Former Staffers Accuse AIDS Healthcare Foundation Of Massive Kickback Scheme

According to a press release published by lawyers representing former AIDS Healthcare Foundation staffers, the combative organization has engaged in a massive patient referral kickback scheme that has defrauded the federal government to the tune of $20M a year. The press release begins:

Three former managers of AIDS Healthcare Foundation, Inc. (AHF) have filed Federal and Florida State Whistleblower Act claims against the nation's largest supplier of HIV/AIDS medical care for illegal patient referral kickbacks. AHF is charged with defrauding Federal healthcare programs such as Medicare, Medicaid and Health and Human Services HIV/AIDS grant programs of at least $20 million a year in false claims since 2010. Cohen Milstein Sellers & Toll PLLC represents the plaintiffs.

Filed in U.S. District Court for the Southern District of Florida on April 3 under the Federal False Claims Act and Florida False Claims Act, the complaint is based on the personal knowledge and documentation of Whistleblowers Jack Carrel of Louisiana, Mauricio Ferrer of Florida, and Shawn Loftis of New York. All held management positions at AHF prior to their jobs being terminated– despite having federal protection under the False Claims Act – after they notified their supervisors about the company's unlawful practices.

According to the complaint, AHF conducted an organization-wide criminal effort across at least 12 states, including Florida, that boosted funding from federal healthcare programs by generating HIV/AIDS referrals to the company's various service centers. AHF did this by unlawfully paying referral incentives to employees and patients in violation of the anti-kickback statute.

The AIDS Healthcare Foundation operates a chain of HIV/AIDS specialty pharmacies and thrift shops. They are perhaps best known for their aggressive advertising campaign against the use of Truvada as a daily HIV preventive and for their campaign to force the use of condoms in porn productions. Hit the link, there's much more in the press release. (Via Towleroad)

UPDATE: AIDS Healthcare Foundation head Michael Weinstein responds via email.

“With more than sixty percent of the 1.2 million people living with HIV/AIDS in the United States currently not in regular medical care and treatment, it remains core to AHF’s mission to try and reduce that number. Not only has AIDS Healthcare Foundation done nothing wrong, our pro-active approach to finding and linking HIV-positive individuals to lifesaving care and treatment is critical to stopping HIV in this country. The fact that the Federal Government and the State of Florida have each already formally declined to intervene in the legal action brought on behalf of three former AHF employees speaks volumes about the merits of this case. Small incentives for linking and retaining people in care are mainstays of public health interventions—including by many CDC projects. We look forward to the opportunity to rebut these baseless charges in court.”

Asshole Of The Day

JMG reader Will points us to the website Asshole Of The Day, which quotes Talking Points Memo about GOP Arkansas state Rep. Josh Miller:

More than a decade ago, Arkansas Rep. Josh Miller (R) was in a catastrophic car accident that broke his neck and left him paralyzed. Medicare and Medicaid paid the $1 million bill for his hospitalization and rehabilitation. But this week, as the Arkansas legislature has debated continuing its privatized Medicaid expansion under Obamacare, Miller has remained steadfast in his opposition. The Arkansas Times highlighted the contrast in a Thursday report. The alternative newspaper reported that Miller receives ongoing coverage through the government programs, including Medicaid-covered personal care assistance. The Times asked Miller, 33, about this apparent contradiction: Shouldn’t someone who has experienced the benefits of health insurance, including insurance paid for by the government, understand the importance of expanding those benefits to others? The difference, he said, is that some of the 100,000 people who have gained coverage through Arkansas’s Medicaid expansion don’t work hard enough or just want access to the program so they can purchase and abuse prescription drugs. "My problem is two things," Miller said. "One, we are giving it to able-bodied folks who can work … and two, how do we pay for it?"

Miller's Wikipedia entry notes that he was so drunk at the time of his accident, neither he nor the other person in the car can recall who was driving. Miller was, perhaps obviously, uninsured.

Facebook Graphic Of The Day

Source.

Tweet Of The Day - The White House

Baldwin Opponent Caught Boasting: I'm The Guy To End Medicaid & Medicare

Tammy Baldwin's Senate opponent has been caught on tape bragging to a Tea Party audience that he's the best man to end Medicare and Medicaid. The Atlantic wonders: "Will this video sink Tommy Thompson?" The clip has already been turned into a pro-Baldwin ad.

MINNESOTA: Republican Lawmakers Block Bill To Ban Medicaid For "Ex-Gay" Therapy

Clip description:

A move to stop using Medicaid dollars for programs that "pray the gay away" was defeated along a mostly party line vote in the Senate. Senator Scott Dibble (DFL-Minneapolis) argued that tax payers should't have to pay the bill for "therapies that do real damage to individuals and are based on a particular, narrow religious perspective." Senator Dibble said research shows that changing a person's sexual orientation is not possible.

The best part is when the GOP douchebag accuses the Democrat of not loving Jesus. Somebody needs to find out how much Ladybird is charging Medicaid.

NEW YORK: Pharmacist Busted In Massive $274M Medicaid Scam To Resell HIV Meds

The New York Attorney General's office has announced the arrest of a Long Island MOMS pharmacist and three others who have been accused reselling HIV medications which had been paid for by Medicaid. The drugs resold on the black market may have been expired or otherwise unusable, putting patients at grave risk for potentially fatal infections.

A pharmacist at the high-volume national HIV drug marketing business, which has sites in Brooklyn, Manhattan, and on Long Island, is charged along with three outside conspirators of running a $274 million black market venture. By relabeling prescription drugs of uncertain quality and origin, the defendants allegedly preyed on patients with HIV and cost the Medicaid program $155 million in New York. MOMS, whose parent is listed as Allion Healthcare, a Melville, L.I.-based company, billed New York State Medicaid for at least $155 million for these unusable drugs, according to New York State Attorney General Eric Schneiderman. The AG's office says Allion cooperated in the investigation.

MOMS Pharmacy, which also has an outlet in the Castro, says they too are a victim of the scam and will fully cooperate with federal Medicaid fraud investigators. The four men are charged with grand larceny, money laundering, commercial bribery, and other crimes.

UPDATE: A spokesman from MOM pharmacy writes us with this message.

Anthony D. Luna, President of MOMs Pharmacy, said, “As the alleged fraud was financial in nature, we have no evidence at this time indicating that the distribution of these products caused adverse health consequences to our patients. In fact, MOMS Pharmacy’s stellar track record in improving patients’ outcomes, clinical tests, and the lack of patient or physician complaints during the time period in question all suggest that the drugs we dispensed were effective.”

GOP Unveils Budget That Overhauls Medicare & Medicaid, Repeals Obamacare

House Budget Committee chairman Rep. Paul Ryan today unveiled a long-term plan that would dramatically overhaul the way the federal government and states administer Medicare and Medicaid. The GOP plan also, of course, repeals "Obamacare."

Ryan's budget proposal aims to slash $6 trillion from the budget over the next 10 years. It would in part accomplish that by changing Medicaid -- which serves low-income families -- from a government-run insurance program to a system of block grants distributed to states. Medicare, a government-run health care program for those over 65, would essentially turn into a "premium support" program -- the government would essentially provide vouchers for health care, but the funds would go directly to the insurer rather than the consumer. The government would give private health insurers a set amount of money to cover senior citizens. The change to Medicare would go into effect in 2022 under the plan. It's a risky proposal politically, given Medicare's overwhelming popularity, but Ryan and the GOP are prepared to argue the changes are necessary.

Below is the PR clip Ryan issued today in support of his plan.

Texas GOP Mulling Medicaid Withdrawal

The Texas GOP, which swept into the state legislature with overwhelming numbers last week, is mulling a complete withdrawal from Medicaid, a move which could leave millions of Texans without any health care coverage.

“With Obamacare mandates coming down, we have a situation where we cannot reduce benefits or change eligibility” to cut costs, said State Representative Warren Chisum, Republican of Pampa, the veteran conservative lawmaker who recently entered the race for speaker of the House. “This system is bankrupting our state,” he said. “We need to get out of it. And with the budget shortfall we’re anticipating, we may have to act this year.”

The Heritage Foundation, a conservative research organization, estimates Texas could save $60 billion from 2013 to 2019 by opting out of Medicaid and the Children’s Health Insurance Program, dropping coverage for acute care but continuing to finance long-term care services. The Texas Health and Human Services Commission, which has 3.6 million children, people with disabilities and impoverished Texans enrolled in Medicaid and CHIP, will release its own study on the effect of ending the state’s participation in the federal match program at some point between now and January.

The Texas state budget currently faces a $25B shortfall. The answer to that problem, of course, is to cut taxes and let those lazy sick people die.

Medicaid Benefits For MA Gays

Excellent news. Yesterday the Massachusetts house passed a bill approving equal Medicaid benefits for married gays.

Gov. Deval Patrick is expected to sign the bill, which was passed by the state House on July 15. The lawmakers' actions defy the federal Defense of Marriage Act, which bans legally wed same-sex couples from receiving federally provided benefits such as Medicaid, the "safety-net" health care program administered by the states.

Supporters say Massachusetts can circumvent federal law by using only state dollars to pay for gay couples' benefits. Under current law, if a same-sex couple owns a house together and one partner has to go into a nursing home, the other could lose the home once all the medical bills are paid, MassEquality said. Changing the law offers significant progress in helping LGBT seniors in crisis, said Lisa Krinksy, director of the LGBT Aging Project, which worked with MassEquality, in a written statement.