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“白卡”不拿白不拿





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01/18/2018


“白卡”不拿白不拿

By enchants

进入2018年,在税改尘埃落定后,特朗普显然把工作重点放在移民改革方面,如解决梦想生问题、修建边境墙、建立以积分制为基础的移民体系等等。但是在福利改革方面,特朗普也不闲着。在11日,美国卫生及公共服务部宣布,各州将可以对申请医疗补助(Medicaid,俗称白卡)的身体健全的低收入成年人提出工作要求。也就是说,适龄无残疾的成年人必须有工作或者自愿参加社区劳动,才能获得白卡。媒体称,特朗普的这项举措将影响数百万依靠联邦政府补助而获得医疗保险的低收入人群,这一消息也在华人社会引起强烈反响。

美国不是典型的福利国家,但林林总总福利不在少数。医疗补助福利就是其中之一。该制度在1965年由联邦与各州共同成立,当时援助的对象生活困难的老弱病残的美国人,其比例约为人口的7%。可以说,这是一项扶持弱势群体的善举。但如同其他福利制度一样,白卡制度长期实施下来,逐渐弊端丛生。首先是日益膨胀,该制度实施约50年后,受益人多达7000多万人,约占美国人口的五分之一。即每四个美国人中,就有一人在享受医疗补助。许多有工作的人,也可以拿白卡。还有一些新移民来美不久就领白卡。白卡变成了不拿白不拿的“香饽饽”。这使得真正辛苦工作,却要支付高额医疗保险的人们心理很不平衡,这也是导致美国社会不满,戾气上升的原因之一。

第二就是欺诈泛滥。在华人社会中,媒体就不断曝光,有些人一边拿着不菲的现金收入一边享受白卡。这些人把现金存放在家里,或把资产转移到其他家庭成员名下,更有人采取各种方式洗钱。这些都构成了美国福利体系乱象的组成部分。因此,打击医疗补助系统中的滥用、浪费和诈欺已经刻不容缓。



Investigators warn of Medicaid fraud and home care abuse

Published on Oct 4, 2016

Federal investigators are raising an alarm over what they call persistent fraud and abuse in Medicaid-funded personal care services. Estimates of questionable billing since 2012 total more than $600 million. Anna Werner reports on a story you'll see only on "CBS This Morning."



白卡泛滥的结果就是联邦和州都不堪重负。研究显示,在1980年,联邦政府的开支中,每41元中才1元用于医疗补助。但到如今,联邦每花10元,就有1元用到其中。在州一级,医疗补助计划竟占用了一些州预算的20%至25%。因此,医疗补助制度不是要不要改的问题,而是如何改的问题。首先要打击欺诈。要严格执行法规,认真对领取医疗补助者进行资格审核,严厉打击欺诈活动。纽约州检察长办公室、州医疗补助欺诈督查控制组的官员们就曾提醒民众,收取回扣等滥用医疗补助的行为涉嫌医疗欺诈,一旦被查实,白卡持有者不仅会被要求退还所滥用的费用,其白卡还有可能被吊销,甚至严重者面临最高十年监禁和50万元罚款的处罚。

其次要让真正的需要者受惠。如果取消无收入者和残障人士的白卡,这些弱势群体将陷入困境。因此,年长者、残疾人士以及孕妇和儿童的医疗补助应该得到切实的保障。但是,有工作能力而不去工作,那就变成变相鼓励懒人。即使是失业者,从事社区活动和参加就业培训也是理所应当的。如肯塔基州在2016年就要求身体健全的成年“白卡”拥有者每月参加至少80个小时的“就业活动”,其中包括就业培训、教育和社区服务。肯塔基州州长贝文(MattBevin)表示,工作规定只是恢复白卡当初的用意,因为这项计划是提供暂时援助,协助受益人重新站稳脚步,而不是长久补助无法工作者的生活方式。贝文的说法应该说是有道理的。因此,改革的方向不仅应保障真正的有需要者,还应鼓励受益者融入社会,并因此改善他们的健康。毕竟工作着的人更健康。 

但要从根本解决这一问题,还是要靠推进有成效的医保改革。众所周知,美国目前医保系统漏洞太多,浪费严重、效益低下。其结果就是带来美国的医保难题。奥巴马医改的一个缺陷,就是对于中产阶级而言,医保费太高,超出了普通工薪阶层的承受能力,但由于强制性条款,民众必须咬牙购买。如今,特朗普在税改案中,“捆绑”废除了奥巴马医保中的强制条款。但是,特朗普还要解决如何降低这部分人保险费,买得起管用保险的问题。

再有,还有一些企业或无能力,或不愿意提供医保的问题。其实对于许多雇员来说,如果雇主提供给他们了保险,他们便不需要医疗补助了。这种情况也迫使人们各显神通去拿白卡。

因此,打击滥用福利,要治标也要治本:要保正有限的福利,用到真正有需要的人身上,更要建立其低成本而高效的医疗保障制度,解决民众的看病问题。 






涉詐騙政府2700萬 紐約華醫被捕


記者黃伊奕/紐約報導 2017年07月14日 01:10


章曉良位於法拉盛診所13日未營業,門口告示寫著「休診,下周通知」。(記者朱澤人/攝影)  章曉良位於法拉盛診所13日未營業,門口告示寫著「休診,下周通知」。(記者朱澤人/攝影)
章曉良位於艾姆赫斯特的診所13日未營業,門口告示寫著7月12日到14日停業。(記者朱澤人/攝影)  章曉良位於艾姆赫斯特的診所13日未營業,門口告示寫著7月12日到14日停業。(記者朱澤人/攝影)

司法部長塞辛斯(Jeff Sessions)與衛生與福利部部長普萊斯(Tom Price)於13日宣布偵破的全國性重大醫療補助欺詐案,聯邦多部門聯合執法,紐約州共逮捕十人,包括在皇后區法拉盛與艾姆赫斯特經營診所的醫生章曉良。

司法部指,此次行動由41個聯邦機構,在密西根州、德州、加州、佛州、紐約州等全國範圍展開,一共逮捕115人,查獲涉嫌欺詐金額高達13億元。其中紐約州共逮捕十人,包括三名醫生、一名脊骨神經師、三名執照物理治療師以及兩家醫療機構負責人。十人共涉及1億2500萬元聯邦耆老醫療補助(紅藍卡)以及低收入醫療補助(白卡)欺詐。塞辛斯說:「這些醫療界專業人士辜負民眾對他們的信任,貪得無厭的尋求非法利益,我們將繼續尋找、逮捕、起訴、關押更多的欺詐者,無論他們在哪裡。」

十名被捕的醫療人員以白人為主,其中包括在皇后法拉盛與艾姆赫斯特擁有兩家痛症康復診所的章曉良。根據法庭文件顯示,章曉良為一名擁有正規執照的醫生,過去通過偽造的醫療帳虛假申報超過2700萬元,但事實上並未向這些病患提供相應的醫療,或者提供非必要的服務。

章曉良位於艾姆赫斯特的診所13日未營業,門口告示寫著7月12日到14日關門。(記者朱澤人/攝影)  章曉良位於艾姆赫斯特的診所13日未營業,門口告示寫著7月12日到14日關門。(記者朱澤人/攝影)
章曉良有兩家診所,13日皆未營業。圖為他在艾姆赫斯特的診所。(記者朱澤人/攝影)  章曉良有兩家診所,13日皆未營業。圖為他在艾姆赫斯特的診所。(記者朱澤人/攝影)
章曉良。(取自網絡)  章曉良。(取自網絡)





National Health Care Fraud Takedown Results In Charges Against 412 Individuals Responsible For $1.3 Billion In Fraud Losses

Attorney General Sessions and HHS Secretary Price Announce National Health Care Fraud Takedown

Published on Jul 13, 2017

The largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings, was announced today by Attorney General Jeff Sessions and Department of Health and Human Services Secretary Tom Price, M.D. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists. 

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Attorney General Sessions. “Amazingly, some have made their practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards. While today is a historic day, the Department's work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”







Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Thursday, July 13, 2017

National Health Care Fraud Takedown Results in Charges Against Over 412 Individuals Responsible for $1.3 Billion in Fraud Losses

Largest Health Care Fraud Enforcement Action in Department of Justice History

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists. 

Attorney General Sessions and Secretary Price were joined in the announcement by Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting Director Andrew McCabe of the FBI, Acting Administrator Chuck Rosenberg of the Drug Enforcement Administration (DEA), Inspector General Daniel Levinson of the HHS Office of Inspector General (OIG), Chief Don Fort of IRS Criminal Investigation, Administrator Seema Verma of the Centers for Medicare and Medicaid Services (CMS), and Deputy Director Kelly P. Mayo of the Defense Criminal Investigative Service (DCIS).

Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG.  In addition, the operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units. 

The charges announced today aggressively target schemes billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 91 Americans die every day of an opioid related overdose.   

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Attorney General Sessions. “Amazingly, some have made their practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards.  While today is a historic day, the Department's work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”

“Healthcare fraud is not only a criminal act that costs billions of taxpayer dollars - it is an affront to all Americans who rely on our national healthcare programs for access to critical healthcare services and a violation of trust,” said Secretary Price. “The United States is home to the world’s best medical professionals, but their ability to provide affordable, high-quality care to their patients is jeopardized every time a criminal commits healthcare fraud. That is why this Administration is committed to bringing these criminals to justice, as President Trump demonstrated in his 2017 budget request calling for a new $70 million investment in the Health Care Fraud and Abuse Control Program. The historic results of this year’s national takedown represent significant progress toward protecting the integrity and sustainability of Medicare and Medicaid, which we will continue to build upon in the years to come.”

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims.  Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.

“This week, thanks to the work of dedicated investigators and analysts, we arrested once-trusted doctors, pharmacists and other medical professionals who were corrupted by greed,” said Acting Director McCabe. “The FBI is committed to working with our partners on the front lines of the fight against heath care fraud to stop those who steal from the government and deceive the American public.”

“Health care fraud is a reprehensible crime.  It not only represents a theft from taxpayers who fund these vital programs, but impacts the millions of Americans who rely on Medicare and Medicaid,” said Inspector General Levinson. “In the worst fraud cases, greed overpowers care, putting patients’ health at risk. OIG will continue to play a vital leadership role in the Medicare Fraud Strike Force to track down those who abuse important federal health care programs.”

“Our enforcement actions underscore the commitment of the Defense Criminal Investigative Service and our partners to vigorously investigate fraud perpetrated against the DoD's TRICARE Program. We will continue to relentlessly investigate health care fraud, ensure the taxpayers' health care dollars are properly spent, and endeavor to guarantee our service members, military retirees, and their dependents receive the high standard of care they deserve,” advised Deputy Director Mayo.

“Last year, an estimated 59,000 Americans died from a drug overdose, many linked to the misuse of prescription drugs. This is, quite simply, an epidemic,” said Acting Administrator Rosenberg. “There is a great responsibility that goes along with handling controlled prescription drugs, and DEA and its partners remain absolutely committed to fighting the opioid epidemic using all the tools at our disposal.”

“Every defendant in today’s announcement shares one common trait - greed,” said Chief Fort. “The desire for money and material items drove these individuals to perpetrate crimes against our healthcare system and prey upon many of the vulnerable in our society.  Thanks to the financial expertise and diligence of IRS-CI special agents, who worked side-by-side with other federal, state and local law enforcement officers to uncover these schemes, these criminals are off the street and will now face the consequences of their actions.”

The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

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For the Strike Force locations, in the Southern District of Florida, a total of 77 defendants were charged with offenses relating to their participation in various fraud schemes involving over $141 million in false billings for services including home health care, mental health services and pharmacy fraud.  In one case, the owner and operator of a purported addiction treatment center and home for recovering addicts and one other individual were charged in a scheme involving the submission of over $58 million in fraudulent medical insurance claims for purported drug treatment services. The allegations include actively recruiting addicted patients to move to South Florida so that the co-conspirators could bill insurance companies for fraudulent treatment and testing, in return for which, the co-conspirators offered kickbacks to patients in the form of gift cards, free airline travel, trips to casinos and strip clubs, and drugs.

In the Eastern District of Michigan, 32 defendants face charges for their alleged roles in fraud, kickback, money laundering and drug diversion schemes involving approximately $218 million in false claims for services that were medically unnecessary or never rendered. In one case, nine defendants, including six physicians, were charged with prescribing medically unnecessary controlled substances, some of which were sold on the street, and billing Medicare for $164 million in facet joint injections, drug testing, and other procedures that were medically unnecessary and/or not provided.

In the Southern District of Texas, 26 individuals were charged in cases involving over $66 million in alleged fraud. Among these defendants are a physician and a clinic owner who were indicted on one count of conspiracy to distribute and dispense controlled substances and three substantive counts of distribution of controlled substances in connection with a purported pain management clinic that is alleged to have been the highest prescribing hydrocodone clinic in Houston, where approximately 60-70 people were seen daily, and were issued medically unnecessary prescriptions for hydrocodone in exchange for approximately $300 cash per visit. 

In the Central District of California, 17 defendants were charged for their roles in schemes to defraud Medicare out of approximately $147 million. Two of these defendants were indicted for their alleged involvement in a $41.5 million scheme to defraud Medicare and a private insurer. This was purportedly done by submitting fraudulent claims, and receiving payments for, prescription drugs that were not filled by the pharmacy nor given to patients. 

In the Northern District of Illinois, 15 individuals were charged in cases related to six different schemes concerning home health care services and physical therapy fraud, kickbacks, and mail and wire fraud.  These schemes involved allegedly over $12.7 million in fraudulent billing. One case allegedly involved $7 million in fraudulent billing to Medicare for home health services that were not necessary nor rendered.

In the Middle District of Florida, 10 individuals were charged with participating in a variety of schemes involving almost $14 million in fraudulent billing.  In one case, three defendants were charged in a $4 million scheme to defraud the TRICARE program.  In that case, it is alleged that a defendant falsely represented himself to be a retired Lieutenant Commander of the United States Navy Submarine Service. It is alleged that he did so in order to gain the trust and personal identifying information from TRICARE beneficiaries, many of whom were members and veterans of the armed forces, for use in the scheme.

In the Eastern District of New York, ten individuals were charged with participating in a variety of schemes including kickbacks, services not rendered, and money laundering involving over $151 million in fraudulent billings to Medicare and Medicaid. Approximately $100 million of those fraudulent billings were allegedly part of a scheme in which five health care professionals paid illegal kickbacks in exchange for patient referrals to their own clinics.

In the Southern Louisiana Strike Force, operating in the Middle and Eastern Districts of Louisiana as well as the Southern District of Mississippi, seven defendants were charged in connection with health care fraud, wire fraud, and kickback schemes involving more than $207 million in fraudulent billing. One case involved a pharmacist who was charged with submitting and causing the submission of $192 million in false and fraudulent claims to TRICARE and other health care benefit programs for dispensing compounded medications that were not medically necessary and often based on prescriptions induced by illegal kickback payments.

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In addition to the Strike Force locations, today’s enforcement actions include cases and investigations brought by an additional 31 U.S. Attorney’s Offices, including the execution of search warrants in investigations conducted by the Eastern District of California and the Northern District of Ohio.

In the Northern and Southern Districts of Alabama, three defendants were charged for their roles in two health care fraud schemes involving pharmacy fraud and drug diversion.

In the Eastern District of Arkansas, 24 defendants were charged for their roles in three drug diversion schemes that were all investigated by the DEA.

In the Northern and Southern Districts of California, four defendants, including a physician, were charged for their roles in a drug diversion scheme and a health care fraud scheme involving kickbacks.

In the District of Connecticut, three defendants were charged in two health care fraud schemes, including a scheme involving two physicians who fraudulently billed Medicaid for services that were not rendered and for the provision of oxycodone with knowledge that the prescriptions were not medically necessary. 

In the Northern and Southern Districts of Georgia, three defendants were charged in two health care fraud schemes involving nearly $1.5 million in fraudulent billing.

In the Southern District of Illinois, five defendants were charged in five separate schemes to defraud the Medicaid program.

In the Northern and Southern Districts of Indiana, at least five defendants were charged in various health care fraud schemes related to the unlawful distribution and dispensing of controlled substances, kickbacks, and services not rendered.

In the Southern District of Iowa, five defendants were charged in two schemes involving the distribution of opioids. 

In the Western District of Kentucky, 11 defendants were charged with defrauding the Medicaid program.  In one case, four defendants, including three medical professionals, were charged with distributing controlled substances and fraudulently billing the Medicaid program.

In the District of Maine, an office manager was charged with embezzling funds from a medical office.

In the Eastern and Western Districts of Missouri, 16 defendants were charged in schemes involving over $16 million in claims, including 10 defendants charged as part of a scheme involving fraudulent lab testing.

In the District of Nebraska, a dentist was charged with defrauding the Medicaid program. 

In the District of Nevada, two defendants, including a physician, were charged in a scheme involving false hospice claims. 

In the Northern, Southern, and Western Districts of New York, five defendants, including two physicians and two pharmacists, were charged in schemes involving drug diversion and pharmacy fraud.

In the Southern District of Ohio, five defendants, including four physicians, were charged in connection with schemes involving $12 million in claims to the Medicaid program.

In the District of Puerto Rico, 13 defendants, including three physicians and two pharmacists, were charged in four schemes involving drug diversion, Medicaid fraud, and the theft of funds from a health care program.

In the Eastern District of Tennessee, three defendants were charged in a scheme involving fraudulent billings and the distribution of opioids.

In the Eastern, Northern, and Western Districts of Texas, nine defendants were charged in schemes involving over $42 million in fraudulent billing, including a scheme involving false claims for compounded medications. 

In the District of Utah, a nurse practitioner was charged in connection with fraudulently obtaining a controlled substance, tampering with a consumer product, and infecting over seven individuals with Hepatitis C.  

In the Eastern District of Virginia, a defendant was charged in connection with a scheme involving identify theft and fraudulent billings to the Medicaid program.

In addition, in the states of Arizona, Arkansas, California, Delaware, Illinois, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New York, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Washington and Wisconsin, 96 defendants have been charged in criminal and civil actions with defrauding the Medicaid program out of over $31 million. These cases were investigated by each state’s respective Medicaid Fraud Control Units. In addition, the Medicaid Fraud Control Units of the states of Alabama, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Missouri, Nebraska, New York, North Carolina, Ohio, Texas, and Utah participated in the investigation of many of the federal cases discussed above.

The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section and from the U.S. Attorney’s Offices of the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois and the Middle District of Florida; and agents from the FBI, HHS-OIG, Drug Enforcement Administration, DCIS and state Medicaid Fraud Control Units.

A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent unless and until proven guilty.

Additional documents related to this announcement will shortly be available here:https://www.justice.gov/opa/documents-and-resources-july-13-2017.

This operation also highlights the great work being done by the Department of Justice’s Civil Division.  In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2.5 billion in judgements and settlements related to matters alleging health care fraud. 

Press Release Number: 
17-768

Updated July 13, 2017







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