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UN children’s agency publishes report on internet and children

(Vatican Radio) The United Nations Children’s Emergency Fund (UNICEF) has published a report entitled “The State of the World’s Children, 2017. Children in a Digital World.” The report examines the availability and impact of the Internet on children across the world.

According to the report 79% of children have access to the internet, compared to 48% of the total population of the world. Children in Africa are the least connected, with 3 out of 5 children being “offline.” In Europe, the number of connected children is much higher. Only 1 in 25 are considered “offline.”

The report contains both alarming statistics concerning online abuse and exploitation, and hope of a growing awareness of the risks associated with the internet and a willingness to tackle them.

For example, whilst 53% of the children depicted in images of child pornography are under the age of 10, that number is, in itself, down from 69% in 2015.

Although the numbers make for disturbing reading, the report also reveals that awareness of the risks of internet amongst children themselves, is on the increase.

 As part of the report, the children surveyed were asked two important questions, What do you dislike about the internet? And  what do you like about it?

23% of those surveyed  chose “Violence” as the aspect of the internet which they like least. The girls surveyed were more sensitive to violence, with 27% of girls saying they were disturbed by episodes of violence, against on 20% of boys. Both sexes were almost equally disturbed by unwanted pornographic content, 32% for girls and 33% for boys.

When asked what they liked about the internet, the majority (40%) replied with “The opportunities to learn new things for school and health.” A further 20% replied with “The chance to learn things I would not have learned in school.”

Forty-two percent of children reported that they had taught themselves to use the internet, whilst 39% reported help from a friend or family member.  

The Director-General of UNICEF, Anthony Lake, said of the report: “For better or the worse, digital technology is currently an irreversible reality of our lives. In the digital world our challenge is twofold: to reduce damage while maximizing the benefits of the web for every child.”

Some such benefits highlighted in the report include the opportunities for children caught up in poverty or humanitarian emergencies to communicate their needs, as well as opportunities for all children to develop skills to help them work in the digital sector. 

UN health agency launches first global monitoring system for dementia

7 December 2017 – The United Nations health agency on Thursday launched the first global monitoring system for dementia, which is expected to affect 152 million people worldwide by 2050 – triple the current 50 million – amid the aging of the global population.

Dementia includes Alzheimer’s disease and other types of memory loss and cognitive disabilities.

“Nearly 10 million people develop dementia each year, six million of them in low- and middle-income countries,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), in a news release.

“The suffering that results is enormous. This is an alarm call: we must pay greater attention to this growing challenge and ensure that all people living with dementia, wherever they live, get the care that they need,” he added.

The Global Dementia Observatory, a web-based platform, launched by WHO, can track progress on the provision of services for people with dementia and for those who care for them, both within countries and globally.

It will also monitor the presence of national policy and plans, risk reduction measures and infrastructure for providing care and treatment.

“This is the first global monitoring system for dementia that includes such a comprehensive range of data,” said Tarun Dua of WHO’s Department of Mental Health and Substance Abuse. “The system will not only enable us to track progress, but just as importantly, to identify areas where future efforts are most needed.”

64632_12-07-infographic_dementia-01 UN health agency launches first global monitoring system for dementia

64632_12-07-infographic_dementia-01 UN health agency launches first global monitoring system for dementia

WHO says the annual global cost of dementia is estimated at $818 billion, equivalent to more than one per cent of global gross domestic product. The total cost includes direct medical costs, social care and loss of income of caregivers.

By 2030, the cost is expected to more than double, to $2 trillion, a cost that could undermine social and economic development and overwhelm health and social services, including long-term care systems.

To date, WHO has collected data from 21 countries. By the end of 2018, it is expected that 50 countries will be contributing data.

Of the countries reporting data so far, 81 per cent have carried out a dementia awareness or risk reduction campaign, 71 per cent have a plan for dementia, 71 per cent provide support and training for caregivers and 66 per cent have a dementia-friendly initiative.

All of these activities are recommended by WHO in the Global action plan on the public health response to dementia 2017-2025.

The Plan provides a comprehensive blueprint for action that can be taken by policy-makers, health- and social-care providers, civil society organizations and people with dementia and their caregivers.

Owner of Detroit home health agency convicted in $1.6 million health care fraud scheme

DETROIT – A federal jury found a Detroit home health agency owner guilty for her role in a scheme involving approximately $1.6 million in fraudulent Medicare claims for home health services that were procured through the payment of kickbacks, and that were medically unnecessary and not provided, officials said.

Editha Manzano, 69, of Troy, Michigan, was convicted Monday of one count of conspiracy to commit health care and wire fraud, one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries and one count of health care fraud following a seven-day trial.

Sentencing has been scheduled for April 19 before U.S. District Judge Gershwin Drain of the Eastern District of Michigan, who presided over the trial.

According to evidence presented at the trial, from 2013 to 2016, Manzano and her co-conspirators engaged in a scheme to defraud Medicare of approximately $1.6 million in fraudulent claims for home health care services in connection with Anointed Care Services, a Detroit area home health care agency.

Evidence showed Manzano paid illegal kickbacks for patients to sign up for home health care with Anointed. The evidence further showed that Manzano conspired with physicians to admit patients for home health care with Anointed when they did not qualify for such services.

To make it appear that the patients qualified, Manzano and her co-conspirators falsified medical records and signed false documents purporting to show that patients admitted to Anointed’s home health program satisfied Medicare’s requirements for admission, the evidence showed.

Four additional people were charged:

  • Liberty Jaramillo, 67, of Troy, Michigan, pleaded guilty in June 2017 and is awaiting sentencing.
  • Dr. Roberto Quizon, 71, of Bloomfield Hills, Michigan, pleaded guilty in June of 2017 and is awaiting sentencing.
  • Dr. Victoria Gallardo-Navarra, 74, of Bloomfield Hills, Michigan was acquitted after trial.
  • Juan Yrorita, RN, 63, of Sterling Heights, Michigan, pleaded guilty during trial and is awaiting sentencing.

Copyright 2017 by WDIV ClickOnDetroit – All rights reserved.

Minnesota vehicle services agency races to clear immense backlog amid computer issues

An internal memo obtained by the Pioneer Press also described bureaucratic work for more expensive vehicles as “more critical” than the same tasks for lower-priced ones.

The directives raise further questions about how troubles with the computer system, known as MNLARS, will affect hundreds of thousands of vehicle transactions, at least some portion of which are already known to have errors.

The motivation for the emphasis on speed appears to come not from a general desire to streamline work flow but from pressure on state officials to wade through a backlog of transactions, which exceeds 350,000.

Here are some quotes from the memo:

• “When you come across a transaction that you are not sure about whether to process it or not, look for a reason why you should do it rather than a reason you should not.”

• “The review of a sale of a vehicle worth $60,000 is more critical than a review of a sale of a vehicle worth $6,000.”

• “Our focus should be on speed rather than detail right now.”

Those passages are from a Nov. 17 email from Craig Flynn, title and registration manager for Minnesota Driver and Vehicle Services (DVS). Part of the Department of Public Safety, DVS is Minnesota’s version of a “DMV,” overseeing license plates, tabs and titles for vehicles, as well as driver’s licenses.

Flynn did not return a phone call seeking comment Thursday, Nov. 30. Through a spokesman, he declined to comment.

In a statement to the Pioneer Press, Dawn Olson, director of Driver and Vehicle Services, said: “To be clear, accuracy will not be sacrificed to increase the speed of processing, and that includes every transaction.”

An earlier statement by Olson reads: “DVS is committed to maintaining the integrity of titles and accuracy in vehicle records when processing transactions. The current DVS process ensures we are meeting those standards while we improve efficiency. It’s important to remember that deputy registrars are responsible for entering data into the system and DVS is responsible for verifying the information before the title is printed and mailed to the owner.

“We are working to reduce the time Minnesotans wait for their titles, including using mandatory and voluntary overtime to process, print, and mail titles.”

In his memo, Flynn pegged the backlog of transactions at “approximately 355,000.” The number fluctuates daily. At close of business Wednesday, the backlog of titles stood at 376,214, a spokesman said.

Quality control sacrificed?

The process at the center of the memo appears to be a step where state workers double-check information entered by workers at car dealerships, license centers and other places that perform the initial processing of vehicle titles and registrations.

It’s not just a matter of proofreading. People are being charged wrong amounts in taxes and fees already, according to state investigators.

A MNLARS feature called the “base value calculator” often incorrectly calculates the value of a vehicle, which determines how much the owner should pay in various taxes and fees.

“We know the transactions aren’t happening for the right amount,” Judy Randall, the state’s deputy legislative auditor, told lawmakers at a Nov. 15 hearing — two days before Flynn’s memo. “Sometimes it’s a dollar, sometimes it’s $100.” But Randall said it’s not clear how far off the miscalculations are. “You have all these citizens who aren’t paying the right amount,” she said. “Are you going to charge them (if they were underbilled)? Are you going to refund them (if they were overbilled)?”

Her question remains unresolved, and Flynn’s suggestion that reviews of transactions of more expensive vehicles are more critical than lower-priced ones and would reduce the total dollar amount of errors — but not necessarily the number of errors. More expensive vehicles also bring more money into state coffers.

Pressure to perform

The memo reveals the pressure DVS is under — from car dealers, lenders, members of the public and state officials — to swiftly process an essentially never-ending stream of transactions that includes new titles, title transfers and license plate issuances and registration renewals. By October 2018, the system will be needed to handle new drivers’ licenses that meet federal REAL ID requirements.

Problems with the $97 million MNLARS (Minnesota License and Registration System) platform began with its rollout in July that immediately saw long lines at license centers. They didn’t end there.

Some people who bought cars in July are still waiting for plates, while dealers are increasingly complaining that not having titles to show banks puts their financing operations in jeopardy. Sooner or later, lenders require proof of a vehicle’s owner to ensure the loans they’re financing are for cars that actually exist.

Earlier this month, Minnesota IT Services Commissioner Thomas Baden told a Senate committee that, in hindsight, MNLARS wasn’t ready. “Had I known what I know now, I wouldn’t have released it at the time,” he said Nov. 15.

Also at that hearing, Public Safety Commissioner Mona Dohman told lawmakers the backlog of what was then an estimated 300,000 titles was on track to be tackled by Jan. 1. On Thursday, the Department of Public Safety said about 3,000 to 4,000 titles are printed and mailed each day. At that rate, fewer than 130,000 titles will be processed by Jan. 1, and new title requests arrive daily.

According to the department’s figures issued Thursday, the turnaround time for MNLARS is actually faster than the previous system, a decades-old dinosaur that was slated for replacement years before Gov. Mark Dayton took office in 2010. Turnaround times for new vehicle registrations are averaging 72 days, title transfers 71 days and duplicate titles 43 days. “Prior to MNLARS, it was about 80 to 90 days,” spokesman Bruce Gordon said in a statement.

Scanning errors

One of the problems with MNLARS has been that it shifts the burden to deputy registrars at local license centers and employees at car dealers and auto auction outfits. In short, they have to input and upload data that, under the old computer system, state workers entered. Supervisors at license centers and those in the auto sales sector have complained that in addition to delays, the extra workload leads to more errors — and some errors can’t be fixed without starting the entire process over.

In theory, the DVS staff is a safeguard against such errors, but Flynn’s memo suggests that some errors, such as those made in scanned records, will just be ignored.

“If an image in MNLARS is not scanned correctly, please do not take the time to request that be rescanned,” Flynn wrote. He clarified that “even if important sections … are blocked out … do not request them to be rescanned. We will have to rely on the deputies and the dealers that they are doing their part and are collecting the appropriate documents and following procedures.”

Health agency reveals scourge of fake drugs in developing world

Issouf Sanogo/AFP/Getty

Fake medicines are removed from a shop during a police raid of a market in Côte d’Ivoire.

One in ten medicines in developing countries is fake or substandard, data from the World Health Organization (WHO) suggest.

Malaria drugs and antibiotics are among the most commonly reported, the agency found. But the problem extends to a variety of medications, including those for cancer, heart disease and HIV, as well as contraceptives and painkillers (see ‘Fake drugs’).

The latest figures come from a pair of reports1, 2 released by the WHO on 28 November — the agency’s first on fake medicines in about a decade. The findings focus on fradulent and poor-quality medications in low- and middle-income countries: of 1,500 hundred cases reported to the agency in the past four years, 42% were from Africa, 21% from the Americas and 21% from Europe.

Data on the issue had until now been scant, because there was no mechanism to track the problem. The WHO set up a global system to report inferior medicines in 2013, tracking drugs that are deliberately fraudulent, fail to meet quality standards, or which have not been evaluated or authorized for market. These medications are often referred as counterfeit drugs, but the agency stopped using the term in May to shift the focus from intellectual-property issues to public health.

The cases captured so far are probably just the tip of the iceberg, the WHO says, because many more go unreported. So far, the agency has trained 550 people in 141 countries to track these drugs. “The more one looks, the more one finds,” it says.

Public-health problem

The studies estimate that roughly 10% of medicines in circulation in poorer countries — where technical capacity to enforce quality standards is often limited — are substandard or falsified. Cases aren’t limited to expensive or well-known medications, and are split about equally between generic and patented drugs. One analysis in the reports estimates that up to 169,000 children could be dying each year from pneumonia because of inferior antibiotics.

Poor-quality medicines not only fail to treat or prevent disease, they also risk worsening antimicrobial resistance, says Mariângela Simão, the WHO’s assistant director-general for Access to Medicines, Vaccines and Pharmaceuticals. People taking substandard antibiotics that don’t fully treat an infection could develop resistant infections that spread.

The findings underestimate the scourge of fake drugs, says Marc Gentilini, a member of the French Academy of Medicine who studies the issue. But crucially, he adds, there is not yet a plan in sight to tackle the problem.

Mental health agency launches healthy holiday campaign

Mental health agency launches healthy holiday campaign

Mental health agency launches healthy holiday campaign

NC taking over embattled mental health agency Cardinal Innovations

Saying Cardinal Innovations “acted unlawfully” in giving its ousted CEO $1.7 million in severance, the State Department of Health and Human Services is taking over the Charlotte-based agency.

The state DHHS also fired the board that gave a total of $3.8 million in severance to CEO Richard Topping and three other departing managers.

“DHHS staff will be on site at Cardinal Innovations and will work closely with interim CEO, Trey Sutten, and other Cardinal staff to manage and stabilize the organization, hire additional executive team members, and develop a corrective action plan to bring Cardinal into compliance with all applicable laws,” DHHS Secretary Mandy Cohen wrote in a letter to lawmakers on Monday.

Cardinal most recently came under fire for a $1.7 million severance package to outgoing Topping, whose last day was set to be Friday.

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“Executive leadership who are in the process of leaving the organization (including former CEO Richard Topping) will not be permitted on the premises of Cardinal during this time,” Cohen wrote.

In October, the state Health and Human Services agency’s Office of the Internal Auditor released a 17-page report that criticized Cardinal’s severance packages for being offered for longer than similar entities and offering severance pay to 10 employees other than the CEO.

The review found that four of seven similar quasi-government groups, including Cardinal, offer severance packages. Three do not offer payouts at all.

In addition, Cardinal’s severance packages range from 24 to 36 months, while the similar entities cap out severance pay at a year.

NC taking over embattled mental health agency Cardinal Innovations

Saying Cardinal Innovations “acted unlawfully” in giving its ousted CEO $1.7 million in severance, the State Department of Health and Human Services is taking over the Charlotte-based agency.

The state DHHS also fired the board that gave a total of $3.8 million in severance to CEO Richard Topping and three other departing managers.

“DHHS staff will be on site at Cardinal Innovations and will work closely with interim CEO, Trey Sutten, and other Cardinal staff to manage and stabilize the organization, hire additional executive team members, and develop a corrective action plan to bring Cardinal into compliance with all applicable laws,” DHHS Secretary Mandy Cohen wrote in a letter to lawmakers on Monday.

Cardinal most recently came under fire for a $1.7 million severance package to outgoing Topping, whose last day was set to be Friday.

Never miss a local story.

Sign up today for a free 30 day free trial of unlimited digital access.

“Executive leadership who are in the process of leaving the organization (including former CEO Richard Topping) will not be permitted on the premises of Cardinal during this time,” Cohen wrote.

In October, the state Health and Human Services agency’s Office of the Internal Auditor released a 17-page report that criticized Cardinal’s severance packages for being offered for longer than similar entities and offering severance pay to 10 employees other than the CEO.

The review found that four of seven similar quasi-government groups, including Cardinal, offer severance packages. Three do not offer payouts at all.

In addition, Cardinal’s severance packages range from 24 to 36 months, while the similar entities cap out severance pay at a year.

NC taking over embattled mental health agency Cardinal Innovations

Saying Cardinal Innovations “acted unlawfully” in giving its ousted CEO $1.7 million in severance, the State Department of Health and Human Services is taking over the Charlotte-based agency.

The state DHHS also fired the board that gave a total of $3.8 million in severance to CEO Richard Topping and three other departing managers.

“DHHS staff will be on site at Cardinal Innovations and will work closely with interim CEO, Trey Sutten, and other Cardinal staff to manage and stabilize the organization, hire additional executive team members, and develop a corrective action plan to bring Cardinal into compliance with all applicable laws,” DHHS Secretary Mandy Cohen wrote in a letter to lawmakers on Monday.

Cardinal most recently came under fire for a $1.7 million severance package to outgoing Topping, whose last day was set to be Friday.

Never miss a local story.

Sign up today for a free 30 day free trial of unlimited digital access.

“Executive leadership who are in the process of leaving the organization (including former CEO Richard Topping) will not be permitted on the premises of Cardinal during this time,” Cohen wrote.

In October, the state Health and Human Services agency’s Office of the Internal Auditor released a 17-page report that criticized Cardinal’s severance packages for being offered for longer than similar entities and offering severance pay to 10 employees other than the CEO.

The review found that four of seven similar quasi-government groups, including Cardinal, offer severance packages. Three do not offer payouts at all.

In addition, Cardinal’s severance packages range from 24 to 36 months, while the similar entities cap out severance pay at a year.

Oregon health agency’s money troubles double in new report

Money problems at the Oregon agency that oversees Medicaid could be more than twice as large as already disclosed, a new report reveals.

Due to errors involving abortion, prison, undocumented immigrants and other factors, the state might have overpaid its contractors or owe other entities as much as $78 million, Oregon Health Authority director Patrick Allen disclosed in a letter to Gov. Kate Brown made public Friday. That’s on top of $74 million in overpayments The Oregonian/OregonLive reported last month.

The agency may have problems taking in money as well as doling it out. Allen listed $34 million that he said is owed to the agency or went untapped, due to budget and accounting problems. The report was Allen’s first biweekly update to Gov. Kate Brown, who directed Allen to submit them in a Nov. 7 letter. Allen’s letter was first reported by the East Oregonian on Friday.

The disclosures hint at the red meat the reports could serve up to the campaign to overturn $340 million in health taxes enacted to fund the state’s Medicaid program. State auditors are also expected to release their report on the state’s Medicaid system in the upcoming weeks. Voters will decide in a Jan. 23 special election whether to keep those taxes, which lawmakers narrowly approved earlier this year.

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In his letter to the governor on Friday, Allen laid out problems that ranged from the state paying Medicaid benefits for unauthorized immigrants to incorrectly using federal funds to pay for abortions.

Allen was careful to say that in most cases, staffers are still investigating the problems and the figures and other details will likely change as they learn more. He cited the following problems:

—Medicaid for unauthorized immigrants: Oregon incorrectly paid health care organizations it contracted with to care for an undisclosed number of unauthorized immigrants, who were mistakenly listed in the state’s computer system as being eligible for more than emergency room care. Allen did not identify the time frame in which the problem occurred, but it caused $25.7 million in “payment errors and over-claimed federal funds” which the health authority already repaid with state general fund in June.

Health officials are still investigating another potential problem related to immigrants in the country illegally. Medicaid covers some emergency care for unauthorized immigrants plus prenatal and delivery care for pregnant women. As health staffers were preparing to implement a new abortion law earlier this year, they discovered the state might have been keeping these mothers on Medicaid after their babies were born, a time when the women were no longer eligible, Allen wrote. Benefits might have continued if the mother’s “provider does not notify us of the delivery date,” but the state is still investigating the issue, according to Allen.

—Paying for patients no longer eligible: Allen said that as of July, health agency staffers estimated Oregon might have to repay $17.3 million in federal funds because the state continued paying health organizations to care for people the state had retroactively deemed ineligible for Medicaid. The problem dates back to January 2014. But new leaders at the agency have cast doubt on whether the $17 million is in the ballpark, saying they are still working to identify the scope of the problem.

—Residential mental health facilities: States cannot claim federal Medicaid funds to care for patients at large residential mental health treatment facilities, such as the state hospital. Oregon “overclaimed” $9.7 million in federal money for people in these facilities, which the state already repaid with general fund money this year, according to Allen’s letter.

—Bariatric surgery payments: Oregon paid more than it should have for these weight loss surgeries from 2009 through 2015, and started trying to recoup the $1.5 million in overpayments a year ago. “As of October 2017, most of the overpayments have still not been repaid by providers, resulting in an accounts receivable balance of $1.1 million,” Allen wrote.

—Medicaid for dead and incarcerated people: “If a client is incarcerated or dies, (per-person)payments should be retroactively adjusted to recoup any payments made after the date of incarceration or death,” Allen wrote. “This is not occurring correctly in the system and … payments have not been fully recouped from the CCOs.” The agency currently seeks repayment only for the last year.

—Abortion coverage: The state estimates it used $1.8 million or so in federal funds for abortions, which it will have to repay. Federal law generally bans using federal funds to pay for abortions, although there are exceptions for cases of rape, incest and when the pregnant woman’s life is in danger, according to the American Civil Liberties Union.

—Money due to drug labelers: Oregon owes an estimated $22.3 million to drug labelers because the state has not passed along some of the money it was supposed to as part of the Medicaid drug rebate program.

Allen also cited problems at his agency and elsewhere with getting money to the right places. They included:

—State accounting problem: The health authority has received an estimated $20 million from the Division of Child Support to pay for children’s health care but has not properly accounted for that money. So state and federal programs were billed for the children’s health care.

—State budget problem: The health agency could gain $14.1 million for nursing facility and post-acute care that was incorrectly sent to the Department of Human Services over the past year.

The health authority might also be able to get federal money for services it has not sought reimbursement for in the past, or for which it claimed less federal funding than it could have, Allen wrote. Examples include services provided to tribal members at non-tribal facilities, and certain preventive services.

Oregon health agency’s money troubles double in new report

Money problems at the Oregon agency that oversees Medicaid could be more than twice as large as already disclosed, a new report reveals.    

Due to errors involving abortion, prison, undocumented immigrants and other factors, the state might have overpaid its contractors or owe other entities as much as $78 million, Oregon Health Authority director Patrick Allen disclosed in a letter to Gov. Kate Brown made public Friday. That’s on top of $74 million in overpayments The Oregonian/OregonLive reported last month.

The agency may have problems taking in money as well as doling it out. Allen listed $34 million that he said is owed to the agency or went untapped, due to budget and accounting problems. The report was Allen’s first biweekly update to Gov. Kate Brown, who directed Allen to submit them in a Nov. 7 letter. Allen’s letter was first reported by the East Oregonian on Friday.   

Patrick Allen is director of the Oregon Health Authority. 

The disclosures hint at the red meat the reports could serve up to the campaign to overturn $340 million in health taxes enacted to fund the state’s Medicaid program. State auditors are also expected to release their report on the state’s Medicaid system in the upcoming weeks.  Voters will decide in a Jan. 23 special election whether to keep those taxes, which lawmakers narrowly approved earlier this year.

In his letter to the governor on Friday, Allen laid out problems that ranged from the state paying Medicaid benefits for unauthorized immigrants to incorrectly using federal funds to pay for abortions.  

Allen was careful to say that in most cases, staffers are still investigating the problems and the figures and other details will likely change as they learn more. He cited the following problems:

Medicaid for unauthorized immigrants: Oregon incorrectly paid health care organizations it contracted with to care for an undisclosed number of unauthorized immigrants, who were mistakenly listed in the state’s computer system as being eligible for more than emergency room care. Allen did not identify the time frame in which the problem occurred, but it caused $25.7 million in “payment errors and over-claimed federal funds” which the health authority already repaid with state general fund in June.

Health officials are still investigating another potential problem related to immigrants in the country illegally. Medicaid covers some emergency care for unauthorized immigrants plus prenatal and delivery care for pregnant women. As health staffers were preparing to implement a new abortion law earlier this year, they discovered the state might have been keeping these mothers on Medicaid after their babies were born, a time when the women were no longer eligible, Allen wrote. Benefits might have continued if the mother’s “provider does not notify us of the delivery date,” but the state is still investigating the issue, according to Allen.   

Paying for patients no longer eligible: Allen said that as of July, health agency staffers estimated Oregon might have to repay $17.3 million in federal funds because the state continued paying health organizations to care for people the state had retroactively deemed ineligible for Medicaid. The problem dates back to January 2014. But new leaders at the agency have cast doubt on whether the $17 million is in the ballpark, saying they are still working to identify the scope of the problem.

Residential mental health facilities: States cannot claim federal Medicaid funds to care for patients at large residential mental health treatment facilities, such as the state hospital. Oregon “overclaimed” $9.7 million in federal money for people in these facilities, which the state already repaid with general fund money this year, according to Allen’s letter.   

Bariatric surgery payments: Oregon paid more than it should have for these weight loss surgeries from 2009 through 2015, and started trying to recoup the $1.5 million in overpayments a year ago. “As of October 2017, most of the overpayments have still not been repaid by providers, resulting in an accounts receivable balance of $1.1 million,” Allen wrote.

 Medicaid for dead and incarcerated people: “If a client is incarcerated or dies, (per-person)payments should be retroactively adjusted to recoup any payments made after the date of incarceration or death,” Allen wrote. “This is not occurring correctly in the system and … payments have not been fully recouped from the CCOs.” The agency currently seeks repayment only for the last year.

Abortion coverage: The state estimates it used $1.8 million or so in federal funds for abortions, which it will have to repay. Federal law generally bans using federal funds to pay for abortions, although there are exceptions for cases of rape, incest and when the pregnant woman’s life is in danger, according to the American Civil Liberties Union.

Money due to drug labelers: Oregon owes an estimated $22.3 million to drug labelers because the state has not passed along some of the money it was supposed to as part of the Medicaid drug rebate program.

Allen also cited problems at his agency and elsewhere with getting money to the right places. They included:

State accounting problem: The health authority has received an estimated $20 million from the Division of Child Support to pay for children’s health care but has not properly accounted for that money. So state and federal programs were billed for the children’s health care.

State budget problem: The health agency could gain $14.1 million for nursing facility and post-acute care that was incorrectly sent to the Department of Human Services over the past year.     

The health authority might also be able to get federal money for services it has not sought reimbursement for in the past, or for which it claimed less federal funding than it could have, Allen wrote. Examples include services provided to tribal members at non-tribal facilities, and certain preventive services.   

— Hillary Borrud

hborrud@oregonian.com

503-294-4034; @hborrud

Managed-care mental health agency fires CEO – WTVD

The board of directors of a regional managed-care mental health agency fired its CEO on Friday, barely a month after his pay had been reduced in response to a state audit questioning his salary and benefits.

The Winston-Salem Journal reports Cardinal Innovations Healthcare Solutions removed Richard Topping from his duties during a vote. The removal takes effect on Dec. 1.

“I support the board’s decision to terminate Richard Topping as CEO, but I’m concerned about the contract that allows 10 other high-ranking Cardinal executives to exit with him, all with two years’ salary payout,” Rep. Verla Insko, D-Orange, and one of the legislators’ top health-care experts, said Saturday.

Trey Sutten, interim chief financial officer of Cardinal, has been appointed to take Topping’s place on Dec. 2 on an interim basis. Sutton is a former N.C. Department of Health and Human Services Medicaid official in the McCrory administration.

The board also voted Friday night to remove Bryan Thompson, the only representative of the former CenterPoint Human Services of Winston-Salem, which Cardinal took over in June 2016.

Both moves took place during Cardinal’s regularly scheduled quarterly board meeting.

The State Auditor’s Office in May accused Cardinal of spending excessively on salaries and benefits for their CEOs and on conferences and Christmas parties.

The state Department of Health and Human Services conducted its own investigation, and its interim report discussed last month by a General Assembly committee raised red flags about generous severance packages for Topping and 10 other executives and key employees through mid-2019.

According to the report, the packages would cover at least two years and kick in for several reasons beyond being fired without justification. Paying them could cost millions, pose a “substantial risk” and could jeopardize Cardinal’s ability to operate should there be a management shake-up, the review said.

In October, Cardinal voted to reduce Topping’s salary to $204,195 after he made more than $600,000 in the year ending June 2016.

The DHHS report calculated Topping’s salary and bonus during the year ending June 30, 2016, as $617,526, nearly three times more than what the next highest CEO made among the state’s seven regional mental health agencies. The Office of State Human Resources told Cardinal in August that Topping’s salary can be no higher than $204,195, in keeping with a salary range.

Cardinal, the largest of the seven, defended Topping’s compensation as lawful and filed a lawsuit to keep it.

Managed-care mental health agency fires CEO – WTVD

The board of directors of a regional managed-care mental health agency fired its CEO on Friday, barely a month after his pay had been reduced in response to a state audit questioning his salary and benefits.

The Winston-Salem Journal reports Cardinal Innovations Healthcare Solutions removed Richard Topping from his duties during a vote. The removal takes effect on Dec. 1.

“I support the board’s decision to terminate Richard Topping as CEO, but I’m concerned about the contract that allows 10 other high-ranking Cardinal executives to exit with him, all with two years’ salary payout,” Rep. Verla Insko, D-Orange, and one of the legislators’ top health-care experts, said Saturday.

Trey Sutten, interim chief financial officer of Cardinal, has been appointed to take Topping’s place on Dec. 2 on an interim basis. Sutton is a former N.C. Department of Health and Human Services Medicaid official in the McCrory administration.

The board also voted Friday night to remove Bryan Thompson, the only representative of the former CenterPoint Human Services of Winston-Salem, which Cardinal took over in June 2016.

Both moves took place during Cardinal’s regularly scheduled quarterly board meeting.

The State Auditor’s Office in May accused Cardinal of spending excessively on salaries and benefits for their CEOs and on conferences and Christmas parties.

The state Department of Health and Human Services conducted its own investigation, and its interim report discussed last month by a General Assembly committee raised red flags about generous severance packages for Topping and 10 other executives and key employees through mid-2019.

According to the report, the packages would cover at least two years and kick in for several reasons beyond being fired without justification. Paying them could cost millions, pose a “substantial risk” and could jeopardize Cardinal’s ability to operate should there be a management shake-up, the review said.

In October, Cardinal voted to reduce Topping’s salary to $204,195 after he made more than $600,000 in the year ending June 2016.

The DHHS report calculated Topping’s salary and bonus during the year ending June 30, 2016, as $617,526, nearly three times more than what the next highest CEO made among the state’s seven regional mental health agencies. The Office of State Human Resources told Cardinal in August that Topping’s salary can be no higher than $204,195, in keeping with a salary range.

Cardinal, the largest of the seven, defended Topping’s compensation as lawful and filed a lawsuit to keep it.

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US health agency to crack down on risky stem cell offerings

U.S. health authorities announced plans Thursday to crack down on doctors pushing stem cell procedures that pose the gravest risks to patients amid an effort to police a burgeoning medical field that previously has received little oversight.

The Food and Drug Administration laid out a strategy for regulating cell-based medicine, including hundreds of private clinics that have opened across the nation in the last decade. Many of the businesses promote stem cell injections for dozens of diseases including arthritis, multiple sclerosis and even Alzheimer’s. They can cost $5,000 to $50,000, but there’s little research that such procedures are safe or effective.

Researchers for years have called for a crackdown. FDA officials said they will focus their enforcement efforts on “bad actors” who inject stem cell mixtures into the bloodstream, nervous system or eyes. Regulators say those procedures pose the biggest risk to patients.

“We’re going to be prioritizing places where we see products — not just being promoted inappropriately — but putting patients at potential risk,” FDA Commissioner Scott Gottlieb told reporters on a conference call.

Gottlieb said the agency plans to use discretion in overseeing lower-risk procedures such as injections for achy joints, adding that this approach would allow the agency to get the “most bang for our regulatory buck.” He also said the agency needs to be “nimble and creative” in its regulation to encourage legitimate researchers in the field.

Stem cell researcher Paul Knoepfler called the FDA announcement a “positive sign” suggesting many clinics will now need to seek FDA permission before promoting experimental stem cell procedures.

“Now that the FDA’s policies are clear, will it back them up with action?” said Knoepfler of the University of California, Davis. “Does it have the resources?”

Stem cells have long been recognized for their ability to reproduce and regenerate tissue. And while emerging research suggests that they will eventually be used to treat a range of debilitating diseases, they are currently only approved for a handful of medical procedures. For instance, adult stem cells from bone marrow transplants have long been used to treat leukemia and other blood diseases.

Most of the new clinics offer adults stem cells isolated from fat. Practitioners collect the fluid from patients via liposuction, treat it with chemicals and then inject it back into the body to treat various conditions.

Three Florida women were left nearly or completely blind by one such fat-based procedure, according to a report published earlier this year in the New England Journal of Medicine. The Florida Medical board previously revoked the license of another stem cell practitioner after two patients died under his care after receiving IV drips of stem cells to the bloodstream.

In August the FDA took action against clinics in Florida and California. The agency issued a warning letter to Sunrise, Florida-based US Stem Cell Clinic for marketing unapproved procedures for heart disease, Parkinson’s disease and other conditions. And U.S. marshals, under FDA instructions, seized vials of an unproven vaccine from StemImmune Inc. of San Diego.

The FDA’s authority to regulate stem cell procedures is a murky area that has been debated for years.

Typically the agency does not regulate individual doctors or their in-office procedures, focusing instead on products developed by drug and medical device manufacturers. But FDA has asserted its authority in certain cases when doctors begin processing stem cells and marketing them to treat serious diseases.

Guidelines released by the agency Thursday aim to clarify how much processing cells can undergo before triggering FDA regulation.

It also laid out a process for speeding up the review of promising cell and genetic therapies long sought by drug and biotech companies in the field.

“I think it’s another example of the FDA supporting innovation while promoting its strong safety standards,” said Michael Werner of the Alliance for Regenerative Medicine, which represents drugmakers.

Agency: Improper wait list used for vets’ mental health care

A watchdog arm of the U.S. Department of Veterans Affairs said Thursday that the agency’s Denver-area hospital violated policy by keeping improper wait lists to track veterans’ mental health care.

Investigators with the VA Office of Inspector General confirmed a whistleblower’s claim that staff kept unauthorized lists instead of using the department’s official wait list system. That made it impossible to know if veterans who needed referrals for group therapy and other mental health care were getting timely assistance, according to the report.

The internal investigation also criticized record-keeping in PTSD cases at the VA’s facility in Colorado Springs. Patients there often went longer than the department’s stated goals of getting an initial consult within a week and treatment within 30 days, investigators found. In one case, a veteran killed himself 13 days after contacting the clinic, which was supposed to see him within a week.

Investigators said the unofficial lists did not always identify the veteran or requested date of care, and they could not determine how many veterans were waiting to receive help and for how long, even with the help of staff at the facilities.

“As a result, facility and mental health managers did not have access to accurate wait time data to help make informed staffing decisions and did not have assurance that all requests for care were adequately addressed,” the report said.

Rep. Mike Coffman, who along with another Colorado congressman, the state’s two senators and Sen. Ron Johnson (R-Wisc.) requested the investigation, said in an interview that the local VA’s behavior reminded him of the 2014 VA scandal in Phoenix. Investigators there found that at least 35 patients died while waiting for care and medical staff falsified records to make it seem veterans were being seen promptly.

“At the end of the day it’s the veterans who suffer,” said Coffman, adding he was going to talk to the Secretary of the VA about the Colorado situation.

The VA Eastern Colorado Health Care system said in a statement that while it agreed with much of the report’s findings it bristled at the idea that its wait lists were “secret.” The statement says that “nothing about this process was secret” and that it was discontinued once staff became aware it violated VA policies.

Brian Smothers, the former VA employee whose complaints got the investigation underway, said he was disappointed the report didn’t make clearer that VA staff knew full well what they were doing. “We renamed the files ‘interest lists’ so people wouldn’t know we were breaking the rules” on how to maintain wait lists, Smothers said.

Smothers said the lists hid how long it takes for veterans to get treatment and made the demand for mental health care appear lower than it really was.

Smothers, 38 was a peer support specialist on the VA’s post-traumatic stress disorder clinical support team in Denver. Smothers said he started the job in April 2015 but quit last November after he was subjected to retaliation for speaking out. He said he’s now working in graphic design and considering graduate school.

Johnson, chairman of the senate’s Homeland Security and Governmental Affairs committee, said in a statement: “Putting veterans on secret wait lists is not acceptable. The VA should implement changes to provide the highest quality care for our veterans and hold wrongdoers accountable.”

Trump Health Agency Challenges Consensus on Reducing Costs …

In September, the department released an outline of a “new direction” for the Center for Medicare and Medicaid Innovation, set up by the Affordable Care Act to test models aimed at improving medical care and reducing costs. While the Obama administration had pushed large, mandatory experiments to test new models of pay, the Trump administration wants to encourage smaller, voluntary programs — and has asked the doctors to help design them.

“Clearly a great big foot has been put on the brake,” said Donald Crane, the chief executive of CAPG, a group of doctors and hospital administrators that, unlike many in the profession, has pushed to tie physician pay to quality measures rather than the old model of fee for service.

Mr. Crane was referring specifically to the scaling back of the cardiac and joint replacement programs by Tom Price, an orthopedic surgeon and Republican former congressman chosen by Mr. Trump as secretary of health and human services. Mr. Price, who resigned in September over his use of expensive private jets, had accused the Obama administration of trying to “commandeer clinical decision-making” by forcing doctors to participate in experiments that test new ways of paying for care. Mr. Trump is said to be close to appointing a successor — possibly Alex Azar, a former pharmaceutical company executive who worked in the Department of Health and Human Services under President George W. Bush — and doctors’ groups will be watching carefully to see if the agency continues in the same direction.

Already, other administration officials have signaled support for protecting doctors and giving them more say. The agency’s Centers for Medicare and Medicaid Services, led by Seema Verma, has suggested it will accept more recommendations than it did in the past from a committee of doctors formed by the American Medical Association on how much Medicare should pay for services and procedures — essentially letting doctors set their own pay.

Ms. Verma’s agency also issued the call for changing the direction of the innovation center. The formal “request for information” proposed, among other potential changes, allowing doctors and hospitals to contract directly with Medicare patients. This would allow doctors and other providers to propose their own prices, moving toward a long-held Republican goal of so-called premium pricing.

Research has shown that the traditional model of paying doctors, known as “fee for service,” often results in unnecessary or inappropriate care. The federal government has been slowly moving away from it since 1983, when Medicare changed some of its payments to hospitals.

But the changes now pushed by H.H.S. are a renunciation of the Obama administration in particular. It had sought to shift 30 percent of fee-for-service Medicare payments to alternative payments based on quality or value by 2016 — a goal it achieved — and 50 percent by 2018. To do so, it required doctors and hospitals in many regions of the country to adopt those new payment models.

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Canceling mandatory bundled payments for cardiac and orthopedic procedures was a pet project for Mr. Price, who had fought against what he saw as unnecessary government intervention since his days as a surgeon in the suburbs north of Atlanta.

Mr. Price defended the old model in front of thousands of doctors and medical administrators gathered in June for the annual meeting of CAPG, the group pushing for new payment models, arguing that the health care system in the United States — “the finest,” he said, in the world — had developed around it.

“So we ought to recognize,” he told the group, that “fee for service may not be the end of the world.”

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2dec2_00DOCTORS2-master675 Trump Health Agency Challenges Consensus on Reducing Costs ...

Seema Verma, left, the head of the Centers for Medicare and Medicaid Services, was a partner in efforts by Tom Price, right, to slow changes in the way doctors are paid.

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Eric Thayer/Getty Images

Many in the health care field criticized some of the rules issued by the Obama administration as overly prescriptive and welcomed the department’s effort to review them.

“Many experiments that the Obama administration launched were overly micromanaged,” said Grace-Marie Turner, an opponent of the health law and president of the Galen Institute, a research center that advocates free-market health policies. “Innovation has to percolate up from the bottom. The Obama administration tried to drive it from the top.”

Even with Mr. Price’s departure, the department still has numerous people who have advocated strongly for doctors and industry in the past. They include senior staff members who have worked representing medical device makers, pharmaceutical and hospital supply companies, the nursing home industry and physician specialty groups. The acting secretary of health and human services, Eric Hargan, is a former lawyer for the law and lobbying firm Greenberg Traurig who served as a deputy secretary at the agency during Mr. Bush’s tenure.

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Miranda Franco, senior policy adviser at the law firm Holland Knight, has closely tracked the changes. She said it appeared the administration was using the innovation center to further its priorities of “more provider-friendly approaches, more voluntary models.”

Ms. Verma, the administrator of the centers, seemed to confirm that when she wrote in a Wall Street Journal op-ed: “Providers need the freedom to design and offer new approaches to delivering care. Our goal is to increase flexibility by providing more waivers from current requirements.”

Last month, Ms. Verma also announced a plan to re-examine and streamline all the ways the federal government has been measuring the quality of the care doctors provide, saying in a speech, “We want to move to a system that pays for value and quality — but how we define value and quality today is a problem.” The goal, she said, was to relieve doctors of excessive regulatory burdens and make sure payment policies are “guided by those on the front lines serving patients.”

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Gail Wilensky, the administrator of the Centers for Medicare and Medicaid in the first Bush administration, said she heard many complaints from doctors who felt that during the Obama presidency the agency was not listening to any of their ideas for how to move toward payment based on quality rather than quantity.

“It’s hard for me to believe that physicians will do any better than they would have done, having Tom Price there,” Ms. Wilensky said. “From their point of view, this was about as good as it was going to get.”

But Tim Gronniger, a deputy chief of staff at the centers during the Obama administration, argued that there was little demand from hospitals or physicians to cancel the bundled payments, or to delay the merit-based payments.

In fact, many doctors are still subject to the rules of the merit-based system, which passed with bipartisan support in Congress in 2015. And other value-based programs are continuing.

“They’ve confused people,” said Mr. Gronniger, now a senior vice president at Caravan Health, which helps health care providers shift to value-based payment models. “The risk that H.H.S. and Tom Price created is that some physicians incorrectly read the press release or hear from their colleagues that Medicare is canceling value-based purchasing and think all of that’s over.”

“Physicians and hospitals need to be engaged in this work,” he added, “and exempting them doesn’t do them any favors.”

Although little has changed since Mr. Price’s departure, there are signs that the agency is still trying to figure out the best way to proceed, said Michael Chernew, an economist at Harvard Medical School who supports moving away from fee for service.

Mr. Chernew said he was “cautiously hopeful” about H.H.S. continuing to promote alternative payment models, pointing out that Medicare rates under fee for service will remain flat over the next decade anyway under the payment law that Congress passed in 2015.

“My general sense, and I’ve met with them, is that they genuinely want to try to have a better set of payment models,” Mr. Chernew said of Ms. Verma and those working for her at the Centers for Medicare and Medicaid Services. “They don’t just want to try to blow everything up.”

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He added, “If you take all the politics out of it, the right thing for them to do is move ahead.”


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Syria: UN health agency calls for immediate and unimpeded access to save lives in Ghouta

12 November 2017 – Amid worsening humanitarian, health and security situation in Syria’s besieged eastern Ghouta, the United Nations health agency has demanded that all parties to the conflict stop attacks on civilians, facilitate immediate medical evacuations, and allow safe passage of medical supplies.

“The situation is heartbreaking,” said Elizabeth Hoff, the head of the UN World Health Organization (WHO) operations in Syria, in a news release Sunday.

“We have now reached a critical point, where the lives of hundreds of people, including many children, are at stake. If they do not immediately get the medical care they urgently need, they will most likely die.”

Severe food and medical shortages are reported in eastern Ghouta, rural Damascus, where as many as 400,000 people remain besieged and cut-off from life-saving assistance. Among them, over 240 people require urgent advanced medical care, including 29 “priority” patients – mostly children – in critical condition who need immediate medical evacuation.

According to the UN agency, plans are in place for medical evacuations from Ghouta to hospitals and medical facilities in the capital, Damascus, and elsewhere. Medicines have also been prepared for immediate dispatch.

“At this stage, however, no formal approval for evacuations has been received from the responsible national authorities,” added WHO in the release.

In addition to the medical necessities in the region, malnutrition – especially among children – is reported to be rising, leaving them at a higher risk of life-threatening infectious diseases.

Safe drinking water is also reportedly hard to find and diseases like Brucellosis, Hepatitis A and tuberculosis have reappeared.




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