as the point of contact in the letter North Carolina received from the Justice Department this month. That means she is the central manager on the matter.

Kennebrew is most certainly a member of the Senior Executive Service. That means that an incoming Trump administration can move her after January 2017 to any other federal agency in any part of the country, such as the National Weather Service in Duluth.

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Candyce Phoenix

Candyce Phoenix is also on the complaint suing North Carolina.

Her resume noted her senior thesis was devoted to a “case study of race and FedEx field,” the football stadium where the Washington Redskins play.

Phoenix majored in “Comparative Ethnic Studies” at Columbia, where she was a columnist for the student newspaper. You can read her writings here. Her favorite topics? Race, race, and race.

In a column titled “Hear Ye, Hear Ye, All Negroes,” she wrote about President George Bush’s “bogus” visit to Howard University:

[Bush] was ecstatic to be able to visit the Negroes on such an important occasion. Needless to say, Bush was not well received, which was to be expected given his recent two percent approval rating among African Americans. One of my classmates said it best when she complained that having Bush on campus was “like inviting the master to the slave cabins for dinner.”

Phoenix also penned “It Was Raining Oreos,” which refers to former RNC Chairman Michael Steele with a racial epithet. She wrote “What I Learned from White People at Howard” (she learned the best ones are “race traitors”). She also wrote “I’m Black,” which stated: “Our curriculum places disproportionate importance on white scholars and effectively denies the importance of scholars of color.”

Yes, yes, we heard it all before. But these are the sort of views held by lawyers earning six-figure taxpayer-funded salaries to fundamentally transform America.

The race-soaked discontent with America no longer is confined to crackpots on campus.

Candyce Phoenix Candyce Phoenix

Phoenix’s qualifications didn’t end with her tiresome critical race studies dogma. She was an activist from the start. Phoenix served as the “United Students of Color Campus Liaison” at Columbia — a real office.

She served as the events chair for the American Constitution Society, a left-wing lawyers club that has mostly failed in its efforts to match the heft and influence of the Federalist Society. She worked with the left-wing “Election Protection” organization, which funnels potential plaintiffs toward civil rights organizations.

She also did a stint with the NAACP Legal Defense and Educational Fund, an organization that routinely fights election integrity laws like Voter ID. (Thankfully, those efforts have recently failed, such as in North Carolina.)

Now, buckle up:

After a Danish cartoonist was nearly murdered by an Islamist with an axe, Phoenix wrote to the Washington Post:

[D]o Muslims really have avenues to express their discontent by what we consider normal democratic means? And if they do, do we listen?

Phoenix started at DOJ less than a year ago, which means she hasn’t vested into civil service protections and can also be moved by a new administration.

Alisa Philo

Philo, hired in October 2015, was co-president of Women of Stanford Law, an organization with a “Social Justice Committee” that organizes “donation based efforts and social justice programing” at Stanford Law School.

Alisa Philo

Philo clerked for First Circuit Court of Appeal Judge Sandra Lynch (appointed by Clinton) and federal Judge Keith Ellison (Clinton). Philo also began her tenure at Justice less than a year ago; she too has not vested her employment.

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Nadia Said

Said was a fellow at Equal Justice America, but her real Civil Rights Division bona fides came from her time spent at the Chicago Lawyers’ Committee for Civil Rights.

The Chicago Lawyers’ Committee was originally designed to end official discrimination, but it has since morphed into a Tides Foundation, Soros-funded leftist organization pushing radical legal theories.

The group has opposed election-integrity measures. It has deployed teams of lawyers to polling locations ostensibly to protect voting rights, but in practice to aid Democrats.

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Christina Cheung

Christina Cheung says she worked as a political consultant prior to her hiring at the Justice Department in 2015. Since becoming a Justice Department lawyer, she has also become a Hillary Clinton donor. When working with Gloria Allred in private practice, Cheung was involved in attempts to torque campus sexual assault cases against universities such as Boise State.

Christina Cheung

That complaint said colleges are required to “take proactive measures to prevent sexual harassment and violence,” and that “the mere presence” of an accused perpetrator on campus “gives rise to a sexually hostile atmosphere.”

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Richard Sexton

Sexton came to the Justice Department from the Equal Employment Opportunity Commision. While at the EEOC, he brought cases against businesses such as Service Master, Terminix, Subway franchises, and prison management companies.

Richard Sexton

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Catherine Sellers

Sellers worked at “Legal Voice,” a group in Seattle dedicated to “transgender rights,” “protecting reproductive justice,” and “advancing economic justice.”

The resume Sellers submitted to the Justice Department for employment consideration documents her time at the Yale University Art Gallery. Wrote Sellers:

Recruited diverse student groups to co-host gallery events and organized “Yale Liberal Party debate on art repatriation, Day With(out) Art” event recognizing LBGT artists and a collaborative tour focusing on women’s issues.

She was involved in the Immigrant Families Advocacy Project, a group dedicated to providing legal services to illegal aliens.

See below: the Justice Department does not want you to see her entire resume. They redacted a portion pertaining to “interests”:

Catherine Sellers

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Kunti Dudakia Salazar

Kunti Dudakia Salazar was an A-team leftist activist before she came to the Justice Department in June of 2015. She graduated summa cum laude with a Woman’s Studies degree from UCLA. There, she was active in both the African student union as well as the Indian student union. She also won the Constance Coiner award for “research on feminist/working class issues.”

Kunti Dudakia Salazar

At law school in Berkeley, she was a founding member of the “Women of Color Collective,” a group dedicated to providing “a supportive space for African-American, Asian-American, Latina, Native-American, and other women and transgender students of color.” Hard to imagine that could have been in short supply at Berkeley.

The Facebook page for the organization toggles between farce and frightening, reframing the student experience through the lens of race and oppression.

She also worked for the Henderson Center for Social Justice on issues “regarding black women, mental health and incarceration,” and served as the “activist coordinator” for the “Berkeley Critical Race Studies Scholars Society.”

She worked for the ACLU in Los Angeles on “racial profiling” and “police misconduct” issues.

The Justice Department also redacted her interests, as well as the name of a professor — David Sklansky — with whom she worked on a law review article.

Dudakia Salazar began her time at the Justice Department in June 2015, and thus her probationary period has not yet ended.

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Stay tuned to learn about the other Civil Rights Division sections suing North Carolina over trans rights.

Healthcare Provider Lawsuits v. Feds Begin

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Blue Cross insurer sues U.S. for funds owed under health care law

BusinessInsurance: Highmark Inc. and its subsidiaries have sued the federal government for failing to pay funds the insurers say they are owed through one of the Affordable Care Act’s public health insurance exchange safety net programs.

Pittsburgh-based Highmark, the fourth-largest Blue Cross and Blue Shield insurer, is demanding $222.9 million, which it argues it is owed through the ACA risk corridor program for 2014 losses, according to the lawsuit filed Tuesday in the U.S. Court of Federal Claims in Washington.

Highmark said the government has paid only $27.3 million of the total owed for 2014. In early April, Highmark President and CEO David Holmberg said during an analyst call that the insurer was owed more than $500 million from the risk corridor program for 2014 and 2015.

The risk corridor program is intended to help stabilize premiums by offsetting insurers’ losses during the first three years of the public health exchanges.

But the U.S. Centers for Medicare and Medicaid Services last year said it would pay only 12.6% of the money insurers requested for 2014 losses. CMS said the rest of the tab would be paid in 2015 and 2016 if necessary.

The suit accuses the government of breach of good faith and fair dealing among other allegations.

CMS could not be immediately reached for comment.

“The United States has specifically admitted in writing its statutory and regulatory obligations to pay the plaintiff insurers the full amount of risk corridor payments owed to them for calendar year 2014, but it has failed to pay the full amount due,” the lawsuit states.

“Instead, the government arbitrarily has paid the plaintiff insurers only a pro-rata share — less than 12.6% — of the total amount due, asserting that full payment to the plaintiff insurers is limited by available appropriations, even though no such limits appear anywhere in the ACA or its implementing regulations or in the plaintiff insurers’ contracts with the government.”

In a statement Monday, Mr. Holmberg said the Highmark has a “fiduciary responsibility to our 5.2 million health plan members to seek payment.”

Still, Mr. Holmberg said the insurer “remains committed” to the public health exchanges.

Highmark said it tried to negotiate with CMS, which the insurer said refused requests for full payment. It also said CMS has taken the position that “none of the risk corridor payments” for 2014, 2015 and 2016 are due until fall 2017 after the program has concluded.

The insurers involved in the lawsuit, First Priority Life Insurance Co. Inc. et al v. USA, include First Priority Life Insurance Co., Highmark BCBSD Inc., Highmark Inc., Highmark Select Resources Inc., Highmark West Virginia Inc., and HM Health Insurance Co.

In February, Lake Oswego, Oregon-based insurer Health Republic Insurance Co. of Oregon, which now is out of business, filed a $5 billion class action against the federal government for failing to make the risk corridor payments.

**** Good news?

Sessions, Cassidy to introduce ‘The World’s Greatest Health Care Bill. Ever’

FNC: House Rules Committee Chairman Pete Sessions, R-Texas, and Sen. Bill Cassidy, R-La., plan to introduce what they are terming an “alternative” health care bill Thursday which will not repeal ObamaCare, but work alongside the existing Affordable Care Act and modify various parts of the system.

 

The legislation is technically called the HELP Act, short for “Health Empowerment Liberty Plan.”  Sessions however prefers a less clinical moniker with a title infused with a dose of Donald Trump-esque hubris. Instead, the Texas Republican calls the legislation “The World’s Greatest Health Care Bill. Ever.”

Sessions notes that the legislation allows people to keep ObamaCare if they so desire, noting that his measure does not entail a full repeal of ObamaCare.

“Someone who repeals (ObamaCare) is left with nothing,” he said.

That’s why his bill works in tandem with the existing law.

Meanwhile, it does get worse.

UnitedHealth Quits 27th Obamacare State as Insurer to Exit N.J.

Bloomberg: UnitedHealth Group Inc. is exiting New Jersey’s Obamacare exchange, marking the 27th state market the insurer is quitting.

UnitedHealth’s Oxford Health Plans unit won’t participate in New Jersey’s individual market in 2017, on the Affordable Care Act exchange or elsewhere, according to a letter obtained by Bloomberg through an open-records request. Another unit will continue selling plans outside of Obamacare, and the company will keep offering coverage to small businesses, according to Marshall McKnight, a spokesman for New Jersey’s Department of Banking & Insurance.

Chief Executive Officer Stephen Hemsley said last month that UnitedHealth would only offer ACA plans in a “handful of states” for 2017, though the company hasn’t listed them. The company is retreating from the markets created by the ACA amid mounting losses on the policies. Bloomberg has confirmed that the insurer is exiting at least 27 of the 34 states where it sold 2016 coverage.

The company will still probably sell ACA plans in at least three states next year: New York and Nevada have confirmed UnitedHealth’s participation and the company has filed plans to participate in Virginia.

In addition to UnitedHealth, several other insurers offered plans in New Jersey last year, according to the Kaiser Family Foundation. They include Oscar Insurance Corp., AmeriHealth, Health Republic Insurance of New Jersey and Horizon Blue Cross Blue Shield of New Jersey.

WTH Tennessee, Against Pro-Life Voters?

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In Tennessee, a Federal Judge Disenfranchises Pro-Life Voters

DFrench/NRO: No one should ever doubt the Left’s commitment to abortion. For the sake of preserving the right to kill an unborn child, the Left will sacrifice democracy and even reason itself. Pro-life lawyers have a term for liberal judges’ tendency to twist the Constitution for the cause of death — the “abortion distortion.” The latest example comes from Nashville, Tenn., where an Obama-appointee federal judge just wrote perhaps the least credible judicial opinion I’ve ever read. But first, some background. Before the 2014 election, Tennessee, one of America’s most conservative and religious states, had become the South’s abortion supermarket, all because of a Tennessee Supreme Court ruling that declared that the Tennessee constitution protected the “right” to an abortion to a greater degree than did even Roe v. Wade or Planned Parenthood v. Casey. Consequently, even if a pro-life law would have passed federal constitutional muster, Tennessee state courts would strike it down.

 KAGSTV

Tennessee voters responded by passing Amendment 1 — a pro-life constitutional amendment that reversed the state’s high court and unequivocally declared that “nothing in this Constitution secures or protects a right to abortion or requires the funding of an abortion.” Tennessee’s amendment process is arduous. First, a proposed amendment has to pass with a majority in both houses. Then, after the next legislative election, the amendment has to pass with a two-thirds majority. Finally, it comes before the people. But even there an amendment faces a double hurdle. It has to pass with a majority of the vote, and the “yes” votes have to equal a “majority of all the citizens of the state voting for Governor.” For decades, Tennessee officials have interpreted this rule as merely requiring that the total “yes” vote exceed half of the total gubernatorial vote. In other words, a person could vote yes on the amendment and still have their vote count even if they didn’t vote for governor. In fact, amendment proponents expressly told voters that they could pursue exactly this strategy — they didn’t have to vote for governor to have their vote count.
After their loss, pro-abortion leftists sued in federal court, making the astonishing claim that this process violated the Fourteenth Amendment. Why? Because it didn’t give the “no” side enough advantages in the fight against the amendment. They claimed that Tennessee’s process violated their right to “participate on an equal basis with other citizens in the jurisdiction.” They also claimed that the Tennessee Constitution required election officials to count only the votes of people who voted for governor. So if you wanted your vote to count for the amendment, you had to vote for governor.
On Friday, Judge Kevin Sharp did what liberal federal judges do: found a way to rule for abortion rights. He backed the plaintiffs, holding that the traditional manner of counting votes for constitutional amendments violated both the state and the federal constitutions. He then ordered a statewide recount, in which only the votes of those who voted in both the amendment contest and the gubernatorial race would be counted.
In an opinion full of insulting asides and other potshots at amendment supporters, Sharp claimed that the votes of those who voted in the governor’s race but against the amendment were “not given the same weight” as those who voted for Amendment 1 but did not vote in the governor’s race. In other words, he claimed that a voter who did not vote for governor but did vote for the amendment had more influence over the process than a voter who chose to vote in both elections. Yet that additional influence was the product not of discrimination but of voter choice, of deliberate voting strategy.
The judge’s solution to this fabricated problem was to give the votes of those who voted for the amendment but not for governor no weight at all. In other words, his concern for voting rights (he called the right to vote “precious” and “fundamental”) was so strong that he just went ahead and disenfranchised thousands of voters who relied on longstanding state-government interpretations of its own constitution. Moreover, he signaled that even if a recount shows that the amendment would still pass under his new, judicially created standard, he may still rule that the election itself should be voided.

When I was in law school, one of my radical leftist professors declared that the role of a judge was to first determine the “right” result, then to manipulate law and precedent to justify the pre-ordained outcome. He turned the process of judicial reasoning on its head, and my classmates loved it. Abortion jurisprudence is the product of exactly this ideology. Sexual revolutionaries aren’t just professors, activists, and lawmakers. Some are robed Robespierres, and you can always count on them to protect the culture of death. — David French is an attorney, and a staff writer at National Review.

AmeriCorps: Broke the Rules with ‘abortion doulas’

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AmeriCorps’ abortion escorts broke federal rules

TheHill: Several members of the national service program AmeriCorps recently escorted young pregnant women to abortion clinics in a “direct violation” of federal funding rules, a government watchdog will report Tuesday.

The volunteers served as clinic escorts, also known as “abortion doulas,” in parts of New York City, according to a source familiar with the report from a federal inspector general’s office. A summary of the report will be published online Tuesday.

In their roles, such volunteers provide emotional support to women seeking abortions, as well as transportation to and from the clinics if needed. That service is prohibited under the language of federal grants that helps fund the program, the source said.

The violation took place among “a few volunteer members” at one of the 38 community health centers that works with AmeriCorps’s health branch, according to a statement from the National Association of Community Health Centers (NACHC), which oversees AmeriCorps’ health volunteers.

Dave Taylor, chief operating officer of NACHC, said in a statement to The Hill that the group’s leadership “self-reported the issue to the proper authorities” immediately after learning about the potential violations.

“We take this matter seriously,” Taylor said, adding that the NACHC has cooperated with the White House’s community service office and the watchdog group throughout the investigation. He declined to provide any details about the investigation, but said his organization had received a copy of the full report.

The group said its response to the investigation has been far-reaching. Taylor said it quickly took steps to stop the program, while also requiring program staff to be retrained on “all relevant rules and regulations related to AmeriCorps prohibited activities.”

“We moved immediately to cease the activity in question, and suspended the identified site’s AmeriCorps members for a period until they and their site supervisors were retrained and revised member service contracts were reviewed and signed,” Taylor wrote in a statement.

The group also revised the contracts of 500 other partners “to prevent future misinterpretations.”

AmeriCorps is a federally funded community service program with about 80,000 volunteers nationally. The program is managed by the White House Corporation for National and Community Service, which received about $1.1 billion in federal funds last year.

**** In 2009, AllGov: Abortion Referral Prohibited for AmeriCorps

AmeriCorps became the center of media attention when the Edward M. Kennedy Serve America Act passed, tripling AmeriCorps’ size and allotting $5.7 billion in federal funding for the community service programs it provides. Few news sources noticed one controversial stipulation that was added to the bill: the prohibition of several activities, among them, abortion referral.

Beginning on October 1, AmeriCorps’ staff and members will be prohibited from “providing abortion services or referrals for receipt of such services.” In the past, AmeriCorps members have joined with clinics that offer abortion services and partnered with Planned Parenthood chapters to work on public health education topics. The new stipulation will allow members to volunteer or provide their services on their own time, but not while affiliated with AmeriCorps, itself.
Also included in the list of prohibited activities: engaging in protests, petitions, boycotts, or strikes; assisting, promoting, or deterring union organization; engaging in religious instruction and conducting worship services.