Newark Doctor and West New York Man Charged with $3.four Million Well being Care and Wire Fraud Conspiracy, Cash Laundering, and Making False Statements | USAO-NJ

CAMDEN, NJ – A Newark physician and West New York man are scheduled to make their initial appearances today on charges of defrauding New Jersey state and local health benefits programs and other insurers out of more than $3.4 million by submitting fraudulent claims for medically unnecessary prescriptions, US Attorney Philip R. Sellinger announced.

Kaival Patel, 53, of West New York, New Jersey, and Saurabh Patel, MD, 51, a Woodbridge, New Jersey resident, are charged in a 12-count indictment with conspiracy to commit health care fraud, and wire fraud and four counts of health care fraud. Kaival Patel is also charged with conspiracy to commit money laundering, substantive counts of money laundering, and making false statements to federal agents. The defendants appeared today by videoconference before US Magistrate Judge Sharon A. King and were released on $250,000 each unsecured bond.

According to the indication:

Kaival Patel and his wife – referred to in the indictment as “Individual 1” – operated a company called ABC Healthy Living LLC (ABC) to market medical products and services, including compound prescription medications. Saurabh Patel is a medical doctor who owns and operates a clinic – referred to in the indictment as “Medical Practice 1” – in Newark. Saurabh Patel is related to Kaival Patel and Individual 1. Paul Camarda, a pharmaceutical sales representative who is listed as a conspirator, pleaded guilty before Judge Kugler in Camden federal court on July 6, 2021, to health care conspiracy and conspiring to commit money laundering and obstruct justice and is awaiting sentencing.

Compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Although compounded drugs are not approved by the Food and Drug Administration (FDA), they are properly prescribed when a physician determines that an FDA-approved medication does not meet the health needs of a particular patient, such as if a patient is allergic to a dye or other ingredient.

Kaival Patel, Saurabh Patel, Camarda, and others learned that certain state and local government employees had insurance that would reimburse up to thousands of dollars for a one-month supply of certain compounded medications. The defendants submitted fraudulent insurance claims for prescription compounded medications to a pharmacy benefits administrator, which provided management services for certain insurance plans that covered state and local government employees. The defendants steered individuals recruited to receive medications from the compounding pharmacies to Saurabh Patel’s medical practice, which enabled him to fraudulently receive insurance payments for those patient visits and procedures. The conduct caused the benefits administrator to pay out $3.4 million in fraudulent claims.

The health care fraud and wire fraud conspiracy count carries a maximum potential penalty of 20 years in prison; the health care fraud charges carry a maximum potential penalty of 10 years in prison; the false statement count carries a maximum penalty of five years in prison – all of these counts are also punishable by a fine of $250,000, or twice the gain or loss from the offense, whichever is greatest. The money laundering charges carry a maximum term of 10 years in prison and a fine of $250,000, or twice the gross gain or loss from the offense or not more than twice the amount of the criminally derived property involved in the transactions.

US Attorney Sellinger credited special agents of the IRS – Criminal Investigation, under the direction of Special Agent in Charge Michael Montanez in Newark; special agents of the FBI’s Atlantic City Resident Agency, under the direction of Special Agent in Charge George M. Crouch Jr. in Newark; and the US Department of Labor Office of Inspector General, New York Region, under the direction of Special Agent in Charge Jonathan Mellone, with the investigation leading to the indictment.

The government is represented by Assistant US Attorneys Christina O. Hud and R. David Walk Jr. of the Criminal Division in Camden.

The charges and allegations contained in the indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.

UNC Well being Superior Care at Residence shortens hospital stays, saves cash :: WRAL.com

– A new program from UNC Health enables many patients to leave the hospital earlier than possible and receive acute care at home. It is a program that will save the patient money and open up the much needed bed space in the hospital.

Local UNC TV legend Roy Underhill was recently a patient who benefited from the new program. His television show “The WoodWright Shop” is still on public television channels across the country.

“[It was] for 37 years. It’s one of the longest-running television programs, “said Underhill, who also teaches students how to use traditional woodworking tools as opposed to power tools.

His students come to his woodcarving school in Pittsboro, some from outside the United States. “In a next class we have a student from Norway who has seen all the shows,” said Underhill.

Less than a month ago, kidney infection robbed the 70-year-old of his strength. “It’s known as sepsis and is fatal,” Underhill said.

He was in the UNC emergency room 24 hours and spent another three days in acute care. However, Underhill was presented with a new option. He describes it this way: “They had a new program and they said I could be home and they would bring me hospital care!”

It’s called Advanced Care at Home, and it includes a home health monitoring system, backup power supplies and communication devices via a phone, and video via an iPad or even a button on a wristband.

“And so they actually see someone six to seven times a day, either virtually or in person,” said Ila Mapp, the program’s administrative director at UNC Health.

She says national data shows that patients recover more quickly on the program. “It allows patients to be more comfortable and in more control,” Mapp said.

She adds, “It’s the patients who aren’t quite sick enough to go to the hospital but can go home and still get the acute care they need.”

She says patients who receive home care are also less likely to get other hospital infections like MRSA or even COVID-19.

Underhill quickly accepted the home care offer. He said, “You wear your own clothes, you are in your own bed and only get the medication you need.”

Underhill points out that it’s also cheaper than staying in the hospital. “Releasing a hospital bed saves money, you get better faster. What’s not to like,” he said.

He’s also excited to be back in his own home as well as his wood construction school, sharing his old woodworking talents with eager students.

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Texas has spent $7B in federal cash to pay short-term well being care staff throughout COVID pandemic

AUSTIN — The state is trying to wind down an expensive, federally paid program of hiring nurses and other health care professionals to keep its hospitals from buckling under staffing pressures and burnout caused by the COVID-19 pandemic.

But the plan could be upended by any spike in COVID-19 cases prompted by gatherings over the upcoming holidays. Already, the state decided to keep up surge staffing at hospitals in El Paso and the Panhandle because of recent outbreaks.

After three huge waves of hospitalizations – in each of the past two summers and the big daddy of them all, last December and January – the state has spent nearly $7 billion of federal COVID-19 money for temporary nurses, respiratory therapists and some doctors to maintain operations at hospitals and “alternate care sites.”

The state set up the alternate care sites, mostly at nursing homes and convention centers, to free up hospital beds for coronavirus patients.

The decision to begin ramping down the “medical surge staffing” could be premature. Some public health officials worry that many Texans will mingle indoors and maskless during the upcoming holidays, among them unvaccinated state residents, creating a spike in both seasonal flu and COVID-19 that strains hospitals to capacity.

The Texas Department of State Health Services has told the three vendors who provide the hospitals with temporary caregivers that it plans to stop doing that in most parts of the state over the next month or so, said spokesman Chris Van Deusen.

“Of course, we’re always flexible about that,” he said. “If the situation changes, we’ll change the direction we’re headed.”

Critics of Gov. Greg Abbott’s management of the public health crisis say he’s used hospital staffing support when he should have used a full range of mitigation measures that are far less expensive, such as mask and vaccine mandates.

While the staffing expense is covered 100% by the federal government, the extravagant spending distorted the marketplace for nursing labor, which was already in short supply, said Rep. Donna Howard, an Austin Democrat and retired nurse who has studied the state’s response closely.

‘Burden on the hospitals’

Early in the pandemic, Abbott ordered hospitals to postpone elective surgeries, which choked off vital revenue streams, Howard said. But the Republican governor only hesitatingly embraced a statewide masking and distancing order, which he fully lifted in early March, she noted.

More recently, Abbott has stressed state provision – again, thanks to Uncle Sam – of COVID-19 treatments and infusion centers, where infected patients receive monoclonal antibodies that reduce the severity of symptoms.

“Those are great,” Howard said. “But again, though, rather than trying to do things to prevent it from happening in the first place, the interventions have been after the fact. And it’s really been a burden on the hospitals.”

Abbott spokeswoman Renae Eze, noting that nearly 36 million shots have been administered to Texans, said Abbott has launched “innovative strategies” to combat the pandemic. She cited mobile vaccine clinics and a “Save Our Seniors” program he announced in March. Under the program, modeled on one in Corpus Christi given statewide attention by The Dallas Morning News, local first responders and other volunteers take shots to homebound seniors or set up central drive-through vaccine clinics.

“Governor Abbott has prioritized protecting the safety of Texans from COVID while also safeguarding their livelihoods and personal freedom,” Eze said in a written statement.

Abbott continues to work closely with state Health Services Commissioner John Hellerstedt and Emergency Management Chief Nim Kidd “to get shots in arms and provide support to communities across the state,” she said.

“While the vaccine has proven effective at reducing the severity of COVID cases and slowing the spread of COVID, Governor Abbott also recognizes the right of Texans to refuse the shot, especially those who have acquired immunity, have health conditions, or other reasons to not take the shot.”

Many Texans, though, are still resistant to the shot. Only 59% of Texans age 5 or older have been fully vaccinated against COVID-19.

Flu prospects

So far this flu season, Texans haven’t been catching influenza at an alarming rate. Of the nearly 39,000 who’ve been tested since early October, just 0.35% tested positive. At the peak of the 2018-2019 flu season, in February 2019, about one quarter of specimens tested positive for flu, noted epidemiologist Diana Cervantes of the University of North Texas Health Sciences Center at Fort Worth.

Still, on Wednesday, the federal Centers for Disease Control issued an alert warning of a recent increase in flu viruses detected in recent weeks, especially among young adults. The federal agency said it “also is aware of influenza outbreaks in colleges and universities in several states.”

Flu seasons in which the particular strain noticed in the recent uptick – A(H3N2) – is predominant “were associated with more hospitalizations and deaths in persons aged 65 years and older,” the alert said.

The CDC urged all Americans six months old and older – if they haven’t already, and many haven’t – to get flu shots.

UNT’s Cervantes explained public health officials’ concern.

“As the COVID vaccine has become available, there are many fewer restrictions and prevention measures directed at COVID prevention such as mask usage, physical distancing this year – so we may likely see a more active flu season compared to last year,” she said.

She continued, “There is a possibility that due to the holidays and increased travel and general contact with others, we could see an increase in COVID cases and flu cases jointly and unfortunately there are always severe cases of both that can require hospitalization leading to dual stresses on our health care system.”

With COVID-19 vaccine widely available and “no new variant of concern” at this point, “I am hopeful we will not see a spike of COVID like we experienced last winter,” Cervantes said.

The surge staffing began in July 2020 with just more than 3,500 visiting health care workers helping Texas hospitals. Peak deployment came after last winter’s surge of cases, with almost 14,000 temporary nurses and other workers used during one week in early February. Last summer, the numbers dwindled. From mid-May to mid-August, no surge staffing was needed.

But then deployments kicked back up with the spike of cases caused by the delta variant. By early October, the department’s three private vendors were supplying nearly 7,800 health care professionals a week. As of Nov. 17, that had dropped to 3,176.

A demobilization ‘pause’

In recent weeks, the department told its three vendors supplying the nurses and other front-line workers – San Antonio-based nonprofit BCFS Health and Human Services, San Antonio-based Angel Staffing Inc. and Columbia, Md.-based Maxim Healthcare Group – that it planned to stop all hospital support in early December.

A flare-up of positive cases in El Paso and the Panhandle has forced the department to keep providing the surge staffing to those two regions, even as it hopes to be able to stop providing nurses and therapists to hospitals in most of the state, said Van Deusen, the state health department spokesman.

“We’ve paused sort of demobilizing staff out in El Paso, for example, because they’ve seen things really start to go up more,” he said. “But yes, that’s been the idea,” to end the program as more Texans are vaccinated and severe cases of the disease taper off.

On Tuesday, the hospital regions where coronavirus patients are taking up the highest percentage of available beds were El Paso (13.3%), Amarillo (11.8%) and Lubbock (9.9%), according to the department’s coronavirus dashboard. Of the four major metros, Dallas had the highest share of its hospital beds devoted to COVID-19 patients – 4.9%. There were 768 people with COVID-19 hospitalized in the Dallas trauma service area’s hospitals. Of them, 94 had been admitted in the previous 24 hours.

From just over a year ago, Dallas has zoomed to account for 28% of the surge staffing statewide, from under 10%. South Texas, which in October 2020 drew 35% of the temporary workers helping Texas hospitals, now is using only 11%. As a share of the statewide deployment, Houston has tapered off (to 21% of the total, from 25% a year earlier), while Austin and Central Texas account for nearly 10% of the statewide staffing help, up from about 1% a year earlier.

President Joe Biden recently said that 100% reimbursement of states’ coronavirus-related response efforts, such as the hospital staffing, would continue through April 1.

Van Deusen said that leaving aside considerations about federal reimbursements, the need for the surge staffing has diminished.

Hospitalizations for COVID-19 in Texas have decreased dramatically from the delta variant-driven spike of confirmed cases in late summer. From nearly 14,000 in late August and early September, hospitalized patients have fallen to under 2,700 as of Tuesday.

“We had started ramping down earlier this month, with the idea that it would take probably four to six weeks to do that,” Van Deusen said.

‘Worth it to them’

Some of the health care workers, such as nurses, have commanded high prices to come work at Texas hospitals.

Howard said at one point, she was told by the state health department that nurses cost the state $100 an hour to $125 an hour. She said she didn’t know if that was the amount being paid to the vendor or the nurses. The online job site Indeed shows the average registered nurse in Texas commanding about $36 an hour, she noted.

Department officials and vendors have declined to discuss wages paid to the temporary hospital workers.

“You had nurses who left their jobs to become traveling nurses because they could make a heck of a lot more money,” said Howard, who said she’s heard from one of her staff members an anecdote about one who gambled on treating COVID-19 patients in order to get a piece of the American dream – a house.

“They knew that it was going to be short term, but it was worth it to them to leave where they were and go wherever they needed to be for the fairly short period of time and bring in an exorbitant salary,” Howard recounted.

“It allowed them to actually get a mortgage. That was out of out of sight for them before. They are now able to buy a house because of this, which is great for them. But the distortion in the market is that those very people who are leaving, now, the hospitals are having to find ways to increase what they pay in order to retain their nurses. They’re doing bonuses, they’re doing premium pay, they’re doing whatever they can do, to try to keep the nurses that they have.”

Texas Gov. Greg Abbott, who has received Regeneron’s monoclonal antibody treatment to help him fight COVID-19, said Saturday that he is wants to see antibody infusion centers opened across the state.

By far the biggest chunk of the nearly $6.9 billion spent since July 2020 has gone to BCFS – $5.3 billion, or 77%.

The state also processed invoices from Angel for $1.14 billion (17% of the total) and from Maxim, the former Medcall Medical Staffing, for $455 million (6%). Angel and Maxim are privately held, for-profit companies.

As of Nov. 15, BCFS had 1,945 medical personnel working in 235 Texas hospitals, said BCFS spokeswoman Evy Ramos. Except for about 300 respiratory therapists, they were all nurses, she said. None was a physician.

Of the $6.88 billion spent, just under $2.4 million was state funds, according to a spreadsheet of vendor payments obtained by The Dallas Morning News.

“The funds obligated are federal, FEMA and CARES Act dollars,” said state health department spokesman Doug Loveday, referring to the Federal Emergency Management Agency and the Coronavirus Aid, Relief and Economic Security Act of 2020.

Another $8.7 million of the money went to alternate care sites.

None of the money spent yet has come from the American Rescue Plan Act passed in March, though state lawmakers last month approved spending up to $2 billion of the American Rescue Plan money on hospital surge staffing, COVID therapeutics and infusion centers.

Texas soon will have spent more than $5.1 billion to hire nurses and other frontline health-care workers at premium rates to keep hospitals from being overwhelmed by COVID-19 patients and deter the disease at group residential settings such as nursing homes. The effort will eat up nearly two-thirds of the $8.1 billion in federal Coronavirus Relief Fund money the state has received. In February file photo, three nurses at Dallas' Parkland Memorial Hospital -- one a traveling nurse and two on-staff -- review an intubated COVID-19 patient’s oxygen levels.

GE to interrupt up into three corporations specializing in aviation, well being care and vitality

US industrial giant General electrics will split into three companies after years of underperformance, the company announced on Tuesday.

The company will be split into separate units focusing on aerospace, healthcare and energy. GE plans to outsource healthcare by early 2023 and energy by early 2024, the company said in a press release.

GE stock, which was up 55% in the past 12 months, rose more than 6% in early trading Tuesday.

“By creating three industry-leading global public companies, each can benefit from greater focus, tailored capital allocation and strategic flexibility to drive long-term growth and value for customers, investors and employees,” said CEO Lawrence Culp in a statement accompanying the announcement . “We use our technology know-how, our leadership role and our global reach to better serve our customers.”

The steps are still a long way off, so concrete naming decisions have not yet been made, but the current General Electric will be the aviation-oriented company.

Co-founded by Thomas Edison in the late 19th century, General Electric has undergone several changes over the past century as the US economy changes, becoming a leading supplier of equipment, jet engines, and power turbines.

The conglomerate expanded rapidly under the late Jack Welch in the 1980s, moving into financial services and broadcasting again with the purchase of NBC, while generating enviable earnings growth and returns for investors.

GE was the largest company by market value until the early 2000s, but then came the financial crisis. Under the pressure of its ailing financial arm, GE was never able to climb to the top under Welch’s successor Jeff Immelt. The stock was removed from the Dow Jones Industrial Average in 2018 after being one of the original members of the blue chip index until 1896.

Culp, who previously directed Danaher, Took over as CEO of GE in 2018. The company has spun off or sold several of its units under Culp as the board of directors sought to simplify the conglomerate’s business structure.

“We have made a lot of progress over the past few years not only in terms of our balance sheet, but also in improving our core business,” said Culp on Tuesday when he called investors and analysts. “But I think, as we’ve seen in so many cases outside of GE over the past decade, doing good business increases focus and accountability.”

Despite the recent outperformance, GE stocks have outperformed the market significantly over the past two decades. The stock has lost 2% annually since 2009, compared to an annual return of 9% for the S&P 500, according to FactSet.

GE’s decision was praised by Wall Street analysts Tuesday morning.

“The move increases costs, but the agility of three focused companies is likely to be seen as an opportunity to more than offset new costs,” Wells Fargo analyst Joseph O’Dea said in a statement to customers.

The company has been plagued by heavy debt over the past few years that has aroused skepticism on Wall Street. The capital structures of the new companies will be announced at a later date, GE said, and Culp added in a call with investors that the energy segment will have the least debt.

The company announced that it would use the proceeds from the recent sale of its aviation finance unit to pay off debt, with gross debt expected to be less than $ 65 billion by the end of 2021. The spin-offs will incur transaction and operating costs of approximately $ 2 billion. GE appreciated.

– CNBC’s John Melloy and Michael Bloom contributed to this story.

Arizona Privatized Jail Well being Care to Save Cash. However at What Value?

In 2017, Walter Jordan wrote a memo to a federal judge from the Arizona State Prison Complex in Florence. “Notice of Impending Death,” it said in a shaky hand.

Jordan told the judge that Arizona corrections officials and Corizon Health, the state prison system’s private health care contractor at that time, delayed treating his cancer for so long that he would be “lucky to be alive for 30 days.” Jordan, 67, had a common form of skin cancer that is rarely life-threatening if caught early, but said he experienced memory loss and intense pain from botched care. Other men in his unit were also denied treatment, he wrote, “all falling, yelling, screaming of pain.”

Jordan was dead eight days later.

Reviewing his medical records later, Dr. Todd Wilcox, a physician hired by lawyers for the state’s prisoners, agreed that Jordan’s death was likely preventable. Corizon’s treatment of Jordan’s “excruciating needless pain,” was “the opposite of how cancer pain should be managed,” he said.

Wilcox will take the stand in a landmark trial that begins Monday in Phoenix, the latest chapter in an almost decade-long struggle to determine whether Arizona’s prisoners are getting the basic health care they are entitled to under the law.

The trial pits Arizona against the people held in its prisons, who argue in a class-action lawsuit that the medical services they receive are so poor, they constitute cruel and unusual punishment. The state’s current health care contractor, Centurion, is the latest in a string of companies that have failed to pass muster with the courts.

None of the companies have been named as defendants in the lawsuit, because, the claimants say, the state is ultimately responsible for their care. The suit was originally filed in 2012, shortly before private contractors took over Arizona’s prison medical services. But whether privatization can provide decent care is one of the biggest issues looming over the trial.

The Arizona Department of Corrections declined to comment on pending litigation. Centurion of Arizona and Corizon, based in Tennessee, did not respond to multiple requests for comment.

Arizona is one of around two dozen states that use a private, for-profit contractor to provide prison medical care, and almost all have been sued. But a trial is rare, as most states settle to avoid this kind of exhaustive public scrutiny.

Health care in Arizona prisons is “grossly inadequate,” the prisoners have said in court papers, with crisis-level understaffing, delayed or denied treatments, and unreliable access to medication.

Attorneys have chronicled a man who died after his swollen legs split open, the wounds weeping pus and swarmed by flies; a man with mental illness who was in such distress that he chewed off parts of his fingers; a man who entered prison with a small bump on his face that went untreated and became a disfiguring baseball-sized tumor; and several people denied access to regular mental health care who later killed themselves.

The trial could spell the end of privatized care in Arizona prisons — or, in a more extreme outcome, the end of Arizona’s control over its prison health care entirely. U.S. District Court Judge Roslyn Silver could appoint an outside official to run it who would answer to her, or she could impose additional financial sanctions against the state. Ultimately, Silver will have to decide: How much cost-cutting is too much when lives are at stake?

Although the trial will not directly affect other state systems, experts say the outcome could show officials across the country that courts are serious about enforcing health standards in prison — and that not providing adequate care can have real consequences.

The case is “a great example of why we have it all wrong,” said Homer Venters, a correctional health care consultant who spent years as the medical director for the New York City jail system. Instead of a judge looking over administrators’ shoulders, “the jail has to stop operations if the conditions are inhumane or if the care is not adequate,” he said.

Few prison health care systems get high marks for quality care, regardless of whether the government or a private company provides services. At least 47 states have been the target of major lawsuits. The judge in a landmark case in California — where health care was not privatized — was so appalled by medical services in prisons there that in 2006, he appointed an outside official to take over the state’s $1.2 billion prison health care system.

But bringing companies with a profit motive into the mix poses additional problems, some experts warn, especially in a setting where patients have so little control over their care. “They’ve got every incentive to delay treatment or provide more minimal treatment, or to count something as treatment when it’s not really treatment,” said Michele Deitch, a University of Texas senior lecturer who studies prison conditions. “It would be so much cheaper to just do the things than spend the money on fighting it.”

Until the 1970s, every state provided medical care in its own prisons. But these services were “inadequately available and frequently primitive,” said Douglas McDonald, a researcher at health consulting firm Abt Associates. There were few doctors on staff, and scant health care standards. Prisoners without medical training were known to pull teeth, dispense medications and perform minor surgery on each other, according to one case in Alabama.

Then in 1976, the Supreme Court found that “deliberate indifference by prison personnel to a prisoner’s serious illness or injury” was cruel and unusual punishment, forbidden by the Eighth Amendment. A series of cases in the decades that followed clarified that people in prison are entitled to routine and emergency medical, dental and mental health care that is “adequate … at a level reasonably commensurate with modern medical science.”

These court decisions forced prisons to hire hundreds of medical personnel and pay for hospital stays and expensive procedures. Just as health care in broader society began relying on “managed care” to limit costs, some states started privatizing prison medical care, using small contractors to provide hard-to-hire staff and negotiated rates with hospitals, specialists and pharmacies, McDonald said.

Arizona began contracting out its prison health care in 2012, around the time several of these small companies combined to create the major industry players of today.

The newly merged and fast-growing companies were an attractive investment for private equity, says Dan Mistak, acting president of Community Oriented Correctional Health Services, a nonprofit that helps prisons and jails improve health care. Unlike hospitals and other settings subject to Medicare’s strict quality standards, Mistak said, prison health care is paid for almost entirely from state coffers, which eliminates many requirements that drive up cost — and quality — on the outside.

Medicare provides “stringent accreditation processes and data transparency,” says Monik Jiménez, an epidemiologist at the Harvard T.H. Chan School of Public Health. In prisons, “we don’t have any of that with these private providers.”

Arizona has employed three prison health care contractors over the past decade: Pittsburgh-based Wexford Health, then Corizon, and now Centurion. Allegations of subpar care and chronic understaffing have dogged all three companies.

The number of medical staff decreased by 11% from 2012 to 2019, despite Arizona’s prison population remaining relatively flat, leaving prisons with hundreds of fewer providers than they needed, according to court documents. During its six-year tenure, Corizon paid the state more than $3 million in fines for failing to hire enough doctors and nurses.

After years of fighting in court, in which the state denied all allegations, officials agreed to settle the case on the eve of trial in 2014. The Arizona Department of Corrections pledged to improve care by ensuring its health care provider met more than 100 benchmarks, including: providing adequate access to counseling and mental health care, providing timely referrals to specialists and following instructions of hospital doctors who release patients.

“When prison officials settle a case of this nature, it’s usually because they recognize that there is a problem, and there’s some commitment to fix it,” said ACLU National Prison Project Director David Fathi, who represents the incarcerated people suing the state.

But the problems have persisted. Two judges have separately held the state in contempt and levied fines totaling $2.5 million for failing to meet the quality standards it had agreed to.

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In a recent whistleblower account — the latest in a string of such stories — a former prison nurse alleged that the company directed her to lie on a medical report in order to save Centurion $100,000 in court sanctions.

The state has spent years contesting the evidence, pushing back on recommendations from court-appointed experts, and appealing court orders, losing most of them.

Finally, this year, Judge Silver rescinded the settlement agreement and set the case for trial, writing in a scathing order that she could no longer trust the state was making a good-faith effort to meet the terms of the settlement.

Dustin Brislan says Arizona’s failure to meet health care standards nearly cost him his life.

Brislan, 39, who is serving 17 years at the state prison in Tucson on various charges including armed robbery, is a named plaintiff in the lawsuit. Among other care issues, he said, medical staff switched him from an antipsychotic medication that helped stabilize him to an anti-anxiety drug he told them had not worked in the past.

As a result, Brislan said, his mental health deteriorated into a yearslong cycle of self-harm: cutting himself, then being placed in isolation for weeks or months as a result of the cutting, which led to additional self-harm. At one point, he almost bled to death.

“They are trying to cut corners and save money,” he said, “rather than give us the medications we need.”

Arizona state Rep. John Kavanagh sponsored the 2011 legislation that privatized health care in state prisons. One of the main goals “was always to save money in tough economic times,” he told The Arizona Republic in 2012.

But cost savings have been elusive from the start.

An earlier version of the bill required that privatization save the state money, but when no company could do that, Kavanagh removed the requirement. The legislature pressed ahead with privatization, and the lowest bidder, Wexford, got the initial contract, which cost the state about $116 million a year, about $5 million more than the state spent the previous year.

Since then, costs have increased each year and with each vendor change. For the 15-month period that began in July, Arizona agreed to pay more than $216 million to Centurion. That doesn’t include the more than $21 million the state has spent on attorney’s fees and other costs of litigation to defend its care in court.

A similar scenario played out in Florida, where an outside auditor said privatization both decreased the quality of care in Florida’s prisons and cost the state more money.

In 2017, the Pew Charitable Trusts published a report that detailed how each state structured its prison health care, and how much each state spends.

Centurion’s health care contract was the most common structure. The state pays the company a set amount per incarcerated person per day, creating what critics say is a perverse incentive: If the company spends less, it pockets the difference.

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Pew’s findings underscore the question of whether privatization actually saves states money. Data from the report showed no meaningful difference in per-patient spending between states with privately-run and publicly-run health care.

Arizona was near the bottom of the pack, spending $3,529 per patient per year, compared to a national median of $5,720. Only five states spent less. Of those, two provide their own care, two have a contractor providing care, and one uses a mix of both.

In 2019, Dr. Marc Stern, a correctional health care expert appointed by Judge Silver to review Arizona’s prison health care system, identified tens of millions of dollars in state spending on privatization instead of health care. The spending ranges from the vendor’s profit margin, to lawyers to manage and oversee the contract, to duplication of services, to the hundreds of hours that staff on both teams spend facilitating transitions from one vendor to another.

“Privatization has not served, and will continue to not serve, [Arizona Department of Corrections] well,” Stern said.

Maria Schiff, a health policy analyst and one of the authors of Pew’s report, said the money a state spends on health care is only one piece in a much larger equation. The state’s oversight of care, high and measurable quality standards, and efficient use of resources all matter, too.

“What kind of care is a state (and more importantly, its incarcerated individuals) getting for the money it does spend?” she said.

The upcoming trial is set to last three weeks. Eight incarcerated people will take the stand alongside state officials and medical experts.

Among the voices who will not be heard is Walter Jordan, who sent notice of his impending death to the court. But his experience — a litany of mismanagement and incompetence that led directly to his death — was “was sadly predictable,” wrote Wilcox, the outside expert.

According to Wilcox, as someone who already had skin cancer in the past, Jordan should have been provided extra-strong sunscreen, but a Corizon nurse denied it. When Jordan developed a scalp lesion, Corizon sent him to a dermatologist, who should have sent him immediately to an oncologist because the lesion had grown so large. But they didn’t.

The dermatologists’ attempts to remove the growth on Jordan’s head “burn[ed] a hole in his skull bone,” allowing the skull to become infected and the cancer to invade his brain. A provider wrote in Jordan’s chart, “THE WOUND IS HORRIFIC.”

One explanation for such poor decision-making, according to Wilcox: The legislature had set unreasonably low caps on how much the state was willing to pay outside specialists, a problem compounded by millions of dollars in bills to outside hospitals and providers that Corizon left unpaid.

“The completely foreseeable result of not paying specialists, or paying them very little, is that there is an ever-shrinking pool of specialists willing to see prisoners, and the quality of those willing specialists can be lower, as was the case here,” Wilcox wrote.

Wilcox warned more people would have similar experiences unless there were drastic changes.

So far, the lawsuit has outlasted lawyers, Department of Corrections directors, the original judge, and even the original plaintiff in the case, known as Parsons v. Ryan.

Victor Parsons had a stomach infection in prison that went undiagnosed for so long it caused permanent damage. After his release, at the age of 42, he was shot and killed by police in Tucson in 2019 after a standoff at his girlfriend’s apartment.

In an interview conducted while still behind bars, Parsons said he was proud to be part of the case. “Even though people forgo their freedoms when they come to prison,” he said, “they shouldn’t have to forgo their lives.”

Hospitals are spending extra money to rent and retain well being care employees throughout the pandemic. That is dangerous for his or her margins.

Hospitals are facing staff shortages made worse by the COVID-19 pandemic, and Wall Street analysts are increasingly concerned that there are insufficient staff for these facilities, which is hurting margins.

“The surge in COVID-19 cases from the Delta variant continues to exacerbate hospital staff shortages, hinder recruitment and retention, drive up wages and hurt hospital profitability,” Moody’s Investors Service said Tuesday. “Over the course of the next year, we expect margins to decline in light of wage inflation, the use of expensive care agencies, increased recruitment and retention efforts, and expanded service packages that include more behavioral health services and offers such as childcare.”

There are several problems involved.

Nursing staff and doctors have been in short supply in some parts of the country for years. Many have burned out – and after 20 months of the pandemic, some are choosing to retire or quit. (A recent survey of 6,000 critical care workers found that 66% considered quitting nursing because of the pandemic.)

“There is no question that the labor market has been under pressure for some time with COVID activity,” said William Rutherford, CFO of HCA Healthcare Inc.
HCA, -0.77%,
one of the largest hospital chains in the US said at the Morgan Stanley Health Care Conference last month, according to a FactSet transcript of the presentation.

Then came the Delta variant and an increase in hospital admissions, which in particular increased the need for nurses to care for COVID-19 patients.

Many hospitals have had to limit or discontinue elective procedures, which are considered critical to their financial success, in order to focus their resources on these patients.

This includes Intermountain Healthcare, Utah’s largest hospital system, which began postponing all non-urgent procedures in 13 nonprofit hospitals due to lack of beds in mid-September. That same week, Idaho began rationing care to hospitals there, citing the “massive increase in COVID-19 patients requiring hospitalization in all areas of the state.”

“In some US regions, hospitals have suspended elective overnight operations, not only because of an increase in cases, but also because of insufficient staffing, which led to a decline in sales,” the analysts from Moody’s write in the report.

And finally some workers made up their minds quit or get fired instead of following the COVID-19 vaccination regulations introduced by some health organizations.

Add all these factors together and consider that salaries and benefits typically make up half the total cost of a hospital.

Hospitals now have to pay their workers more, including hiring more expensive temporary or travel nurses; spend more on social benefits and other “perks” to keep; and increase the amount of money they invest in recruiting clinical talent. (This is a good thing for healthcare recruitment agencies like AMN Healthcare Services Inc.
AMN, -0.33%
and Cross Country Healthcare Inc.
CCRN, + 1.69%,
Analysts say.)

“When COVID spikes occur, hospital beds will primarily be assigned to COVID patients and non-COVID admissions will be postponed,” Jefferies analysts wrote this week in a notice to investors on nonprofit hospitals. “If we leave the delta rise, we believe that demand for temporary nurses will weaken from current levels, but will remain elevated (lower placement rates compared to current average) as postponed admissions and procedures are rescheduled.”

The delta rise subsides, and the number of new cases, hospital admissions and deaths are falling. The current 7-day average for COVID-19 hospital admissions is 7,271 (as of Friday), according to the Centers for Disease Control and Prevention. That’s already lower than last week’s 7-day average of 8,378, but that doesn’t mean all hospitals aren’t ready.

“Even if the average daily COVID hospital stays are decreasing, we continue to see many hospitals and intensive care units across the country operating at full capacity,” said CDC director Rochelle Walensky on Wednesday during a briefing at the White House.

Read more about related coverage from MarketWatch:

New York health workers who are laid off for getting vaccinated are in most cases not eligible for unemployment benefits

“You have to do the right thing”: 50 health groups ask employers to prescribe COVID vaccines for workers – but one major obstacle remains

Court Upholds Houston Hospital’s Mandatory COVID-19 Vaccine Policy: “All Employment Has Restrictions On Worker Behavior”

Children elevate cash for hospital staff who look after COVID-19 sufferers

A family of four from the city of Atlantis, South Florida – who had and won a battle against COVID-19 – are paying it on. The Baudo family were moved by how hard healthcare workers work to comfort COVID-19 patients. They decided to donate money from their homemade lemonade stand to Bethesda Hospital East in Boynton Beach. Sophie Baudo (10) and Anniina Makila (9) are professionals in running lemonade stands with the idea of ​​selling lemonade, “said Baudo. Baudo and Makila are best friends.” When we were little, we decided to be partners in sales to be, “Makila said safely under there, very safe, unbreakable and fireproof,” said Jack Baudo. Idalia Baudo said she and her entire family had COVID-19. “It just hit us, there were no symptoms or anything,” said Idalia Baudo. “It was just – boom – and then we were out.” She is proud that her children give something back. “I couldn’t be more moved that you have the compassion,” said Idalia Baudo. “This is something I always pray for that they have some sensitivity to be in tune with.” Hospital officials appreciate the support they are inspired to be a future fundraiser, “said Barbara James of the Bethesda Hospital Foundation.

A family of four from the city of Atlantis, South Florida – who had and won a fight against COVID-19 – continues to pay.

The Baudo family were so moved by how hard the health care workers work to comfort COVID-19 patients that they decided to donate the money raised from their homemade lemonade stand to Bethesda Hospital East in Boynton Beach.

Sophie Baudo, 10, and Anniina Makila, 9, are professionals in running lemonade stands.

“It started about a year ago when I first came up with the idea of ​​selling lemonade,” said Baudo.

Baudo and Makila are best friends.

“When we were little, we made the decision to become a partner in sales,” said Makila.

Sophie’s brother Jack Baudo, 8, collects the money.

“There’s a safe underneath, very safe, unbreakable and fire-proof,” says Jack Baudo.

Idalia Baudo said she and her entire family had COVID-19.

“It just hit us, there were no symptoms or anything,” said Idalia Baudo. “It was just – boom – and then we were out.”

She takes pride in the fact that her children give something back.

“I couldn’t be more moved that you have the compassion,” said Idalia Baudo. “This is something I always pray for that they have some sensitivity to be in tune with other people.”

The hospital management appreciates the support.

“I thought I’d come out and give them a little love and hopefully one of them will be inspired to do a future fundraiser,” said Barbara James of the Bethesda Hospital Foundation.

See how a lot Covid-19 reduction cash well being care suppliers in your state bought

C.ongress set up a massive $ 178 billion fund in 2020 to help mitigate the impact of the Covid-19 pandemic on healthcare providers, known as the Provider Relief Fund.

The Trump and Biden administrations have not always been great to send the money – or send it on time. But STAT’s new analysis of a health and welfare database of money shows where it is going and who has received the most so far.

By far the largest payments were made to the largest hospital systems in the country. Five of the top 10 recipients of cash were hospitals or health systems in the New York City area; together they received about $ 3.1 billion. The New York and Presbyterian Hospital (usually referred to as NewYork-Presbyterian) alone raised $ 631 million, surpassed just one of the $ 1.2 billion that went to New York City Health and Hospitals Corporation Group that operates New York City’s sprawling public system hospitals and clinics.

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STAT also publishes the entire database here in a searchable and sortable format.

Many smaller providers also benefited from the program. Of the 412,591 payments published to date, the median was just $ 12,530. Ninety percent of all payments were below $ 192,569.

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Mississippi has the highest average payment amount of any state at $ 17,563. The Vermont average payment was the lowest at $ 3,802. In Puerto Rico, a U.S. territory with a population greater than 21 states, the average payment was only $ 1,281. Puerto Rico also received less money overall than any other state: $ 180,788,664 so far.

Below are all payments to providers in each state. First select a state and then click the column headings in the table to sort by that column, or use the search box to enter names of providers and / or cities to narrow the results.

J. Emory Parker / STAT
Source: US Health Resources & Services Administration

NJ Gov. Murphy mandates vaccines for state well being care and different frontline staff

New Jersey Governor Phil Murphy speaks at a press conference after touring the Covid-19 vaccination center at the New Jersey Convention and Exposition Center in Edison, New Jersey on January 15, 2021.

Mark Kauzlarich | Bloomberg | Getty Images

New Jersey Governor Phil Murphy ordered vaccines for a variety of frontline workers at a news conference Monday, setting a September 7 deadline for healthcare workers and prisons.

Murphy added that employees who fail to get vaccinated must have regular coronavirus tests up to twice a week. The mandate applies to all employees in New Jersey’s hospitals, correctional facilities and assisted living centers.

“I want to make it perfectly clear that we are ready and willing to require all employees to be vaccinated as a condition of their employment unless we see a significant increase in vaccination rates among employees at these facilities,” Murphy said at the news conference.

Murphy’s latest move comes less than a week after he made a statement recommending vaccinated and unvaccinated citizens to wear masks in indoor public spaces where there is an increased chance of contracting the coronavirus. Citing Covid cases that “tend in the wrong direction”, Murphy and Health Commissioner Judy Persichilli stated in a statement that the increased portability of the Delta variant was a decisive factor in the consultation.

Murphy originally lifted the New Jersey mask mandate with an executive order on the 24. In his order, Murphy also removed corporate social distancing requirements and capacity limits for indoor gatherings.

In New York, Governor Andrew Cuomo, one of Murphy’s frequent contributors to Covid protocols, ordered vaccines for the state’s transport workers this morning, just days after a similar mandate was issued involving government hospitals.

Data from Johns Hopkins University shows that the average of seven-day coronavirus cases in New Jersey reached 938 last week, a nearly 38% increase from the previous week. The CDC reports that 77% of New Jersey residents over 12 years of age have received at least one dose of coronavirus vaccine.

CNBCs Nate Rattner contributed to this reporting.

Former Pittsburgh-area Doctor Pleads Guilty to Unlawfully Prescribing Opioids, Health Care Fraud and Money Laundering | USAO-WDPA

PITTSBURGH – A former doctor pleaded guilty in federal court of drug diversion, health fraud and money laundering related to his holistic medical practice in suburban Pittsburgh, U.S. Attorney Stephen R. Kaufman said today.

Andrzej Kazimierz Zielke, 66, from Allison Park, Pennsylvania 15101 (Hampton) confessed to senior US District Judge Nora. Barry Fischer guilty of unlawful supply and distribution of List II controlled substances, one health fraud and one money laundering case,

In connection with the admission of guilt, the court was informed that Zielke is owned by Medical Frontiers, LLC, an alleged pain management practice based in Gibsonia, Pennsylvania. On or about October 3, 2017, May 25, 2017, October 3, 2017, and December 17, 2014, Zielke knowingly distributed List II drugs, including oxycodone, methadone, hydrocodone, and oxymorphone, to four patients outside of professional treatment practice and not for a legitimate medical purpose. Zielke has committed health fraud by fraudulently making Medicaid claims for payments to cover the cost of illegally prescribed drugs. Finally, Zielke broke federal money laundering laws when he arranged for about $ 150,000 in proceeds from his illicit drug trafficking to be transferred from a bank account to Kitco Metals, Inc. in Canada to purchase silver and collector coins.

“We are intensely focused on reducing the supply of illicit opioids to our communities, whether street-corner dealers or abusing their doctor’s oath by prescribing pain medication for no legitimate medical reason,” said acting US Attorney Kaufman. “We will continue our critical work to prosecute all those who fuel our nation’s ongoing opioid crisis.”

“Mr. Zielke has created a lucrative program to sell opioids while undermining our health care system with fraudulent billing,” said Mike Nordwall, Special Representative for the Pittsburgh FBI. “Unethical, corrupt doctors who choose to fill their pockets, are driving up health care costs for everyone. The FBI is committed to holding those who believe they will not be caught accountable. “

“Andrzej Zielke ruthlessly smuggled opioids into the neighborhoods of Pittsburgh, fueling the climax of the epidemic that kills 13 Pennsylvanians every day,” said Attorney General Josh Shapiro. “We are working closely with our federal partners to address this crisis that continues to destroy families and communities in Pennsylvania.”

Judge Fisher scheduled the conviction for November 1, 2021. The law provides for a maximum sentence of 10 years in prison, a $ 500,000.00 fine, or both for controlled substance offenses. Zielke faces an additional maximum 10 years per charge and a $ 250,000.00 fine for health fraud charges; and a maximum penalty of 10 years per charge and a US $ 250,000.00 fine for money laundering offenses. Under federal constitutional guidelines, the actual sentence imposed would be based on the gravity of the offense and the criminal record of the accused, if any. According to the Federal Constitutional Guidelines, the penalty actually imposed depends on the gravity of the offense and any previous convictions of the accused.

The court continued Zielke on bail until the judgment was announced.

Assistant Attorney General Robert S. Cessar and Attorney General Summer Carroll of the Pennsylvania Attorney General are pursuing this case on behalf of the government.

The investigation that led to the filing of charges in this case was conducted by the Western Pennsylvania Opioid Fraud and Abuse Detection Unit (OFADU). The Western Pennsylvania OFADU, led by federal attorneys from the US Attorney’s Office, combines the expertise and resources of federal and state law enforcement agencies to address the role of unethical medical professionals in the opioid epidemic. The agencies that make up OFADU in western Pennsylvania include: Federal Bureau of Investigation, US Health and Human Services – Office of Inspector General, Drug Enforcement Administration, Internal Revenue Service – Criminal Investigations, Pennsylvania Office of Attorney General – Medicaid Fraud Control Unit, Pennsylvania Office Attorney General – Bureau of Narcotic Investigations, United States Postal Inspection Service, U.S. Attorney General – Criminal Division, Civil Division and Asset Forfeiture Unit, Department of Veterans Affairs – Office of Inspector General, Food and Drug Administration- Office of Criminal Investigations, USA Office of Personnel Management – Office of Inspector General and the Pennsylvania Bureau of Licensing.