Category Archives: Medicaid/Medicare

Caregivers of disabled left in dark under Kansas’ private healthcare system

Source: Andy Marso, Kansas City Star, November 12, 2017

… The Star found other caregivers who were asked to sign off on plans of care without knowing if they included cuts — one of several concerns about transparency that have arisen since the state became the first in the country to privatize its entire Medicaid program by establishing KanCare in 2013. KanCare has made the Medicaid system in Kansas less collaborative and more secretive for people with disabilities, a group of independent case managers from Johnson County said in an August interview with The Star. When the system was run by the state and a network of disability non-profits, the case managers said, the focus was on figuring out what services could help and how to find them. Now it’s about justifying the services they’re getting. …

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Kansas proposes Medicaid work requirement
Source: Jonathan Shorman, Kansas City Star, October 27, 2017

The next version of Kansas’ privatized Medicaid program will require about 12,000 adults to work, a stipulation no state’s program currently includes. State officials unveiled their proposal for KanCare 2.0 on Friday. The program serves more than 400,000 residents but right now has no work requirement. The federal government must approve the proposal before implementation, a process expected to take months. …

Federal health officials approve one-year extension previously denied to KanCare program
Source: Allison Kite, Topeka Capital-Journal, October 17, 2017

The federal government has granted a one-year extension of Kansas’ privatized Medicaid program after denying the request and citing deficiencies in the program earlier this year. Following an on-site visit a year ago, the Centers for Medicare and Medicaid Services in January denied Kansas’ request for an extension and cited several concerns about the way the state ran its Medicaid program, KanCare, including limited oversight and coordination it argued posed a risk to recipients. The Kansas Department for Health and Environment, which runs KanCare with the Kansas Department for Aging and Disability Services, took issue with the January findings. In a letter dated Friday, CMS approved the request to extend the program through next year, as long as the state follows a list of directives, including continued compliance with a corrective action plan it submitted following the denial. The letter says the state has to apply for its full five-year reapplication by the end of the year. …

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Iowa Will Delay Plans to Add 3rd Company Back Into Medicaid

Source: Associated Press, November 7, 2017
 
An Iowa agency is delaying plans to add a third company back into the state’s privatized Medicaid program.  Iowa Department of Human Services Director Jerry Foxhoven says the agency will hire another company to offer Medicaid coverage in 2019. The agency originally said such a company would start next July.  Foxhoven says the agency will begin its search for a company soon, but the 2019 delay ensures adequate time.  Foxhoven provided the information Tuesday to a health care council. It comes one week after AmeriHealth Caritas announced it will drop Medicaid coverage in Iowa at the end of the month after failed contract negotiations with the state. Two other private insurance companies, Amerigroup and UnitedHealthcare, will continue Medicaid coverage. …

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DHS: Iowa Will Give $60M More to Companies for Medicaid
Source: Associated Press, November 2, 2017
 
An Iowa official says the state will spend an additional $60 million this budget year for private insurance companies to keep running the Medicaid program.  Iowa Department of Human Services spokesman Matt Highland said Thursday that additional costs announced this week as part of new state contracts with two companies will total $140.4 million. The state will pay $60.8 million of that. The federal government will pay about $80 million. …

Private insurance company to leave Iowa’s Medicaid program
Source: Barbara Rodriguez, Associated Press, October 31, 2017
 
An insurance company that helps run Iowa’s new privatized Medicaid program is withdrawing its participation after less than two years, state officials announced Tuesday, a move that highlights failed negotiations between the company and the state over future coverage expenses.  AmeriHealth Caritas will end its Medicaid coverage in Iowa at the end of November, the company confirmed in a press release. It offered no details on why a new contract with the state, through the Iowa Department of Human Services, could not be reached. DHS officials also declined specifics and focused attention to new contracts with the remaining companies, Amerigroup and UnitedHealthcare. …

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Exclusive: Nursing Home Sought Help From Lobbyist Friend Of Governor

Source: Jim Defede, CBS Miami, November 3, 2017

State officials intended to permanently shut down the now infamous The Rehabilitation Center at Hollywood Hills in 2014, when a lobbyist with deep ties to Governor Rick Scott interceded on behalf of the man who wanted to take it over, CBS4 News has learned. The role of one of the Governor’s friends lobbying state officials on behalf of Dr. Jack Michel so Michel could obtain the license for the Hollywood Hills nursing home has not been previously reported. The nursing home is now drawing intense scrutiny following the deaths of more than a dozen residents after its air conditioning system lost power during Hurricane Irma. … In 2014, Michel wanted to buy the nursing home, whose owner at the time, Karen Kallen-Zury, had just been convicted of Medicare fraud and was sentenced to 25 years in prison. … Political leaders have questioned whether Michel should have been granted a license given the fact that Michel and two former business partners paid $15.4 million to the federal government to settle fraud claims. …

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Hollywood nursing home should never have been licensed, state senator says
Source: Bob Norman, Local 10 News, October 26, 2017

The U.S. Justice Department hit Michel with civil Medicare fraud charges in 2004, alleging he received $70,000 each month in kickbacks to funnel nursing home patients into Larkin Community Hospital in South Miami for medically unnecessary procedures. … Michel eventually purchased the Larkin hospital (beginning with what the feds alleged appeared to be sham transactions) and, according to the complaint, began paying to other doctors for more bogus Medicare referrals. … Farmer says the fraud described in the Michel complaint has become all too common. … Michel and his business partners — including Chicago Rabbi Morris Esformes and his son, Philip — paid $15.4 million to settle the fraud case while admitting no wrongdoing. Published reports show that the Esformeses have a long history of nursing home violations going back decades in Chicago and other cities, including one case in 2001 involving the deaths of four women during a heat wave in St. Louis. Criminal investigations netted no charges in that case, but the nursing home was hit with a $275,000 civil judgment in one suit while three others ended with undisclosed settlements. But after paying the $15.4 million settlement to the federal government, both Michel and the Esformeses simply continued in the business of running nursing homes and hospitals. …

Hurricane Irma: Hospital linked to nursing-home deaths was paid $48M to care for Florida prisoners
Source: Arek L Sarkissian, Naples Daily News, September 26, 2017

The owner of a Florida nursing home whose 11 residents died after Hurricane Irma has benefited for years from millions of dollars in government contracts despite repeatedly running afoul of state and federal regulators. Dr. Jack Michel, owner of Rehabilitation Center at Hollywood Hills, owns a Miami hospital that has received $48 million in taxpayer money since 2006 to treat state prisoners. The payments to Larkin Community Hospital started the same year Michel settled a federal fraud lawsuit that accused him of bilking taxpayers. They continued after the state barred one of his assisted-living homes from taking new patients. And state officials are giving no indication that the payments will stop now despite Florida Gov. Rick Scott’s comments that the owner is unfit to care for patients after deaths at his nursing home.

Larkin provides the prison hospital care under no-bid agreements that the Florida Department of Corrections approved, according to agency contract and finance records. The hospital has served as a subcontractor to the state’s prison health care vendors with approval from corrections officials. Eight elderly patients died Sept. 13 after Irma knocked out power at Michel’s nursing home and residents remained for several days without air conditioning. Three other patients died days later after being hospitalized with complications. …

County services for disabled moving to private providers

Source: Rita Price, Columbus Dispatch, October 30, 2017
 
Federal rule changes about case management and Medicaid payments are forcing county disabilities boards throughout the state to privatize and outsource many of their remaining programs. The Centers for Medicare and Medicaid Services has mandated “conflict-free case management” by 2024 in Ohio, which means counties cannot be both the coordinator and the provider of services paid with Medicaid waiver funds.  But county boards still must pay for services and put up the local share of the Medicaid match — in Franklin County, more than $60 million a year for adult waiver services. Medicaid waivers provide money for community-based services so that people don’t have to be in an institution to get the care and programs they need. … Some 300 members of the county’s adult-services staff are to become ARC Industries employees in January 2019. … ARC is the disabilities program that provides job training, workshop employment, transportation and other services. Although ARC already was a nonprofit employer for people with disabilities, the workshops and programs have been staffed by county employees. Early childhood and school programs can continue to be operated by the board because they’re not funded through Medicaid waivers. … Initially, Morison said, the board’s costs might increase as a new infrastructure is established. He expects it to even out in coming years. …

Consultant: BRF lacks cash, experience to adequately manage hospitals

Source: KTBS, October 10, 2017
 
Biomedical Research Foundation’s lack of cash could cause the state to lose funding for free and low-cost health care at the former public hospitals the foundation operates in Shreveport and Monroe.  Documents obtained by KTBS through an open records request show state officials are concerned the hospitals could lose Medicaid funding. That federal money helps cover the cost of treating poor people without insurance at the hospitals BRF operates as University Health through a wholly-owned subsidiary.  In September, state officials put BRF on notice it had breached its contract to operate the hospitals, in part because BRF has failed to pay doctors at LSU Medical School in Shreveport for treating patients. BRF also owes the state for a lease on the hospital property. …

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$135M boost going to LSU hospital managers under new deals
Source: Melinda Deslatte, Associated Press, October 27, 2016

The private operators of LSU’s charity hospitals and clinics are in line for a $135 million boost in their payments as part of new deals struck by Gov. John Bel Edwards’ administration, and the university’s medical schools will benefit from some of the new money. State lawmakers are being asked Friday to increase financing for the privatization deals to nearly $1.3 billion in the current budget year, only four months after lawmakers were told the previous level of funding was sufficient. … The money for the hospital and clinic operators is part of a larger budget adjustment requested by the Louisiana Department of Health at Friday’s meeting of the joint House and Senate budget committee. Jeff Reynolds, chief financial officer for the health department, said $135 million is a financing increase for the private managers that have taken over LSU’s hospitals, clinics and patient services. He said the additional payments are part of the renegotiated deals recently worked out by the Edwards administration. … The renegotiated privatization deals crafted by the Edwards administration included provisions in which some of the hospitals will be paying more money for the services of LSU’s doctors who work at the hospitals. … Henry said he wanted to know why the dollars weren’t available when lawmakers were crafting the budget in June, when they were told the previous level of agreed-upon financing was sufficient for the privatization agreements. …

Negotiating over, Edwards makes offers on LSU hospital deals
Source: Melinda Deslatte, Associated Press, September 7, 2016

Gov. John Bel Edwards’ administration will make its offer Thursday to the operator of LSU’s hospitals in Shreveport and Monroe for a renegotiated contract with the state, as the governor pushes to rewrite all the LSU hospital privatization deals. Edwards’ lead negotiator on the contracts, Commissioner of Administration Jay Dardenne, said Thursday’s presentation to the Biomedical Research Foundation of Northwest Louisiana is the last offer to be made. … Dardenne wouldn’t provide details about what changes are being sought in the north Louisiana hospitals’ deal — or any others. But he said negotiations are over and hospital operators can either take or leave the reworked arrangements offered. … Former Gov. Bobby Jindal privatized nine LSU-run hospitals and their clinics through no-bid contracts, with the earliest deal starting in April 2013. In most instances, the management company of a nearby hospital took over operations. Three contracts closed an LSU hospital — in Baton Rouge, Lake Charles and Pineville — and shifted its services to private hospitals. The Edwards administration says the deals were too hastily slapped together, with terms that aren’t favorable to the state. … LSU System President F. King Alexander described the arrangement to have the foundation, known as BRF, run the Monroe and Shreveport hospitals as dysfunctional from its start in October 2013. Alexander said the research foundation, which runs the two hospitals as the University Health System, doesn’t have the resources or experience, isn’t paying bills on time and isn’t providing enough support to the LSU medical school in Shreveport. BRF and University Health leaders say Alexander’s accusations are untrue and LSU’s Shreveport medical school has financial problems of its own making. They say the research foundation’s hospital management has improved health care. …

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Judge: IBM Owes Indiana $78M For Failed Welfare Automation

Source: Associated Press, August 7, 2017

A judge has ruled that IBM Corp. owes Indiana $78 million in damages stemming from the company’s failed effort to automate much of the state’s welfare services. … Indiana and IBM sued each other in 2010 after then-Gov. Mitch Daniels cancelled the company’s $1.3 billion contract to privatize and automate the processing of Indiana’s welfare applications following numerous complaints. The Indiana Supreme Court ruled last year that IBM breached its contract. The justices affirmed a lower court’s award of nearly $50 million to IBM in state fees, but that ruling allowed Indiana to seek more than $172 million in damages from IBM.

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IBM contests judge’s removal petition in welfare-privatization suit
Source: Dave Stafford, Indiana Lawyer, May 25, 2016

The state’s petition to remove a trial court judge who oversaw the civil lawsuit over the canceled $1.3 billion contract with IBM to overhaul Indiana’s welfare system is “factually incorrect,” according to an attorney representing IBM. Andrew Hull of Hoover Hull Turner LLP said in a statement that Marion Superior Judge David Dreyer did nothing to merit removal and didn’t violate Indiana Trial or Appellate Rules in an order issued on remand from the Indiana Supreme Court, as Barnes & Thornburg LLP lawyers representing the state argued in briefs filed Monday. Their petitions and brief seeking writs from the Supreme Court argue Dreyer overstepped his authority by issuing the order without proceedings, called into question his impartiality in the matter, and asked the court to vacate his order on remand and bar him from issuing further orders in the case.

Indiana Seeks New Judge After No Damages Awarded in IBM Case
Source: Rick Callahan, Associated Press, May 10, 2016

Attorneys for the state are challenging a judge’s decision not to award Indiana damages in its long-running fight with IBM Corp. over the company’s failed effort to privatize state welfare services, saying a new judge should be appointed to handle the case. The Indiana Supreme Court ruled in March that IBM had breached its $1.3 billion contract to automate much of Indiana’s welfare system. The high court directed the trial court judge to determine what damages IBM owed the state, opening the door for Indiana to seek up to $175 million. But on Friday, that judge, Marion County Superior Court Judge David Dreyer, ruled that “the costs for which the State seeks reimbursement were not adequately proven, and thus cannot be recovered as damages.” The state’s private attorneys in the case quickly filed a motion seeking a new judge to oversee the case. … The resulting lawsuits between Indiana and IBM were assigned to Dreyer, who found in 2012 that Indiana had failed to prove IBM breached its state contract and awarded the New York-based company about $50 million in state fees. Indiana appealed that ruling, and the state Court of Appeals found in February 2014 that IBM had committed a material breach of its contract by failing to deliver improvements to the state’s welfare system. But it also found IBM was entitled to nearly $50 million in state fees.

Mediation coming in IBM, Indiana contract dispute
Source: Associated Press, December 10, 2014

IBM Corp. and the state of Indiana are turning to mediation in hopes of settling their dispute over IBM’s failed attempt to privatize Indiana’s welfare services. The two parties said in a Monday court filing with the Indiana Supreme Court that they have agreed to mediation and chosen John R. Van Winkle of Indianapolis-based Van Winkle-Baten Dispute Resolution to hear their differences at a Feb. 25 mediation session. The state Supreme Court heard oral arguments in the welfare-privatization contract dispute on Oct. 30. The following week, Chief Justice Loretta Rush suggested that the parties consider mediation “to seek a mutually agreeable resolution of their dispute.” Rush’s order also said that if mediation failed, the court would move ahead to reach a decision in the long-running dispute.

Appeal of IBM-deal fees heard
Source: Niki Kelly, Journal Gazette, November 26, 2013

The fallout from the failed $1.3 billion IBM welfare modernization contract continued Monday as the Indiana Court of Appeals heard arguments over $100 million in disputed fees. … Attorney Peter Rusthoven, representing the state, said the system was plagued with problems from the outset and IBM refused to hire more people to add to the “human dimension.” …. But attorney Jay Lefkowitz, on behalf of IBM, pointed out that Indiana was trying to hire IBM to run the new hybrid system up until the day the company was terminated.

IBM, state in court Monday
Source: Tim Evans, Indianapolis Star, November 20, 2013

The Indiana Court of Appeals will hear oral arguments Monday in the legal battle over a $52 million judgment the state has been ordered to pay IBM over the failed attempt to privatize public welfare services under former Gov. Mitch Daniels. …. The state is appealing a Marion Superior Court judge’s 2012 ruling awarding $52 million to IBM after the state canceled a contract Daniels had hailed in 2006 as the solution for fixing one of the nation’s worst welfare systems. …. “Neither party deserves to win this case,” he wrote in his 65-page ruling. “This story represents a ‘perfect storm’ of misguided government policy and overzealous corporate ambition. Overall, both parties are to blame, and Indiana’s taxpayers are left as apparent losers.”

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Part of food stamp website offline for two weeks
Source: Tony Cook, Indianapolis Star, November 6, 2013

Earlier this year, state contractor RCR Technology wrongly released the private information of Indiana welfare recipients. Now, part of the state’s benefits website administered by the company is broken. …. The problems come just four months after revelations that RCR wrongly revealed private data of FSSA clients, including Social Security numbers. … RCR was initially an FSSA subcontractor, but was later elevated to prime contractor after Gov. Mitch Daniels fired IBM over a botched 10-year, $1.37 billion deal to overhaul the state’s welfare system, Gavin said.

Ind. court sets hearing on IBM welfare lawsuit
Source: Associated Press, September 3, 2013

The Indiana Court of Appeals has set a November hearing in the state’s legal fight with IBM Corp. over a failed attempt to overhaul Indiana’s welfare system. The state is appealing a Marion County judge’s ruling last year awarding $52 million to IBM after then-Gov. Mitch Daniels canceled what was a 10-year, $1.37 billion contract to process applications for food stamps, Medicaid and other programs….

The Unequal State of America: Indiana’s rocky road to welfare reform
Source: David Rohde and Kristina Cooke, Reuters, December 20, 2012

In 2006, Gov. Mitch Daniels privatized the management of the welfare-benefits system with a project led by IBM. Two-thirds of Indiana’s social-service agency’s staffers became employees of IBM and its partners. In a process dubbed “welfare modernization,” recipients would apply for benefits online and by phone rather than meeting social workers face to face. It was, by Daniels’s own admission, a failure…..

JEditorial: Human toll of FSSA deal laid bare
Source: Journal Gazette, July 24, 2012

Editorial: Decision to privatize state welfare system a mistake from start
Source: Evansville Courier & Press, July 22, 2012

Judge denies Indiana claim over failed IBM project
Source: Charles Wilson, Associated Press, July 18, 2012

A judge on Wednesday spurned Indiana’s efforts to recoup roughly $170 million from IBM Corp. over its failed effort to overhaul the state’s welfare system as part of a broader privatization push that was an early hallmark of Republican Gov. Mitch Daniels’ tenure. Marion County Judge David Dreyer said in a 75-page order that neither side deserved to win the dispute, and awarded IBM only a small fraction of what it was seeking. … Dreyer blamed “misguided government policy and overzealous corporate ambition” for the failure of the system, which he called an “untested theoretical experiment.” … Dreyer said Indiana failed to prove that IBM breached its contract, and he denied the state any of the money it sought.

IBM questions Daniels’ resistance to deposition
Source: Carrie Ritchie, IndyStar.com, December 19, 2011

In court, state and IBM spar over welfare system’s design
Source: Carrie Ritchie, Indianapolis Star, March 9, 2012

IBM to begin making case in welfare trial
Source: Indianapolis Star, March 21, 2012

IBM: Indiana canceled deal because of budget woes
Source: Associated Press, April 3, 2012

IBM, state in final arguments at welfare system trial
Source: Carrie Ritchie, Indianapolis Star, April 3, 2012

Judge orders Gov. Daniels be deposed in IBM lawsuits
Source: Carrie Ritchie, IndyStar.com, December 16, 2011

A judge has ordered Gov. Mitch Daniels to share his knowledge of a canceled $1 billion contract with IBM to help resolve a legal battle between the state and the company.

Attorneys for the state had said a law protects Daniels and other high-ranking state officials from testifying….

Michigan begins to design 4 pilot projects to test mental health integration

Source: Jay Greene, Crain’s Detroit Business, August 4, 2017

What is going on at the Michigan health department about designing four pilot programs to test a controversial plan to combine physical and behavioral Medicaid services among mental health agencies, providers and HMOs? So far, nothing, at least on the selection and design of the pilots. … Section 298 is a controversial budget section that, under Snyder’s original plan put forth in early 2016, would have allowed some of the state’s health plans to manage the $2.6 billion Medicaid behavioral health system. The Medicaid HMOs already manage a nearly $9 billion physical health system. Over the past two years, Michigan’s 11 Medicaid health plans have lobbied legislators and the public to try a semi-privatized approach under Snyder’s plan, which was finally approved in June. … Republicans in Michigan want to test the concept in four pilot projects that everyone believes will be Kent County, an urban area like metro Detroit, a northern Michigan rural area and in western Michigan, which could include Kalamazoo County, sources tell me. Lori said the state has not received any formal suggestions for where the four pilots would be located. …

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Plan to privatize Mich. mental health aid advances
Source: Karen Bouffard, Detroit News, June 20, 2017
 
The first step in a plan to turn control of Michigan’s $2.6 billion mental health budget over to privately owned insurance companies is poised for inclusion in next year’s state budget, despite a wall of opposition from mental health providers, patients and families across Michigan.  The contentious plan is embedded in two provisions of the state budget for the Department of Health and Human Services, part of the Omnibus Budget bill approved by the state House on Tuesday expected to be approved by the state Senate on Thursday. …

Lobbying ramp-up precedes mental health funding proposal
Source: Justin A. Hinkley, Lansing State Journal, April 27, 2017

Physical health insurers ramped up lobbying operations and far out-spent their behavioral health counterparts in the months before lawmakers pulled an about-face on who should manage billions of Medicaid dollars for mental health services. Community mental health groups and allied advocacy groups spent about $52,400 on lobbying in 2016, nearly $8,700 more than their average from the previous three years, state records show. That happened as they fought to maintain management of Medicaid money for behavioral health. However, lobbyists for the private insurers who currently manage Medicaid dollars for physical health spent a combined nearly $838,000 last year, about $21,000 more than their previous three years’ average as they seek to take over the mental health dollars. … That ramp-up happened as lawmakers and Gov. Rick Snyder’s administration changed positions on the Medicaid issue — to the benefit of the physical health insurers. In February 2016, Snyder called for the private health management organizations who oversee physical health spending to also take over mental health money by Oct. 1, 2016. Lawmakers denied that proposal and instead asked the administration to study the issue and make recommendations by spring 2017. The administration did that last month, changing its position from 2016 and calling for the two funds to remain under separate management. Last week, however, lawmakers in the Senate advanced a budget proposal that would give the mental health money to HMOs by 2020. …

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Privatization Is Changing America’s Relationship With Its Physical Stuff

Source: Brian Alexander, The Atlantic, July 12, 2017
 
… As vague as Trump’s pronouncements have been on the matter, it is clear that the general thrust behind the promised building-and-repair push involves using federal dollars as up-front investment to entice private enterprises to provide most of the financing. While Democrats announced their opposition, the general idea of increased privatization of infrastructure has had a bipartisan cast. President Obama supported a plan to create an “infrastructure bank” that would help finance so-called public-private partnerships (known, for their alliteration, as P3s), but that idea fizzled under the glare of Republican opposition. He also floated the idea of selling off the Tennessee Valley Authority. …

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Selling Back To The Public What It Already Owned: ‘Public-Private Partnership’ Shark Bait
Source: Mercedes Schneider, Huffington Post, June 12, 2017
 
Today, I read two articles centered on this idea, both of which concerned Vice President Mike Pence – and one that concerned Pence’s role in the aftermath of Hurricane Katrina.  One article also included a sprinkling of US secretary of [privatized] education, Betsy DeVos.  A major goal of corporate education reform is to deliver public education to private entities (corporations, or even nonprofits, but don’t think that an entity termed “nonprofit” cannot be a handsome money dispenser for those running the nonprofit and doling out contracts). However, the extreme-right-Republican aim does not end with public education but with delivering the operation of the entire American infrastructure to private entities.  In the end, what this entails is having private corporations front money to state and local governments in order to lease back to the public what the public already owns.

How President Trump Might Carry The Torch Of Privatization
Source: Here & Now, WBUR, May 8, 2017

… Now President Trump is poised to continue privatization and private contracting in all kinds of industries, from education to incarceration. Here & Now’s Jeremy Hobson looks at the history and politics of privatization with Donald Cohen and Shahrzad Habibi of the group In The Public Interest. …

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Paul Ryan Still Talking Up The Idea Of Privatizing Medicare

Source: Tierney Sneed, Talking Points Memo, May 12, 2017

House Speaker Paul Ryan hasn’t let go of his cherished idea of privatizing Medicare and in an interview with a local Wisconsin radio station Friday, suggested that a blueprint for overhauling Medicare would advance in the Budget Committee again this year. … Ryan has released various versions of his so-called “Path to Prosperity” budget blueprint that have included a privatization of Medicare. The general idea he has promoted is turning Medicare into a so-called “premium support” system — i.e. a voucher system — in which seniors would get a set amount of money to shop around for private health care plans. Earlier versions of his proposal would have lead to a phase-out of Medicare altogether. Some experts have argued that even the most recent iteration of his blueprint, which ostensibly leaves some form of traditional Medicare available, would eventually lead to its phase-out as well. … It’s not just Ryan that’s trying to make Medicare privatization happen. Trump’s Office of Management and Budget Director Mick Mulvaney, a former House member with a reputation as a budget hawk, said last month that it was his “guess is the House will do either that or something similar to that.” …

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Trumpcare Will Be A Gold Rush For Private Contractors
Source: Donald Cohen, Huffington Post, March 16, 2017

… What the bill would do to Medicaid, the health care program for poor, elderly, and disabled Americans, plays right into the hands of private contractors looking to score big on taxpayer money. By including Medicaid “block grants,” which is a fancy way of saying “cuts,” the bill would force states to slash costs. And when budgets are tight, corporations come calling, claiming they’ll do the work cheaper, better, and faster. But, whether it’s running private prisons or operating water utilities, their claims often ring hollow, especially when it comes to helping those on the margins of society. Just look at what happened to cash assistance for families with children, known as “TANF.” After the program was block granted in 1996, a cottage industry sprung up to squeeze profits from the limited pool of welfare funds. Within five years, over $1.5 billion in taxpayer dollars meant for poor families had gone to contractors like IBM and Lockheed Martin. By 2014, only 26 percent of TANF dollars were going to basic assistance for poor families. … Over 60 percent of nursing home residents and two in five kids in the U.S. rely on the program. It’s also the main public funding source for family planning, like contraceptive counseling and care, and screenings for sexually transmitted infections and cancer.

… The struggle to protect Medicaid, let alone expand it, will only get tougher. On Wednesday, the Senate confirmed Seema Verma, a private health care consultant, to lead the agency in charge of the program. Verma supports block grants and has helped a number of states, including Iowa, privatize their Medicaid programs. Less than a year in, Iowa’s privatized program is spinning into disaster for 600,000 poor, elderly, and disabled Iowans. If Trump wanted somebody who knows the corporate takeover of Medicaid in and out, he certainly found her. While helping Indiana overhaul its program, Verma was also on the payroll of one of the state’s largest Medicaid vendors, Hewlett-Packard. …

Senate confirms Trump’s Medicaid, Medicare pick
Source: The Hill, March 13, 2017
 
The Senate voted to clear Seema Verma to lead the Centers for Medicare and Medicaid Services under President Trump.  Verma was confirmed in a 55-43 vote Monday evening. She will now be dropped into the fight over how to repeal and replace the Affordable Care Act and is expected to play a large role in any attempt to reform either Medicare or Medicaid. … Democrats largely said they opposed Verma’s nomination after trying unsuccessfully to pin her down on a number of policy issues during her confirmation hearing, including if or how she would reform the programs.

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Hospice owner sentenced to 6 years in $20 million SNF kickback scheme

Source: Emily Mongan, McKnight’s, March 9, 2017

The owner of an Illinois hospice company was sentenced to six and a half years in federal prison on Tuesday for his role in a Medicare fraud scheme that paid kickbacks to nursing homes. Seth Gillman owned Passages Hospice LLC, which grew to be the largest hospice provider in the state before Gillman was charged in 2014 with inappropriately designating nursing home residents as hospice patients and overbilling for hospice services. Gillman also was accused of paying kickbacks to nursing homes that participated in the scheme, as well as providing residents of his family’s nursing home chain, Asta Healthcare, with fraudulent hospice services through Passages. Those residents often received services for years, far beyond the six-month cap in place for federal funding for hospice services, authorities said. The family of some former Passages patients told the Chicago Tribune that employees told them their loved ones were terminally ill, when they actually weren’t, in order to move them to hospice care or the more lucrative general inpatient care, or GIP. …