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With Lax Oversight, Fraud Flourishes in California’s Drug Rehab Clinics

A receptionist at Pride Health Services in Inglewood, Calif., said there were no counseling sessions on April 3. But the clinic billed taxpayers about $1,600 for serving 60 clients that day, records show. (Photo/CNN)

A receptionist at Pride Health Services in Inglewood, Calif., said there were no counseling sessions on April 3. But the clinic billed taxpayers about $1,600 for serving 60 clients that day, records show. (Photo/CNN)

By Christina Jewett and Will EvansThe Center for Investigative Reporting

Addiction counselor Tamara Askew discovered something wrong soon after she started working at Pride Health Services, an Inglewood rehab clinic.

Askew grabbed a stack of files and began contacting patients to introduce herself. That was harder than she had figured.

Some were in jail, Askew said. Several never showed up. One was dead.

Her boss, she said, wanted to bill the government anyway, for counseling addicts she never saw.

“He basically said, ‘How do you think you’re going to get paid?’ ” Askew said.

They lure patients in from the street by handing out cash, cigarettes and snacks. They have patients sign in for days they aren’t there.
Pride Health Services specializes in billing for “ghost clients,” fabricating paperwork for patients who don’t actually come in, according to former employees and whistle-blower complaints.

It is part of a rehab racket – a pattern of fraud by rehabilitation clinics that collect government funding to help the poor and addicted, a yearlong investigation by The Center for Investigative Reporting and CNN has found.

Thousands of pages of government records and dozens of interviews with counselors, patients and regulators reveal a widespread scheme – concentrated in the Los Angeles region – to bilk the state’s Medicaid system. Continue reading

Boston ER Doctor Finds Marathon Memories Hard to Shake

By Leana Wen, for NPR

(Jim Rogash/Getty Images)

(Jim Rogash/Getty Images)

I have a recurring nightmare where I am performing CPR on a patient who turns out to be my husband.

Last Monday, my nightmare nearly came true.

It was 2:50 p.m., and the Massachusetts General Hospital ER was filled to capacity.

In the section where I was working, my patients were critically ill, with strokes, heart attacks and overwhelming infections. Even the hallways were packed with patients receiving emergency treatments.

A call over the loudspeakers announced that there had been two explosions. Many people were injured. That’s all we knew.

Screams mixed with ambulance sirens. The loudspeaker sounded again and again, announcing that more patients were on their way.
Doctors, nurses and transporters disconnected monitors and rushed to send every patient to other areas of the hospital.

As we cleared the emergency room, there was a second call. These were bombings. There were fatalities and dozens, maybe hundreds, of injured. How many were coming to Mass General? Nobody knew.

Three minutes later, the doors flew open. Stretchers came, one after the other. Some victims had no pulse and weren’t breathing. Others had legs blown to shreds. All were covered with blood and soot.

The ER smelled of burnt flesh, and each stretcher left behind a fresh trail of blood. Continue reading

Sacramento Native and Her Husband Face Amputation, Rehab Together After Boston Bombings

Patrick and Jessica Kensky Downes, newlyweds, who each lost their lower left leg in the Boston bombings. (Photo from Jessica's Facebook page)

Patrick and Jessica Kensky Downes, newlyweds, who each lost their lower left leg in the Boston bombings. (Photo from Jessica’s Facebook page)

A week after the Boston Marathon bombing, only the most seriously injured are still hospitalized. Sacramento native Jessica Kensky Downes and her husband Patrick are among them. As Martha Bebinger of WBUR reports, the couple were at the finish line when the explosions ripped through the crowd. Patrick and Jessica both each lost the lower part of their left legs.

From WBUR:

Friends are having a hard time reconciling this news with memories of the joyful pair who married just last August.  Smiles in photos of Jessica and Patrick jump off the screen.

“But that’s not just a photograph,” says Leslie Kelly, who watched Jessica grow up just outside Sacramento, Calif.  “Those two are the happiest, most optimistic, wonderful people,” continues Kelly, which provides “a real good foundation for both of them going forward.” Continue reading

Supreme Court Watch: Decision on Health Care Expected Shortly

We’re closely monitoring the events at the Supreme Court. The Justices will enter the courtroom momentarily. The health care decision will likely be the last of those issued today, according to scotusblog.com.

Someone asked the moderators there why healthcare is being decided on the last day of the term. The answer:

For one thing, it was only argued in late March and it often takes several months to write opinions in complicated cases. In addition, in big cases where there are multiple opinions, it takes a while for the dissents and concurrences to get written. Finally, the Justices often just take as much time as is available to polish their opinions in big cases.

For more on the possible implications for California see this excellent post by KQED’s Jon Brooks and Mina Kim.

Court Considers Whether Entire Health Care Law Should Be Struck Down

By: KQED News Staff and Wires

(Jessica Marcy: KHN)

(Jessica Marcy: Kaiser Health News)

The Supreme Court signaled Wednesday that it could throw out other key parts of the Affordable Care Act if it first finds the individual insurance requirement unconstitutional.

On the third and last day of arguments, the justices appeared to accept the administration’s argument that at least two important insurance changes are so closely tied to the insurance requirement that they could not survive without it. Those two changes are the popular provisions that both require insurers to offer insurance to applicants with pre-existing conditions and also requires insurers to charge the same rates to people who are roughly the same age, regardless of their health.

Those changes should go, the Obama Administration argued, because without the individual mandate, people might wait until they’re sick before they signed up for coverage. Not enough people would be in the health insurance pool to spread risk. Ruin could come to the insurance market.

In short the Court faces three scenarios if it strikes down the individual mandate: Continue reading

Audio/Transcripts of Supreme Court Hearings on the Fate of the Health Law

Updated 12:15pm PT

The Supreme Court heard two sets of oral arguments today in its final day of considering the health care overhaul. The second arguments were extended and wrapped up about an hour ago. In that session, the Court addressed the question:

Is the Medicaid expansion constitutional?

Remember that Medicaid is the health care plan for the poor and disabled that is run by individual states with both state and federal dollars. The Affordable Care Act expands those eligible for Medicaid to adults earning 133 percent of the federal poverty level. But in order for states to continue receiving any federal money for Medicaid, the ACA requires them to comply with this expansion. Twenty-six states have challenged this requirement saying that withholding all monies for Medicaid is coercive and therefore unconstitutional. Those states which support the expansion–including California–say that Congress can constitutionally attach such conditions under what’s known as the “Spending Clause.”

You can listen to the complete oral arguments about Medicaid expansion here:

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Or read on for the complete transcript … and for audio/transcripts of all the Court’s earlier sessions:
Continue reading

Can Health Law Stand Without the Individual Mandate?

The constitutionality of the Medicaid expansion is also before the Court today.

(Image: Kaiser Health News)

(Image: Kaiser Health News)

WASHINGTON (AP) — The heart of the Obama administration’s health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down.

The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people.

The first two days of fast-paced and extended arguments have shown that the conservative justices have serious questions about Congress’ authority to require virtually every American to carry insurance or pay a penalty. Continue reading

Slideshow: A Cold Morning But Crowds Pro and Con Gather at Supreme Court

Slideshow produced by Jessica Marcy, Kaiser Health News and Amanda Stupi, KQED

Inside the Supreme Court building this week, the nation’s highest court is hearing oral arguments in a case that seeks to overturn the 2010 health law. Outside the building, Americans gathered to express their support or opposition to the law — or just to see history being made.

The second image is of Spike Dolomite Ward, who wrote an apology to President Obama in December.

What Impact Will the Court’s Decision Have on California?

(Ronnie Pitman: Flickr)

Over the last year as the myriad court cases about the federal health care law have made their way to the highest court in the land, California has spent that time moving ahead aggressively in implementing the Affordable Care Act (ACA). California was the first state to pass legislation to set up a health insurance exchange. The state also set up a new high risk pool so people with pre-existing conditions can get health insurance.

But what happens if the Supreme Court declares the individual mandate unconstitutional? Or overturns the entire law? What can still go forward in California?

The answer depends in part upon whom you ask. But for the most part California — like all states — will find it tough to move forward without the backing of the federal law. Continue reading