This report originally appeared in the July 2009 issue of DOTmed Business News

National: Senators Introduce End-of-Life Care Legislation

Senators John D. Rockefeller IV (D-WV) and Susan Collins (R-ME) have recently reintroduced a more expansive, comprehensive version of their original "Advance Planning and Compassionate Care Act." According to a press release on Sen. Rockefeller's web site, Senators Herb Kohl (D-WI), Ron Wyden (D-OR) and Tom Carper (D-DE) are co-sponsors of the bill S.1150.

"Death is a very personal and complicated issue that we all must confront one day. We have an obligation to help the sick maintain dignity and proper care for as long as possible," said Senator Rockefeller, Chairman of the Senate Finance Subcommittee on Health Care, in the press release. "Our efforts on health care reform must include improvements to end-of-life care. Far too often, patients, their families, and their health care providers do not have the information needed to make educated decisions about their options. We must make sure that patients' final wishes are known, respected, and complied with - always."

The Act would provide: Improved consumer information about advance care planning and end-of-life care; improved provider education (establishing a National Geriatric and Palliative Care Service Corps); portability of advance directives between states, ensuring that such directives are easily visible; funding for new approaches to advance care planning; Medicare, Medicaid and CHIP coverage for consultations; improved consumer access to hospice and palliative care; development of quality measures for end-of-life care assessment; and establishment of a new National Center on Palliative and End-of-Life Care at the National Institute of Health.

State: NY AG Arrests Operator Distributing Fake Home Health Aide Certifications

Attorney General Andrew M. Cuomo announced in a press release the arrest of Ronald Kehinde for an alleged theft of more than $50,000 from Medicaid, through Kehinde's operation of a home health aide training school in the Bronx. Kehinde was charged with several counts including grand larceny in the second degree. AG Cuomo says the Bronx school allegedly issued phony certifications to health aides across New York City. (The charges are accusations, and the defendant is presumed innocent unless proven guilty.)

The Attorney General's press release says that Kehinde operated a training facility (NCLEX Review and Preparatory Solutions, LLC) where allegedly: students did not have to complete the requisite hours of training for a home health aide certificate; student test results were fabricated; individual students were charged higher enrollment fees than the New York State Department of Health (DOH) permits; and that Kehinde submitted a false application with the DOH in order to open NCLEX, failing to identify Kehinde as NCLEX's operator and director. Kehinde had previously been charged in 2007 for a similar home health aide training school, which the AG says led to a ban from his involvement with the State's Medicaid system.

"To unlawfully manipulate New York's Medicaid system is a brazen abuse of our tax dollars and the public trust," said Attorney General Cuomo in the press release. "Today's arrest should send a message to individuals who prey on Medicaid recipients that they are neither above the law, nor out of sight."

National: FTC Applauds House Subcommittee Actions on "Pay-for-Delay"

The Federal Trade Commission Chairman Jon Leibowitz gave high marks in a recent press release to the U.S. House Energy and Commerce Committee's Commerce, Trade, and Consumer Protection Subcommittee, for its vote to pass the Protecting Consumer Access to Generic Drugs Act of 2009 (H.R. 1706). This Act (previously described in May's column - see online dm8869) would prohibit "pay-for-delay" patent settlements between manufacturers of brand-name medications and potential generic competitors, so that the generic companies stay out of the drug market.

"Escalating health care costs are a pressing concern for American consumers, employers, and local, state and federal governments," Chairman Leibowitz said in the press release. "Stopping pharmaceutical companies from colluding with each other to delay entry of generic drugs, which sometimes cost 80 to 90 percent less than their brand name versions, is a simple and surefire way to control costs. Today, Members of the Subcommittee acknowledged this by approving H.R. 1706."

Chairman Leibowitz in particular thanked Chairmen Henry Waxman and Bobby L. Rush and Representative Jan Schakowsky for their efforts in working on ending the "pay for delay" agreements. Leibowitz said that ending this practice will save American consumers and the government "billions of dollars" every year. "We urge Congress to pass this legislation to restore the full benefits of generic competition so that consumers will benefit from earlier access to generic drugs, which are substantially less expensive than branded drugs," Leibowitz further said.

State: California AG Files Medi-Cal Fraud Charges Against Home Health Workers

California Attorney General Edmund Brown has filed criminal fraud charges against two dozen in-home health workers who the AG says "shamelessly bilked" the state Medi-Cal system by allegedly obtaining payment for services to patients who were in fact deceased, incarcerated or hospitalized. AG Brown announced the charges in a press release on his web site.




According to the press release, an audit in 2008 revealed that hundreds of payment requests had been submitted for in-home services that were never performed. AG Brown's office and the California Department of Health Care Services then investigated Medi-Cal's In-Home Supportive Services program, which resulted in the recent charges.

In the In-Home program, health workers perform non-medical services for qualified Medi-Cal recipients, such as housekeeping, grocery shopping and meal preparation. The workers must submit timesheets certified by the clients in order to receive payment. At least 400,000 Californians received in-home services in 2008, at a cost of $2 billion. In this recent investigation, most defendants allegedly submitted timesheets for services to close relatives who had actually died before the time periods in question. Other patients were hospitalized, in nursing homes or incarcerated during the time the defendants allegedly claimed to have provided services.

National: GAO Reports Hundreds of Possible Abuse Incidents of Disabled Students

Representative George Miller (D-CA) has recently announced a General Accounting Office report that detailed hundreds of cases concerning alleged abuse to schoolchildren, some resulting in death, as a result of inappropriate use of seclusion and restraint in classrooms. These practices were "used disproportionately on children with disabilities," Rep. Miller stated in a press release.

"GAO's report shows that in too many cases, a child's life wound up being threatened even though that child was not a threat to others," said Rep. Miller in the release. "This behavior, in some instances, looks like torture. The current situation is unacceptable and cannot continue." Rep. Miller further stated that legislation is needed to address the situation.

The report, part of testimony before the House Committee on Education and Labor, discussed the GAO's examination of ten restraint and seclusion cases involving a criminal conviction, a finding of civil or administrative liability, or a large financial settlement. The cases mostly concerned children with disabilities who were restrained and secluded (even when not physically aggressive, and without parental consent). The report found that the type of restraints used may block air to the lungs and can be deadly; in addition, that teachers and staff in the cases were often not trained on the use of seclusions and restraints. "Even if no physical injury is sustained," the report says, "...individuals can be severely traumatized during restraint."

State: New Jersey Senate Passes Medical Marijuana Act

Following the approvals of medical marijuana for use in Michigan and areas of Massachusetts last year, the New Jersey State Senate has now passed S119, the "New Jersey Compassionate Use Medical Marijuana Act." The bill now awaits vote in the state Assembly.




The bill provides that the New Jersey Department of Health and Senior Services establish a registration program authorizing alternative treatment centers to produce and dispense medically-related marijuana. Any alternative treatment center permit holder and employee would not be subject to arrest or prosecution, provided the amount of marijuana possessed by the center, combined with the amount possessed by the registered patient and his primary caregiver, does not exceed a predetermined limit. In addition, patients and caregivers who possess a special registry identification card and collectively possess no more than the established amount would be protected from arrest, prosecution, civil penalty or disciplinary action.

The Statement to accompany the bill said in part, "Medical research suggests that marijuana may alleviate pain or other symptoms associated with certain debilitating medical conditions...Changing state law would therefore provide legal protection to the vast majority of seriously ill people who use marijuana medically. Thirteen other states permit the use of marijuana for medical purposes, and with this bill, New Jersey would join the effort to protect patients using marijuana to alleviate suffering from arrest, prosecution, and other legal sanctions."

National: Senators Urge Paid Sick Days to Help Working Families

Senators Edward M. Kennedy (D-MA) and Christopher Dodd (D-CT) have announced the introduction of the "Healthy Families Act," which would enable workers to earn paid sick days to care for themselves and their families without risk of losing their jobs. The Act was announced in a press release on Senator Dodd's web site. According to the press release, nearly half of today's private sector workers do not have a single paid sick day, including 79% of low-wage workers.

The legislation will enable workers to earn one hour of paid sick time for every 30 hours worked, up to 56 hours (seven days) in a year. The workers will be able to use the saved time to care for self or family, receive preventive or diagnostic treatment, or seek help if they are a victim of domestic violence. Small employers with fewer than 15 employees are exempt from the Act, and employers that already provide such leave will not have to change their current policies, so long as existing leave can be used for the same purposes described in the Act. Employers can require workers to provide documentation supporting any request for leave longer than three consecutive days.

Senator Kennedy stated in the press release, "Every worker has had to miss days of work because of illness. Every child gets sick and needs a parent at home to take care of them. And all hardworking Americans deserve the chance to take care of their families without putting their jobs or their health on the line."

Federal: New Interagency Health Care Fraud Prevention and Enforcement Action Team

U.S. Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius have recently announced in a press release on the Department of Justice's (DOJ) web site a new interagency creation, the Health Care Fraud Prevention and Enforcement Action Team (HEAT). AG Holder says the HEAT initiative offers increased tools, resources and leadership.

"Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud." Secretary Sebelius stated in the press release. "Most providers are doing the right thing and providing care with integrity. But we cannot and will not allow billions of dollars to be stolen from Medicare and Medicaid through fraud, waste and serious abuse of the system. It's time to bring the fight against fraud into the 21st century and put the resources on the streets and out into the community to protect the American taxpayers and lower the cost of health care."

The HEAT team features senior officials from DOJ and HHS, and will be building upon and strengthening existing programs and using new technology to combat and prevent fraud, waste and abuse. The efforts will also include the expansion of joint DOJ-HHS Medicare Fraud Strike Force teams that have successfully fought fraud in South Florida and Los Angeles. According to the DOJ's press release, resources will be directed for specific tasks in fraud prevention, including expanding demonstration projects by the HHS Inspector General and the Centers for Medicare & Medicaid Services that focus on suppliers of durable medical equipment (DME).

State: Delaware Bill Introduced to Give Stronger Protections for Elderly, Disabled

In Delaware, a bill has been introduced (House Bill 165) that will offer the public online access to an Adult Abuse Registry. Delaware Governor Jack Markell announced the legislation in a press release on his web site. Governor Markell expressed his support for the bill, along with State Representative Valerie Longhurst and State Senator Patricia Blevins, and its protections of senior citizens and Delaware citizens with disabilities. Senate Majority Whip Blevins is the lead Senate sponsor of HB 165, and House Majority Whip Longhurst is the House sponsor.

The legislation will assist those who wish to hire caretakers for the elderly or disabled and need to check an applicant's name against the State Abuse Registry. According to the press release, Rep. Longhurst had acted in response to reports that access to the list is a difficult and lengthy process, including having to obtaining a signed affidavit. "People have to jump through hoops to get this vital information, which helps families make important health care decisions," Rep. Longhurst stated in the press release. "This bill would put the registry online."

Governor Markell added, "This will protect our seniors and help them safely remain in their homes as they age. By allowing public access to the registry, we're allowing the public to have peace of mind that they are doing everything possible to ensure their loved ones are safe and well cared for."