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Meaningful Use Audits – You Bette Be Prepared

And you though it was easy? Just attest by stating “yes” – The government has put shackles on you physicians and now they are going to squeeze them closed and tight – you can only blame yourselves. Nothing is innocus, nothign is by chance.[backtopost]

The Pennsylvania Medical Society has been contacted by member practices who are currently going through a Medicare Meaningful Use audit by Figliozzi and Company.  There have been some issues brought to our attention and we would like to see if any other practices have been experiencing this.

 First, any measure that was attested to with a “yes or no” answer must be corroborated with a screen print as supporting documentation confirming that your system did or did not complete the measure.  However, the screen print MUST have the EHR company logo printed somewhere on the document or it will not be accepted.  Secondly, the Security/Risk Analysis, the practice must provide an actual security risk analysis that was conducted including who conducted the test (i.e., IT Vendor) date of the test, time of the test and the result of the test in report format.  A check list is not enough and will NOT suffice or be accepted.  From what we understand this risk analysis report must have been done on each computer within the practice.

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Bitter Pill: Why Medical Bills Are Killing Us

Article clearly shows that we have a free market system that works. 2 trillion spent by people that can afford healthcare – fair market. If you don’t have the money for the best mechanic, you will get sub standard repairs.  The article below fails to state that the money spent SAVED HIS LIFE! If he was on medicare, he would not have gotten the best help and may have died.
There is no health care crisis! Its made up![back to post]

By Feb. 20, 2013

1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.

Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.

Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.

About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”

Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”

The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was $83,900.


The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.

(In-Depth Video: The Exorbitant Prices of Health Care)

Dozens of midpriced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.

Every time a nurse drew blood, a “ROUTINE VENIPUNCTURE” charge of $36.00 appeared, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done on Recchi amounted to more than $15,000. Had Recchi been old enough for Medicare, MD Anderson would have been paid a few hundred dollars for all those tests. By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.

On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.

When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”

The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1

The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”

DePinho’s salary is nearly two and a half times the $750,000 paid to Francisco Cigarroa, the chancellor of entire University of Texas system, of which MD Anderson is a part. This pay structure is emblematic of American medical economics and is reflected on campuses across the U.S., where the president of a hospital or hospital system associated with a university — whether it’s Texas, Stanford, Duke or Yale — is invariably paid much more than the person in charge of the university.

I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.

The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the U.S. by 2020 are related to health care. America’s largest city may be commonly thought of as the world’s financial-services capital, but of New York’s 18 largest private employers, eight are hospitals and four are banks. Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.

The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

SOUND OFF: Are Medical Bills Too High? Tell Us Why

When you crunch data compiled by McKinsey and other researchers, the big picture looks like this: We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%, more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capita income in the U.S. vs. those other countries. Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance. This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses.

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Higher Government “Fees” – Politicians Don’t Call Them Taxes

As a business person, I try to keep my prices as reasonable as possible for my customers to continue to purchase and for me to make a small profit (“small” will be discussed in a later post)
Under this administration, my business has been “blessed” with ever increasing costs of Doing Business.Hence, my “fair share” has become my unfair burden with me spending almost 65% of every dollar i make for some tax or fee imposed on me. These blessings have increased my cost of goods as the trickle down economics eventually reaches us all. As my suppliers, their suppliers and their suppliers become burdened with the higher costs, they invariable trickle them down to us. Now can we raise our prices and expect customers to keep purchasing? no of course not. So we continue to absorb the extra costs that eat away at our profits. What does this mean long term? No growth, less customers and less profits – so what do we do? we lay people off & spend less – how great for the economy!

Small businesses are the lifeblood of this country – don’t let anyone else tell you different. Wallmart, Amazon Home Depot and others are not breathing life into local economies. Nor are their so called “profits” to be believed. Everyone is looking at total sales not profit! Yea we did 15% more then last year – a billion dollars extra – great wonderful rock on!!! But wait – how much profit did you make? Profit? we don’t need no stinking profit!@ Thats right whilst retail numbers may appear to be on the rise, the cost of doing business aka profits are WAYYYY down. Hence holiday sales that everyone like to watch are meaningless because they are all discounted prices meaning less profits. Less profits means less people to hire and so on.

Just a brief look at my new “fees” aka taxes:
1. The MTA illegally taking money from me (remember that MTA tax that was declared unconstitutional – I am still waiting for my $46,678 refund from them – imagine if i owed the IRS this”)

2. My property value magically has risen so i can pay more property taxes but guess what? My appraisal value went DOWN meaning banks wont lend me / refinance me – can someone explain this?

3. Water bill has magically quadruples with the NEW meters installed – that’s right my water bill for over 15 years has never been more than $220 – now since the new meters have been installed it has risen to over $475 with every bill going up! Magically when you complain an $8 an hour person says “you have a leak” yea ok.

4. New bill in teh mail – city wants me to pay insurance on the pipes OUTSIDE my buildings and houses in case they break. HUH? is this not what the water and sewer and taxes are for? Double dip into my pocket.

5. Obama care – need i go on?

6. Gas prices – oh yea lets drive an electric car. Really? what about the delivery companies that bring me my products and supplies? Oh we forgot about them – UPS, USPS (which should be shut down – another post), Fedex etc.. all have raised their prices AND added a fuel surcharge guess who pays this?

7. Unregulated competition from other countries has driven up the cost of raw materials such as protein, dairy, wheat, gas etc….

8. Pay roll taxes have increased

That’s just a few of my ever increasing burdens against a backdrop of high unemployment and lower sales – guess what I have to do? Thats correct – let people go, spend less. Great how this makes the economy go round no?

Well mr president and all those that believe in his redistribution of wealth aka socialism – when i release my last employee and close down – who will feed the voracious government then?

To quote Will Rogers ” It is a good thing that we do not get as much government as we pay for”

When this 4 last years are over……

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Trusts Offer a Legal Loophole for Buying Restricted Guns

[preamble]How much more damage can this president do? – I still want to know who voted for him[backtopost]
A growing number of shooting enthusiasts are creating legal trusts to acquire machine guns, silencers or other items whose sale is restricted by federal law — a mechanism that bypasses the need to obtain law enforcement approval or even undergo criminal background checks.

The trusts, called gun trusts, are intended to allow the owners of the firearms to share them legally with family members and to pass them down responsibly. They have gained in popularity, gun owners say, in part because they may offer protection from future legislation intended to prohibit the possession or sale of the firearms.

But because of a loophole in federal regulations, buying restricted firearms through a trust also exempts the trust’s members from requirements that apply to individual buyers, including being fingerprinted, obtaining the approval of a chief local law enforcement officer and undergoing a background check.

Lawyers who handle the trusts and gun owners who have used them say that a majority of customers who buy restricted firearms through trusts do not do so to avoid such requirements. And most gun dealers continue to require background checks for the representative of the trust who picks up the firearm. But not all do.

Christopher J. Dorner, the former Los Angeles police officer who embarked on a weeklong assault on law enforcement officers this month that ended with his death on Feb. 12, said in a rambling 11,000-word manifesto that he had used a gun trust to buy silencers and a short-barreled rifle from a gun store in Nevada without a background check.

Referring to a computer program available from the personal finance software company Quicken, Mr. Dorner wrote, “I was able to use a trust account that I created on quicken will maker and a $10 notary charge at a mailbox etc. to obtain them legally.” Mr. Dorner was not a felon and probably would have passed a background check had he received one.

Mike Campbell, a spokesman for the Bureau of Alcohol, Tobacco, Firearms and Explosives, which enforces firearms regulations, said that applications filed with the A.T.F. for transfers of restricted firearms to trusts or corporations have more than doubled in the last four years, to more than 39,000 in 2012 from about 15,000 in 2008. He said the increase was largely attributable to the growth in the number of trusts.

Mr. Campbell confirmed that under current regulations, background checks were not required for the buying of restricted firearms through trusts. The agency, he added, was aware of the loophole and was reviewing changes to close it.

Lawyers who prepare gun trusts said requests for the documents had been increasing in recent months as proposals for gun legislation proliferated in state legislatures and on Capitol Hill. They said some gun owners were even creating trusts for nonrestricted firearms like semiautomatic rifles and pistols, hoping to protect them against the specter of future legislation.

The cost of setting up a trust can vary from a small amount for an online form to $100 to $2,500 in lawyers’ fees, depending on location and the type of trust.

The sale and possession of silencers, fully automatic guns manufactured before 1986 and other firearms and accessories that fall under the 1934 National Firearms Act are legal in many states. But the A.T.F. keeps a registry of the firearms and must approve their sale, a process that can take several months, and the buyer must pay a $200 tax.

J. W. Hagan, a computer administrator in Jacksonville, Fla., said he created a trust to buy silencers, which have become popular for target shooting and hunting and can be owned legally in a growing number of states. He said the trust would ensure that if he died, his firearms would remain legal. The trust would also allow his fiancée to use the silencers once the couple married.

“If I didn’t have a trust, she wouldn’t even be able to have the password for my safe,” he said.

David Goldman, an estate lawyer in Jacksonville who pioneered the use of gun trusts six years ago, said most dealers carried out background checks for restricted firearms. He called the notion that criminals might use the trusts to buy the firearms through a dealer “ridiculous.”

“Illegal versions of these items are not only cheaper,” he said, “but you can obtain them six months faster and you don’t have to form a trust, which could be $500 or $1,000 depending on the level, and you don’t have to tell the A.T.F. about it.”

Mr. Goldman, who has prepared several thousand gun trusts and teaches courses on their use, said the trusts have many benefits, like ensuring that firearms were passed on responsibly when an owner dies, keeping them from falling into the wrong hands in a difficult divorce or helping to negotiate moves to other states that might have different gun laws.

“There was never a proper way of dealing with firearms with estate planning and whether beneficiaries were appropriate to receive them,” Mr. Goldman said.

Gun owners also turn to trusts, other lawyers who handle them said, because in many jurisdictions, law enforcement officials refuse to sign off on the purchase of restricted firearms, making it difficult or impossible for enthusiasts to buy them as individuals.

Brian Reynolds, a lawyer in Denver, said he had prepared several gun trusts, mostly for people who wanted to buy silencers for long-range target shooting. But in many parts of Colorado, he said, sheriffs and police chiefs will not approve such purchases. “By having a trust, you bypass the need to get that authorization,” Mr. Reynolds said.

However, Jim Bueermann, the president of the Police Foundation, a research organization in Washington, said, “My guess is that the majority of police chiefs would agree that there is a reason why, as a general rule, people are prohibited from owning silencers, machine guns and what we would call sawed-off rifles or shotguns.”

Mr. Bueermann said that he was especially concerned about the loophole in A.T.F. regulations that made it possible to buy restricted firearms without a background check and that he thought most Americans would find this shocking. The A.T.F.’s regulations, in fact, exempt trusts from background checks, as noted in the Federal Firearms Regulations Reference Guide, known as the White Book, and on the forms for gun sales that dealers file to the agency. (In one publication, its handbook on the National Firearms Act, the agency does say that the trust representative who picks up a restricted firearm at a dealer must have a background check, but that deviates from what the regulations require, the A.T.F. confirmed.)

Many dealers conduct checks anyway. But others take the government at its word. One dealer, for example, said he did not think he had to run background checks for sales to trusts because Form 4473, the record of the transaction filled out by the dealer and the customer and sent to the A.T.F., specifically lists trust transfers of restricted firearms as an exception to the requirement for background checks.

Bob Irwin, who owns the Gun Store in Las Vegas, said his store always performed background checks for firearm purchases involving trusts — the store has handled three so far this year — but he was aware that some dealers did not.

The gaps in the law that allow such lapses, he said, are “astronomically stupid.”

“That really is a loophole,” Mr. Irwin said. “I can certainly see how a felon could wind his way through it and end up with machine guns.”

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Single use grocery plastic bags are bad – hence tax us .15 cents per bag

Yes people again our great leaders have failed us and now try to tax their way out of stupidity. Remember paper bags? They decided they were no good for us so we stopped them for plastic bags – NOW they are no good fir us so what do we do? Tax us! .15 cents per un-reusable bad.

Hmmm – lets see we recycle? nope! stop using plastic go back to glass – doneGo back to paper bags that are made of starch like packing peanuts – they disintegrate over time – done

But nope – akin to the last post – a few people cry foul on certain things and we react without thinking

government fails at every level of management –


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St. Luke’s-Roosevelt Hospital will pay a big fine to settle charges it bilked taxpayers

ST. LUKE’S-Roosevelt Hospital Center used “billing shenanigans” to bilk taxpayers out of millions of dollars in Medicare and Medicaid payments, prosecutors said the hospital admitted Thursday.

St. Luke’s will pay more than $2.3 million in damages and civil penalties to the feds and the state to settle a federal lawsuit, prosecutors said.


Mariela Lombard/for New York Daily News

U.S Attorney Preet Bharara said the medical center bilked taxpayers.

The Morningside Heights hospital improperly billed Medicare and Medicaid for psychiatric services it provided at an outpatient mental health clinic from 1998 to 2010, according to the suit that was filed and settled Thursday.

“St. Luke’s engaged in billing shenanigans that siphoned millions of taxpayer dollars out of … programs intended to benefit elderly and low-income individuals,” Manhattan U.S. Attorney Preet Bharara said.

The hospital said the billing issues “overwhelmingly” date from 1999 to 2002. The hospital is “firmly committed to compliance and integrity in our billing” and cooperated fully with the feds’ review, it said.