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Written by: Editor

Published: 25 March 2009

SACRAMENTO – State Sen. Patricia Wiggins (D-Santa Rosa) is co-author of legislation (Assembly Bill 324 and Assembly Joint Resolution 4) that would use the elder Economic Security Standard Index (known as the Elder Index) to provide a better measure of poverty to plan for the needs of California's growing aging population.

 

Wiggins said that the Elder Index is “a new tool that accurately quantifies the annual cost of meeting basic needs for retired, older adults in each county. “

 

Assemblyman Jim Beall, Jr. (D – San Jose) is the lead author of AB 324 and AJR 4; Senator Carol Liu (D – Pasadena) is principal co-author.

 

Wiggins said the measures are needed because policymakers are seeking a more accurate picture of what it really takes to make ends meet in today’s economy.

 

Lawmakers typically measure poverty and determine benefits eligibility using the Federal Poverty Line (FPL), which is a 1963 measure based solely on the cost of a bare-bones food diet. Although it is updated annually using the Consumer Price Index (CPI), the 2008 FPL is the same dollar amount – $10,400 for an individual living alone – whether one lives in a high- cost market or a low-cost one.

 

As a result, the FPL vastly understates the real number of people struggling to make ends meet – leaving policymakers with unreliable data and poor planning tools.

 

“Many seniors fall through the cracks of this faulty system, with too much income to qualify for support, but not enough to cover their most basic human needs,” Wiggins noted.

 

California leads the nation with the most elders (300,000) living below the FPL, the majority of them women and people of color. An estimated 864,000 California elders do not have enough income to cover their most basic needs (e.g. housing, healthcare, food, transportation), while 677,000 elders living alone or with a partner struggle to survive on incomes above the FPL but below the Elder Index. Public programs (e.g., Food Stamps, Medi-Cal, Medicare subsidies) are failing to help these seniors because eligibility for these programs is based on the FPL.

 

The U.S. Census Bureau projects that the national population of people age 65 and over is expected to more than double by 2030. California already has the largest percentage of adults age 65 or older in the country (3.5 million). Without an accurate, regional picture of economic needs, local Agencies on Aging cannot adequately plan for the needs of this growing population.

 

To provide policymakers with a better measure of elders’ needs, AB 324 would:

 

• Require California Area Agencies on Aging (AAA) to use the Elder Index to determine poverty in preparing their needs assessment and in developing local area plans;

• Require the California Department of Aging (CDA) to include a compilation of the index data in its State area plan;

• Require any new California State needs-based program to use the index, or some percentage thereof, in determining eligibility (this would also apply to any current program that is later modified to become needs-based);

• Require the CDA to annually update the Elder Index for each county of California and annually calculate the number and demographic profile of seniors living below the updated index (less than $60,000 a year).

 

The second measure – AJR6 – urges the U.S. Congress and President to modernize the Federal Poverty Guidelines to reflect the actual costs to survive in each state and county of the U.S.

 

Wiggins represents California’s 2nd District, which includes portions or all of Humboldt, Lake, Mendocino, Napa, Solano and Sonoma counties.

 

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Written by: Editor

Published: 24 March 2009

LOS ANGELES – Responding to a whistleblower's allegation of "massive Medi-Cal fraud and kickbacks," Attorney General Edmund G. Brown Jr. joined legal action against seven private laboratories to recover hundreds of millions of dollars in illegal overcharges to the state's medical program for the poor.

"In the face of declining state revenues, these medical laboratories have siphoned off hundreds of millions of dollars from programs intended for the most vulnerable California families." Attorney General Brown said. "Such a pattern of massive Medi-Cal fraud and kickbacks cannot be tolerated, and I will take every action the law allows to recover what is owed.”

According to whistleblower Chris Riedel, the chief executive officer of Hunter Laboratories, "I confirmed with the California Department of Health Care Services that these practices were illegal. We then had a choice – either join the other labs in violating the law or be unable to compete for business. We choose to suffer the financial consequence, and follow the law."

The lawsuit, which is pending in San Mateo Superior Court, contends that the seven medical labs systematically overcharged the Medi-Cal program over the past 15 years.

The defendants include:

• Quest Diagnostics Inc., based in Madison, NJ; its affiliate Specialty Laboratories, Inc., based in Valencia; and four other Quest affiliates;

• Health Line Clinical Laboratories Inc., now known as Taurus West Inc., based in Burbank;

• Westcliff Medical Laboratories Inc., based in Santa Ana;

• Physicians Immunodiagnostic Laboratory Inc., based in Burbank;

• Whitefield Medical Laboratory Inc., based in Pomona;

• Seacliff Diagnostics Medical Group, based in Monterey Park;

• Laboratory Corporation of America, based in Burlington, NC.

California law states that "no provider shall charge [Medi-Cal] for any service … more than would have been charged for the same service … to other purchasers of comparable services … under comparable circumstances." Yet, these medical laboratories charged Medi-Cal up to six times as much as they charged some of their other customers for the very same tests.

For instance:

– Quest Diagnostics Inc. charged Medi-Cal $8.59 to perform a complete blood count test (CBC), while it charged some of its other customers $1.43 for the exact same test. This is one of the most frequently requested blood tests.

– Laboratory Corporation of America charged Medi-Cal $30.09 to perform a Hepatitis C Antibody screening, while it charged some of its other customers only $6.44 for the test.

– Health Line Clinical Laboratories charged Medi-Cal $12.65 to perform an HIV Antibody screening, while charging some of its other customers $1.75 for the test.

These are not isolated examples. They are part of a pattern of fraudulent overcharging and kickbacks that developed over the past decade.

Here's how the lawsuit alleged it worked:

– The defendant labs provided deep discounts when they were being paid directly by doctors, patients or hospitals. Prices were often below the lab's cost and sometimes free.

– In exchange for these steep discounts, the defendants expected its customers to refer all of their other patients (where the lab was paid by an insurance company, Medicare, and Medi-Cal) to its lab. Under California law, this amounted to providing an illegal kickback.

– These sharply reduced prices, however, were not made available to Medi-Cal. Instead of charging the discounted prices, the defendants charged Medi-Cal up to six times more than the defendant charged others for the same tests. In effect, defendants shifted the costs of doing business from the private sector to Medi-Cal.

– Additionally, defendants offered their clients who paid them directly (not through Medi-Cal or other insurance) deeper and deeper discounts in order to get a larger share of the lab testing business. This created an unfair playing field, and laboratories that followed the law could not effectively compete. These law-abiding companies were sometimes forced to sell or go out of business completely.

The case was filed under seal in San Mateo Superior Court under California's False Claims Act by a whistleblower and qui tam plaintiff Hunter Laboratories, which processes blood tests. Hunter Laboratories had found that it could not compete in a significant segment of the marketplace where many of the major players were offering referring doctors, hospitals, and clinics far lower rates than they were charging Medi-Cal.

After the whistleblowers filed the complaint, the Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse investigated the allegations and Attorney General Brown intervened under seal. The case became public this week.

Hunter Laboratories' attorney, Niall P. McCarthy of Cotchett, Pitre & McCarthy, commented, "At a time when California is laying off teachers and firefighters and is in a massive budget crisis, it is unconscionable that these defendants would bilk the system to the tune of hundreds of millions of dollars."

Under California's False Claims Act, anyone who has previously undisclosed information about a fraud, overcharge, or other false claim against the state, can file a sealed lawsuit on behalf of California to recover the losses. They must notify the Attorney General as well.

Such a case is called a "qui tam" case. If there is money recovery, the law provides that the qui tam plaintiff receives a share of the amount recovered if the requirements of the statute are met.

The lawsuit asks for relief in the amount of triple the amount of California's damages, civil penalties of $10,000 for each false claim; and recovery of costs, attorneys' fees and expenses. It is estimated that damages could amount to hundreds of millions of dollars.

The clinical testing field is a $50 billion industry nationwide. The defendants named in the lawsuit include some of the largest clinical laboratories in the country.

Quest Diagnostics is the leading provider of diagnostic testing, information and services in the United States, with more than 500 patient service centers in California.

Laboratory Corporation of America performs more than one million tests on approximately 400,000 samples each day and has more than a dozen patient centers in Los Angeles.

To report fraud or abuse, call the Bureau of Medi-Cal Fraud and Elder Abuse's hotline at 800-722-0432.

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Details

Written by: Editor

Published: 23 March 2009

LAKEPORT – Lake County's First 5 Commission will meet this Wednesday, March 25.

The commission will meeting beginning at 1:30 p.m. at the Lake County One-Stop/WIA Assessment Room, located at 55 First St. in Lakeport.

Agenda items include the impact of Proposition 1D in Lake County, revisiting the strategic plan and a kindergarten assessment report.

The executive director also will offer a report, including year-to-date financial reports, and reports will be made by commissioners.

For more information call the commission at 263-6169 or visit the First 5 Lake County Web site, www.first5lake.org.

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