Tag Archives: Medicaid

AI Fraud could target America’s most vulnerable communities like Medicare and Social Security with criminals operating all over the world

Revelations 13:14 “…by the signs that it is allowed to work in the presence of the beast it deceives those who dwell on earth…”

Important Takeaways:

  • AI-assisted fraud schemes could cost taxpayers $1 trillion in just 1 year, expert says
  • Artificial intelligence smashed the floodgates to unprecedented fraud that could cost taxpayers hundreds of billions, if not $1 trillion, over the next 12 months, an expert told Fox News Digital.
  • Haywood Talcove, CEO of LexisNexis Risk Solutions’ government division, which evaluates and predicts risk, said he’s already seeing criminals on the dark web using people’s faces to steal from government and state agencies.
  • Benefits to America’s most vulnerable communities, such as Social Security, Medicare and Medicaid, and unemployment, are ending up in the pockets of criminals and criminal enterprises that are operating all over the world.
  • “Being one of the wealthiest countries in the world makes us a huge target,” Talcove said. “The amount of money that we’re going to lose over the next 12 months, if we do nothing, is going to make the COVID pandemic look like child’s play.”

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U.S. Supreme Court rejects Republican challenge to Obamacare law

By Lawrence Hurley

WASHINGTON (Reuters) -The U.S. Supreme Court on Thursday rejected a Republican bid that had been backed by former President Donald Trump’s administration to invalidate the Obamacare healthcare law, ruling that Texas and other challengers had no legal standing to file their lawsuit.

The 7-2 ruling authored by liberal Justice Stephen Breyer did not decide broader legal questions raised in the case about whether a key provision in the law, which is formally called the Affordable Care Act, was unconstitutional and, if so, whether the rest of the statute should be struck down.

The provision, called the “individual mandate,” originally required Americans to obtain health insurance or pay a financial penalty.

It marked the third time the court has preserved Obamacare since its 2010 enactment.

“The Affordable Care Act remains the law of the land and will continue to provide millions of Americans with healthcare,” said Sabrina Singh, a spokeswoman for Vice President Kamala Harris. “Today is a good day.”

Breyer wrote that none of the challengers, including Texas and 17 other states and individual plaintiffs, could trace a legal injury to the individual mandate.

President Joe Biden’s administration in February urged the Supreme Court to uphold Obamacare, reversing the position taken by the government under Trump, who left office in January.

After Texas and other states sued, a coalition of 20 states including Democratic-governed California and New York and the Democratic-controlled House of Representatives intervened in the case to try to preserve Obamacare after Trump refused to defend the law.

“For more than a decade, the Affordable Care Act has been the law of the land, providing health coverage and a multitude of protections to tens of millions of Americans across the nation, and today’s decision solidifies those protections for generations to come,” New York Attorney General James said.

The two dissenting justices were conservatives Samuel Alito and Neil Gorsuch. Justice Amy Coney Barrett, a Trump appointee whose confirmation hearing last fall included many questions from Democrats over whether she would vote to strike the law down, was in the majority in the ruling.

Republicans fiercely opposed Obamacare when it was proposed, failed to repeal it when they controlled both chambers of Congress and have been unsuccessful in getting courts to invalidate the law, which was Democratic former President Barack Obama’s signature domestic policy achievement. The Trump administration did take steps to hobble the law.

The Supreme Court has a 6-3 conservative majority bolstered by the October confirmation in a Republican-led Senate of Trump’s third appointee, Amy Coney Barrett, but the Republican Obamacare challengers still came away disappointed. The Supreme Court in 2012 and 2015 also fended off previous Republican challenges to Obamacare.

Biden has pledged to expand healthcare access and buttress Obamacare. Biden and other Democrats had criticized Republican efforts to strike down the law at a time when the United States was grappling with a deadly coronavirus pandemic.

If Obamacare had been struck down, up to 20 million Americans stood to lose their medical insurance and insurers could have once again refused to cover people with pre-existing medical conditions. Obamacare expanded the Medicaid state-federal healthcare program and created marketplaces for private insurance.

In 2017, Trump signed a Republican-backed tax law that eliminated the financial penalty under the individual mandate, which gave rise to the Republican lawsuit. The tax law meant the individual mandate could no longer be interpreted as a tax provision and was therefore unlawful, the Republican challengers argued.

The Supreme previously upheld Obamacare by deeming the financial penalty under the individual mandate a tax permissible under the Constitution’s language empowering Congress to levy taxes.

The impetus for the Supreme Court case was a 2018 ruling by a federal judge in Texas that Obamacare as structured following the 2017 change violated the U.S. Constitution and was invalid in its entirety. The New Orleans-based 5th U.S. Circuit Court of Appeals agreed that the individual mandate was unconstitutional but did not rule that the entire law should be stricken.

Biden’s administration notified the court of the government’s new position in February in a letter filed by Deputy Solicitor General Edwin Kneedler. The Biden administration believes that the individual mandate was constitutional and, even if it was not, the rest of the law should remain in place, Kneedler wrote.

(Reporting by Lawrence Hurley; Additional reporting by Trevor Hunnicutt; Editing by Will Dunham)

U.S. Supreme Court takes up Trump bid to revive Medicaid work requirements

By Lawrence Hurley

WASHINGTON (Reuters) – The U.S. Supreme Court on Friday agreed to hear a bid by President Donald Trump’s administration to revive pilot programs adopted by the states of Arkansas and New Hampshire that allow work requirements to be imposed on people who receive healthcare under the Medicaid program for the poor.

The justices took up the administration’s appeals of rulings by a lower court that found the programs unlawful.  Seventeen other states are pursuing similar policies.

The administration said in court papers that the appeals court rulings cast a legal shadow on the efforts in those other states to adopt work requirements for Medicaid, a state-federal program that provides medical insurance for the poor. New Hampshire and Arkansas filed court papers in support of the administration.

The U.S. Department of Health and Human Services in 2018 approved those projects as part of a push to put a conservative stamp on Medicaid, which was expanded in 37 states and the District of Columbia following the 2010 passage of the Affordable Care Act, also known as Obamacare, to help provide coverage to millions more Americans.

The department gave the go-ahead for states to carry out test projects requiring able-bodied people on Medicaid to work or do volunteer work.

(Reporting by Lawrence Hurley; Additional reporting by Nate Raymond; Editing by Will Dunham)

U.S. Supreme Court rebuffs Planned Parenthood defunding case

By Andrew Chung

(Reuters) – The U.S. Supreme Court on Tuesday turned away South Carolina’s bid to cut off public funding to Planned Parenthood, the latest case involving a conservative state seeking to deprive the women’s healthcare and abortion provider of government money.

The justices declined to hear South Carolina’s appeal of a lower court ruling that prevented the state from blocking funding under the Medicaid program to Planned Parenthood South Atlantic, the organization’s regional affiliate.

Planned Parenthood South Atlantic operates clinics in Charleston and Columbia, South Carolina, where it provides physical exams, cancer and other health screenings, as well as abortions. Each year the clinics serve hundreds of patients who receive Medicaid, a government health insurance program for low-income Americans.

Numerous Republican-governed states have pursued direct and indirect restrictions involving abortion. Planned Parenthood often is targeted by anti-abortion activists. Planned Parenthood is the largest single provider of abortions in the United States and also receives millions of dollars in public funding for other healthcare services.

Planned Parenthood and Medicaid patient Julie Edwards sued the state’s Department of Health and Human Services in 2018 after officials ended the organization’s participation in the state Medicaid program.

The state took the action after Governor Henry McMaster, a Republican, issued executive orders declaring that any abortion provider would be unqualified to provide family planning services and cutting off state funding to them. The state’s action forced Planned Parenthood to turn away Medicaid patients seeking healthcare services, according to a court filing.

South Carolina already did not provide Medicaid reimbursements for abortion except in cases of rape, incest, or if the mother’s life was in danger, as required by federal law.

The Richmond, Virginia-based 4th U.S. Circuit Court of Appeals blocked the state’s decision in 2019, saying that by ending Planned Parenthood’s Medicaid agreement for reasons unrelated to professional competency, the state violated Edwards’ right under the federal Medicaid Act to receive medical assistance from any institution that is “qualified to perform the service.”

In appealing to the Supreme Court, the state’s health department said Medicaid recipients do not have a right to challenge a state’s determination that a specific provider is not qualified to provide certain medical services.

The Supreme Court in 2018 rejected similar appeals by Louisiana and Kansas seeking to terminate Planned Parenthood’s Medicaid funding. At that time, three conservative justices – Clarence Thomas, Samuel Alito and Neil Gorsuch – said the court should have heard the states’ appeals.

President Donald Trump has asked the Senate to confirm his Supreme Court nominee Amy Coney Barrett, a favorite among religious conservatives, before the Nov. 3 election. Barrett was picked to replace liberal Justice Ruth Bader Ginsburg, a supporter of abortion rights who died on Sept. 18.

(Reporting by Andrew Chung and Jan Wolfe; editing by Will Dunham and Grant McCool)

California governor’s ‘homelessness tour’ seeks money, solutions to crisis on streets

By Dan Whitcomb

(Reuters) – California’s governor began a week-long “homelessness tour” on Monday seeking $750 million to address growing numbers of people living on the streets, stopping first in a rural community to show his state’s problems extend beyond the big cities of San Francisco and Los Angeles.

Democratic Governor Gavin Newsom last week asked state lawmakers to create the $750 million fund as part of his 2020-21 budget and plans to petition the federal government for additional money to help California’s Medicaid program improve services for the homeless.

“Homelessness isn’t just a concern in our cities, it’s a suburban issue and a rural issue, too. No Californian can say that homelessness is someone else’s problem,” Newsom, 52, said in kicking off his tour in Grass Valley, a town of about 12,000 in the Sierra Nevada mountains northeast of Sacramento.

“Every corner of our state has too many people living on the streets. And the crisis puts stress on public resources, from emergency rooms to jails to public works departments. It takes an unprecedented level of partnership between local, state, and federal government,” Newsom said in a prepared statement.

An estimated 130,000 people are homeless somewhere in California on any given day, more than any other state, according to the U.S. Department of Housing and Urban Development (HUD). California, home to about 39.6 million people, is the most populous state in the United States. Newsom and other California officials have traded barbs with U.S. President Donald Trump over the issue, with Trump blaming state and local leaders for failing to solve the problem.

On a visit to San Francisco and Los Angeles in September, Trump said conditions on their streets including trash, feces, and hypodermic needles left by homeless people were hurting their prestige.

That same month HUD Secretary Ben Carson rejected requests for more federal money.

Los Angeles Mayor Eric Garcetti formally asked the Trump administration for federal assistance on Monday in a letter that indicated the two sides had productive negotiations on the matter.

Newsom, who last week called for the emergency deployment of state-owned travel trailers and tents, was joined by state and local lawmakers on a visit to two homeless shelters in Grass Valley on Monday.

The first-term governor’s tour will also take him to Los Angeles County, the San Francisco Bay area and the Central Valley.

(Reporting by Dan Whitcomb in Culver City, California; Editing by Sonya Hepinstall

Trump enacts anti-opioid abuse package in rare bipartisan step

FILE PHOTO: A syringe filled a narcotic, an empty syringe and a spoon sit on the roof of a car, where a man in his 20's overdosed on opioids in Lynn, Massachusetts, U.S., August 14, 2017. REUTERS/Brian Snyde

By Yasmeen Abutaleb

WASHINGTON (Reuters) – Medical treatment will be more widely available to opioid abusers while mailing illicit drugs will be more difficult under a measure to fight drug addiction that was signed into law on Wednesday by U.S. President Donald Trump.

In a year more typically marked by partisan gridlock, Trump signed the rare bipartisan package passed by Congress earlier this month to tackle a problem that led to a record 72,000 drug overdose deaths in 2017.

The legislation expands access to substance abuse treatment in Medicaid, the government health insurance program for the poor and disabled; cracks down on mailed shipments of illicit drugs such as fentanyl, a synthetic opioid far more powerful than heroin; and provides a host of new federal grants to address the crisis.

The Senate passed the measure by a vote of 98-1 in September after a 353-52 vote in favor in the House. The bill had 252 bipartisan cosponsors in the House, more than almost any other bill in recent years, according to website GovTrack Insider.

Trump declared the opioid epidemic a public health emergency last year, which enabled the government to respond more quickly to crises. But addiction experts, advocacy groups and Democrats said the administration was not doing enough.

On Tuesday, Democratic Senators Elizabeth Warren and Patty Murray released a U.S. Government Accountability Office report that they said showed Trump’s emergency declaration fell short of his promises. The report said the government has used few of the powers it could use, under the declaration.

“Hand waving about faster paperwork and speeding up a few grants is not enough. The Trump administration needs to do far more to stop the opioid epidemic,” Warren said in a statement.

Trump adviser Kellyanne Conway said the criticism from the senators was “predictable and unfortunately very partisan,” noting that both voted for the opioids legislation.

In addition to educating the public and expanding access to treatment, Conway said the administration was also focused on securing the border with Mexico to stop drugs from coming into the United States.

(Reporting by Yasmeen Abutaleb; Editing by Kevin Drawbaugh and Cynthia Osterman)

Soaring costs, loss of benefits top Americans’ healthcare worries: Reuters/Ipsos poll

An examination room is seen at an onsite health clinic at the Intel corporate campus in Hillsboro, Oregon, U.S., April 25, 2018. REUTERS/Caroline Humer

By Maria Caspani

(Reuters) – For over a year now, Americans have listed healthcare as the most important problem facing the country, according to Reuters/Ipsos polling.

When asked what concerns them about U.S. healthcare, this is what they had to say:

TOTAL COST OF HEALTH INSURANCE

Sixty-five percent of Americans said in the poll that they are “very concerned” about the overall cost of health insurance, including premiums, deductibles and copays.

This concern is consistent throughout the country: A majority of both millennials and baby boomers, whites and minorities, Democrats and Republicans were worried about healthcare costs.

PRESCRIPTION DRUGS

Nearly three in four Americans use prescription drugs, and 58 percent said they are “very concerned” about the cost of paying for them, according to the Reuters/Ipsos poll. These drugs are expected to see the fastest annual growth over the next decade, rising an average of 6.3 percent per year, according to the U.S. Centers for Medicare and Medicaid Services (CMS).

CHOOSING CARE

Sixty-six percent of U.S. adults who took part in the survey said they were concerned about their ability to see a doctor of their choice going forward.

MEDICARE AND MEDICAID

About one in three U.S. adults said they were “very concerned” about losing benefits from government-run programs Medicare and Medicaid.

Enrollment in Medicare is expected to increase as baby-boomers reach retirement age, according to CMS projections, which will contribute to growing healthcare spending.

The poll also showed that 58 percent of Americans think Congress should keep the Affordable Care Act either entirely as it is, or with some fixes, while 24 percent think lawmakers should repeal it once an alternative law is passed and 18 percent want the ACA to be repealed immediately.

The Reuters/Ipsos poll surveyed 3,982 people in English in the United States from May 22 to June 3 and it has a credibility interval of about 2 percentage points.

For more Reuters polling, visit http://polling.reuters.com/

(Reporting by Maria Caspani, Editing by Chris Kahn and Chizu Nomiyama)

Voters in Maine approve expansion of Medicaid under Obamacare

Voters in Maine approve expansion of Medicaid under Obamacare

By Brendan O’Brien

(Reuters) – Voters in Maine on Tuesday approved a ballot initiative to expand the state’s Medicaid program under Obamacare, sending a clear signal of support for the federal healthcare law to lawmakers in the state and Washington D.C.

The approval of the ballot question in Maine comes after Republicans in Washington failed several times over the last few months to pass legislation that would dismantle the Affordable Care Act, former President Barack Obama’s signature healthcare law.

Maine has recently figured prominently in the nation’s debate on how to reform healthcare. U.S. Senator Susan Collins, a moderate Republican from Maine, helped block her party’s efforts to repeal Obamacare this year, which angered President Donald Trump.

Maine, which becomes the first U.S. state to approve Medicaid expansion by ballot initiative, is one of 19 states that has not expanded Medicaid under the Affordable Care Act.

About 60 percent of voters in Maine approved the ballot initiative, according to the Bangor Daily News newspaper.

Tuesday’s ballot asked Maine voters to approve or reject a plan to provide healthcare coverage under Medicaid for adults under the age of 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 is about $16,000 for a single person and about $22,000 for a family of two.

The state’s Republican governor, Paul LePage, staunchly opposes expansion of federal health care insurance, vetoing legislation to do so on several occasions.

“I’ve said it before, “free” is very expensive to somebody,” LePage said in a radio address last week.

About 70,000 residents in Maine would be eligible for the state’s Medicaid program when and if state officials certify the results of the election. Lawmakers could vote to repeal or alter the referendum, much like they have recently for several citizen-initiated referendums, the Bangor Daily News reported.

“It is now the responsibility and the duty of the governor and the legislature to fully and faithfully implement this law,” the state’s Speaker of the House, Sara Gideon, said in a statement.

The Legislature’s Office of Fiscal and Program Review in Maine estimated that expansion of Medicaid would cost the state about $55 million and bring in about $525 million of federal money to the state each year, according to the Bangor Daily News.

(Reporting by Brendan O’Brien in Milwaukee; Editing by Nick Macfie)

House Republicans seek $1 billion in Medicaid funds for Puerto Rico

A local resident sits on the roof of his home that was damaged by Hurricane Maria in Guaynabo, Puerto Rico, October 2, 2017. REUTERS/Alvin Baez

WASHINGTON (Reuters) – Puerto Rico, struggling to recover from hurricane damage, could receive $1 billion in additional funding for the Medicaid health insurance program for the poor under a proposal from a U.S. House of Representatives panel, a congressional aide said on Tuesday.

Republicans who lead the House Energy and Commerce Committee included the request for more Medicaid funding for Puerto Rico as part of a separate bill to reauthorize the Children’s Health Insurance Program. It is scheduled to be considered and voted on in committee on Wednesday.

The U.S. territorial island, hard-hit by Hurricane Maria, already had faced a drop-off of Medicaid funding at the end of the year, according to the Washington Post, which first reported Republicans’ plan.

Now Puerto Rico also faces massive damage from Maria that wiped out much of its infrastructure, left hospitals struggling and residents without clean water, electricity and cellphone service.

Committee spokeswoman Jennifer Sherman said the panel would take up the bill on Wednesday as part of its effort to renew funding for the larger U.S. children’s insurance program, which saw its funding expire during the weekend.

Under the proposal, Puerto Rico would receive $880 million through 2019. It also would get another $120 million if its financial oversight board certified that the joint federal-state program there had taken steps to prevent fraud and abuse and improve efficiency, among other oversight steps.

Lawmakers sought to pay for the additional Medicaid funding by charging higher premiums on wealthier people in the Medicare health insurance program for seniors, and redirecting some prevention health funding from community-based health centers, among other changes, according to a copy of the plan.

Republican U.S. President Donald Trump visits the island on Tuesday amid criticism over his administration’s response to the storm. [nL2N1ME09T]

About 3.4 million people live in Puerto Rico, which in recent years had faced recession and, in May, bankruptcy.

(Reporting by Susan Cornwell; Writing Susan Heavey; Editing by Bill Trott)

Illinois Republican governor signs controversial abortion bill

FILE PHOTO - Bruce Rauner talks to the media at the White House in Washington December 5, 2014. REUTERS/Larry Downing/File Photo

By Chris Kenning

CHICAGO (Reuters) – Illinois Republican Governor Bruce Rauner signed a controversial bill into law on Thursday to expand state-funded coverage of abortions for low-income residents on Medicaid and state employees.

The bill, approved by the state legislature in May, would also keep abortions legal in Illinois if the U.S. Supreme Court follows President Donald Trump’s call to overturn its landmark Roe v. Wade ruling that made abortions legal 44 years ago.

Illinois’ Medicaid program has previously covered abortions in cases of rape, incest and when a mother’s life or health is threatened.

The expansion would enable poor women to obtain elective abortions. The bill would allow state employees to have the procedures covered under state health insurance.

Rauner, who had earlier suggested he would veto the measure, said in a statement that he had talked to woman around the state before making his decision.

“I understand abortion is a very emotional issue with passionate opinions on both sides. I sincerely respect those who believe abortion is morally wrong,” he said.

“But, as I have always said, I believe a woman should have the right to make that choice herself and I do not believe that choice should be determined by income,” Rauner added. “I do not think it’s fair to deny poor women the choice that wealthy women have.”

The decision comes as conservative legislatures and other Republican governors have sought in recent years to tighten regulations on abortion clinics and forced closures in states such as Texas and Kentucky.

The move by Rauner upset conservatives.

“Taxpayers should not be forced to fund something as controversial and culturally divisive as abortions,” Republican state Senator Dan McConchie told the Chicago Tribune.

Currently, 15 other states allow Medicaid to pay for abortion, including some required by courts, according to the Kaiser Family Foundation.

But Illinois is the first state in decades to voluntarily lift its restriction on Medicaid coverage of abortion, according to National Asian Pacific American Women’s Forum.

“Under the Trump administration, we are potentially facing the greatest threat to reproductive rights in more than a generation. HB 40 ensures that abortion will remain legal in Illinois, regardless of what happens at the federal level,” the forum’s executive director, Sung Yeon Choimorrow, said in a statement.

(Reporting by Chris Kenning; Editing by Diane Craft)