Office of the Inspector General calls out Health Safety Net on porous procedures that lead to fraud

I recently proposed a plan to free up resources allowing the state to step up the battle on fraud, waste and abuse. This week, I posted an article questioning the idea of a global payments system being the panacea for controlling health insurance costs.

Today, I’d like to draw your attention to a report released this month by the Office of the Inspector General (OIG) that 1) reveals inadequate systems in place to guard against fraudulent claims paid by the Health Safety Net (HSN), and 2) questions the potential cost savings of a global payments system.

The HSN makes payments to hospitals and community health centers (CHC) for health care services provided to low-income Massachusetts residents who are uninsured or underinsured. Key words here are “low-income” and “residents.” During the year ending June 30, 2010, $405 million was paid out in claims.

According to the OIG report, people claiming to be poor and uninsured are not required to provide their social security numbers. This makes it impossible for the HSN claims processors to verify income or residency. Even when they can check income, they only check for wage income. That means self-employed individuals and trust fund babies fly right through the system without being challenged.

The OIG, as you would expect, also noted claims paid to nonresidents who live in other states and other countries. The Patrick administration finally fessed up last October to the fact that $35.7 million had been spent on emergency health care for 52,000 illegal immigrants in a year’s time.

Other fraud, waste and abuse includes $6 million paid to hospitals and CHC’s for 13,000 duplicate claims, $15.1 million for 60,987 medically unnecessary claims, and $2.7 million for medically unlikely claims.

On the issue of a global payments system, the OIG warns that the Blue Cross Blue Shield pilot program creates a baseline that includes all of the sins of the past and grows it from there. There is no evidence that such a system will save any money at all.

Read the OIG summary report here (it’s a quick read).

Boston Herald: Out-of-staters “reap free care”

Read the HSN 2010 annual report here.

Proposed boardwalk project may be over before it gets started

Guest article by Carl Johansen

We need to have an objective discussion around the proposed boardwalk, Brady's Island, and the abutting marsh in the Town of Sandwich. I will not go into the rationale of the community preservation committee providing some $49,000 of taxpayers' money for a study.

The following information was obtained by researching the historical documents at our town library. A copy of this information has been given to the town manager to be copied and given to each member of the board of selectman for evaluation.

Charles Brady, in 1959, sold his property to Joseph and Helen Bazzinoti.

The Bazzinotis conveyed the island and marsh to the Town of Sandwich in 1967. The town, along with state funding, purchased another parcel of land just to the west and these two constitute the present Brady's Island Conservation Area.

The conveyance assured that this property would remain in its natural state, as I understand the agreement between the state and the Bazzinottis under the Conservation Restriction Act (MGL chapter 184, sections 31 and 32). Purchased by the Conservation Commission in 1967 with state money, it also is protected under the Wetlands Act, by the Massachusetts Historical Society, by the Massachusetts Secretary of Environmental Affairs, and by the Army Corps of Engineers.

I will post only a part of section 31 that relates to Brady's Island and Marsh:

"No structure can go on or above the ground."

Unless the owner places a limitation on its operation as part of a restriction, this property cannot be used for economic benefit, only for conservation use.

A conservation restriction runs with the land and is binding upon subsequent owners of the real estate.  A conservation restriction is valid and enforceable in perpetuity.

Brady's Island and Marsh as it stands now has been given three uses:

• Road side rest area
• Town park
• Wildlife area

Hiking is not listed as a use of this property.

This property includes 6 acres of marsh and 2.9 acres of upland, give or take.

Brady's Island is in a flood zone.

Given the environmental protection granted in perpetuity and all of the potential roadblocks, not to mention clearing the Cape Cod Commission, I ask: How much will it cost to get a permit? Or, more likely, how much will it cost to be denied a permit?

In my opinion, this process has failed before it has even begun just by the nature of all the levels of protection granted under the law to keep Brady's Island and Marsh in its natural state.

What say you, all citizens of Sandwich?

Carl Johansen

A concerned citizen of Sandwich

Global Payments System: Is it déjà vu all over again?

I have found an issue that seemingly has everyone on the same side. No disagreements. No debates.

The cost of health insurance is too high.

The IRS generates a chart each year comparing small group health insurance premiums state by state. For 2010, Massachusetts topped the list with family plans at $14,138 per year, the average across the country being $11,560.

Solutions to runaway health insurance premiums abound. Interstate competition; capping insurance company profits; high deductible health care plans; a single payer system; a global payments system.

One version of a single payer system is called “Medicare for All.” The concept is simple: Eliminate the eligibility age for Medicare. One argument for this approach is that Medicare administrative costs are far below that of private insurance companies. Although debatable, Medicare places its administrative costs at about 2%. This compares to an average of over 15% for private health insurance companies.

In the category of lies, damned lies, and statistics, one must watch out for the math as it pertains to the cohort served by Medicare versus those served by private health insurance companies. The cost of caring for people 65 and older, Medicare’s cohort, averaged $6,600 per person in 2003. The average for privately-insured individuals that year was $2,700. Simple math tells you that the 2% administrative cost figure is lower partly as a result of the higher per capita cost to provide health care to senior citizens.

There are other items not counted in the 2% figure for Medicare’s admin costs, such as the cost of the IRS acting as Medicare’s collection agency and the cost of working capital (cash used to fund operations), which is borne by the U.S. Treasury. The Council for Affordable Health Insurance has an interesting white paper called “Medicare’s Hidden Administrative Costs: A Comparison of Medicare and the Private Sector.”

The biggest issue ignored by a simple slogan like “Medicare for All” is that Medicare pays health care providers significantly reduced rates for doctor visits, diagnostic tests, treatments, hospital stays, and therapy. These health care providers balance their books on the backs of privately-insured patients. No hospital can survive solely on the payments received by Medicare, which are less than the cost of providing the services.

I touch on these issues to illustrate the complexities in the arena of health care finance that are often overlooked by advocacy groups that cannot be overlooked by responsible legislators when crafting solutions to the problem of high costs.

So what is being proposed by the governor and our Beacon Hill legislative leadership? A concept called the Global Payments System. Seems like a plan that might help us find our way to a solution to high health care costs. (At least the initials, GPS, would imply that.)

The idea is for providers to form coalitions that offer health care, starting with a primary care physician (PCP) and including all facets of health care providers, from diagnostic centers to specialists to hospitals to therapeutic and chronic care practices. The popular term for these health care provider groups is Accountable Care Organization, or ACO. That has replaced MCO, Managed Care Organization, and its subset, HMO, Health Maintenance Organization.

These ACOs would then be paid a fixed amount of money by health insurance companies to care for their enrollees. A qualitative calculation would be made to offer bonuses to those ACOs whose populations are healthier than some standard that will be established by a government agency.

Being a fan of Back To The Future and the many quips attributed to Yogi Berra (“it’s déjà vu all over again” being one of them), I was moved to dust off my HMO financing book, circa 1973.

At that time, this concept was called capitation. HMOs were paid a fee per enrollee and encouraged to keep everyone healthy, because if they weren’t kept healthy, the cost of treating sick people would come out of the profits of the health care provider, not the insurance company. In effect, the risk was shifted from insurance companies to doctors and hospitals. Each doctor became a miniature insurance company, having to weigh the cost saved by not ordering a diagnostic test against the possibility that the patient might have a more serious condition that would cost the HMO even more money down the road.

After years of frustrated patients trying to get primary care physicians to make referrals to specialists, PPOs (Preferred Provider Organizations) were born because people were willing to pay more to have a choice of doctors rather than dealing with the gate keeping PCP.

So are we watching a rerun of the same movie with the names of characters changed? Stay tuned for the GPS debut.

New York Times begins digital subscriptions on March 28th

As newspapers across the country move to subscriptions for accessing online content, will free news be relegated to blogs? Or will an alternative model emerge that maintains profitability and free access?

The New York Times kicks off its pay subscriptions for online access beginning March 28th, ranging from $15 to $35 a month. Nonsubscribers will be allowed 20 articles per month and people linking to articles via search engines and social media will be allowed access, though controls will be in place to prevent these links from becoming a free subscription.

The Boston Globe can’t be far behind and, as we know, the Cape Cod Times has already moved to digital subscriptions featuring a chintzy three free articles per month, though I understand that if you’re a quick clicker, you can get around this limitation.

I hear people claim “I’ll never pay for an online subscription.” I think I remember my parents saying the same thing about television. And who would have ever considered paying for radio? (I love Sirius Radio, by the way. And for an extra $2 a month, you can listen to it on your computer as well.)

Here’s the New York Times announcement:

An important announcement from the publisher of The New York Times

Dear New York Times Reader,

Today marks a significant transition for The New York Times as we introduce digital subscriptions. It’s an important step that we hope you will see as an investment in The Times, one that will strengthen our ability to provide high-quality journalism to readers around the world and on any platform. The change will primarily affect those who are heavy consumers of the content on our Web site and on mobile applications.

This change comes in two stages. Today, we are rolling out digital subscriptions to our readers in Canada, which will enable us to fine-tune the customer experience before our global launch. On March 28, we will begin offering digital subscriptions in the U.S. and the rest of the world.

If you are a home delivery subscriber of The New York Times, you will continue to have full and free access to our news, information, opinion and the rest of our rich offerings on your computer, smartphone and tablet. International Herald Tribune subscribers will also receive free access to NYTimes.com.

If you are not a home delivery subscriber, you will have free access up to a defined reading limit. If you exceed that limit, you will be asked to become a digital subscriber.

This is how it will work, and what it means for you:

• On NYTimes.com, you can view 20 articles each month at no charge (including slide shows, videos and other features). After 20 articles, we will ask you to become a digital subscriber, with full access to our site.

• On our smartphone and tablet apps, the Top News section will remain free of charge. For access to all other sections within the apps, we will ask you to become a digital subscriber.

• The Times is offering three digital subscription packages that allow you to choose from a variety of devices (computer, smartphone, tablet). More information about these plans is available at nytimes.com/access.

• Again, all New York Times home delivery subscribers will receive free access to NYTimes.com and to all content on our apps. If you are a home delivery subscriber, go to homedelivery.nytimes.com to sign up for free access.

• Readers who come to Times articles through links from search, blogs and social media like Facebook and Twitter will be able to read those articles, even if they have reached their monthly reading limit. For some search engines, users will have a daily limit of free links to Times articles.

• The home page at NYTimes.com and all section fronts will remain free to browse for all users at all times.

For more information, go to nytimes.com/digitalfaq.

Thank you for reading The New York Times, in all its forms.

Sincerely,

Arthur Sulzberger Jr.
Publisher, The New York Times
Chairman, The New York Times Company

2011 Sandwich School Committee candidate questions

This post will provide a single place for readers to ask their questions of the candidates for school committee in Sandwich. As is normal, anyone can post here anonymously, but if you do, I strongly suggest that you select the Name/URL option and choose a screen name in order for the candidates to reply to your questions/comments without confusion.

2011 Sandwich Board of Selectmen candidate questions

This post will provide a single place for readers to ask their questions of the candidates for board of selectmen in Sandwich. As is normal, anyone can post here anonymously, but if you do, I strongly suggest that you select the Name/URL option and choose a screen name in order for the candidates to reply to your questions/comments without confusion.

Glenn Paré responds to reader comment

I had an interesting response to the overview piece I wrote a few weeks ago about running for Selectman.

Noting that I said “watching from the sidelines,” a reader questioned whether I had the level of expertise and experience as the other candidates running for Selectman. If I could, I would like to share my answer here.

I certainly didn’t mean to suggest that I was watching from up in the bleachers and confused by the scrambling of the players on the field. I understand Sandwich, the operation of Town government, and how our finances work.

I am running for Selectman because Sandwich faces serious challenges and I believe I can bring the leadership necessary to help meet those challenges. I want to serve the best interests of all of the people of Sandwich. I am committed to our community and devote as much effort as I can to helping Sandwich move forward. And, I have a clear vision for Sandwich’s future. I am committed to strengthening our business base while protecting Sandwich’s historic culture and character.

Since 2006, I have served on the Sandwich’s Finance Committee, and have been chairman for the past year. In 2007 and 2008, along with other Town officials and volunteers, I helped to formulate and create the Sandwich’s 10-year Local Comprehensive Plan, calling for smart growth and careful development. In 2004, I helped to establish Sandwich’s own Chamber of Commerce, was Treasurer and on the Executive Committee, and served on its Board of Directors for the past six years. I cannot begin to add up the thousands of hours of participating in meetings and workshops, reading and reviewing budgets, projections, and other materials, touring public buildings and programs, sitting in on other Town Board and committee meetings. . . .

Those who know me know that I have a record of successful leadership and decision-making – which I hope is balanced with fairness, a willingness to listen and comprehend, and my belief in the importance of collaborating to do what is best for all. In my career, I spent 25 years in museum and non-profit leadership positions. Then, in 2005, I became a small business owner when I opened and operated my retail business here in Town. In 2006, I was elected to the Vestry and currently serve as Senior Warden at St. John’s Church in the village.

We have to make difficult choices about the services our Town provides, the people we employ, the education we offer our children, and the general quality of life for all of us who live here. We need to take positive steps in addressing the Town’s issues, programs, and infrastructure, and, to do so, we need to allocate and spend our limited funds wisely and fairly.

If I am elected, I will strive to make the right choices for all the people of Sandwich, set clear policy and direct Town employees strategically, ensure that the town provides the highest quality services possible, and keep Sandwich strong and moving forward.

I am asking the voters of Sandwich to give me an opportunity to serve them as Selectman. The election is May 5 and I need your support and your vote.

Thank you.

Glenn Paré

Bob Catalini, Sandwich school committee candidate

My name is Bob Catalini and I am a candidate for Sandwich School Committee. Information about my background and motivation for running can be found at my website http://www.catalini4sc.com/.

My family and I are hosting a campaign kickoff event at the British Beer Company on Friday, March 25th, at 6:30pm. All interested residents are welcome.

I can be contacted at bob@catalini4sc.com and would be available to speak to any interested groups or individuals.

Thanks you!

Bob Catalini

Sidewalks on Quaker Meetinghouse Road: Time to act before we experience a tragedy

Governor Patrick signed the budget for fiscal year 2008 on July 12, 2007, a budget that included $1 million for constructing sidewalks on Quaker Meetinghouse Road (QMR) in Sandwich from Route 6A to Route 130.

As of today, that $1 million remains tied up at the Mass DOT (Department of Transportation) because our project has a lower priority than many others around the state. And, on its surface, I can understand why the Secretary of Transportation, Jeff Mullan, might consider the project’s priority to be appropriate. When we have crumbling bridges and VW Beetle-sized pot holes to deal with, sidewalks in Sandwich seem like a nice-to-have rather than a must-have.

But our board of selectmen in 2007 did not request this assistance from the state because sidewalks would be an esthetic improvement or a recreational benefit to our residents. Instead, we listened to testimony from a number of citizens, primarily parents who face the life and death choice of allowing their children to walk/bicycle to school using this busy and dangerous street with short shoulders and no protective curbing.

QMR is host to two K-8 schools and Sandwich High School. Most parents of students in grades 5 and up who live within a mile of either of the K-8s are forced to drive their kids to school or having them walk the back streets or through the forest to get there; routes that raise other questions regarding safety.

My primary concern is that we bring this safety issue to the attention of Mass DOT before we have a tragic situation drive the release of the funding. And this is where I’m asking for everyone’s help.

Please write a letter, or send me an email (randy.hunt@mahouse.gov), or comment here at my blog to express your concerns and appeal for Mass DOT to take action on this project in order to save the life of or prevent serious injury to one of our children. I will gather all of the correspondence and meet with Mass DOT to explain that we’re addressing a critical safety issue by constructing curbed sidewalks on QMR.

By the way, I did not live on this street when I voted with the others on the board of selectmen to request this funding in 2007. The fact that I do now simply adds my personal observations to the existing anecdotal evidence that we need to address the situation as soon as possible.

Send letters to:
Rep. Randy Hunt
93 Route 6A
Sandwich, MA 02563

If anyone is willing to coordinate an effort to bring more attention to the issue, perhaps via a petition drive, that would also be welcomed.

On a final note, Senate President Therese Murray’s office has been very helpful with our efforts to-date along with my predecessor state representative and our town manager and assistant town manager. However, it’s time that the citizenry get behind our efforts to convince the powers that be to move this project forward.

What's getting your goat?

It seems that we’ve got reason to be upset with a number of things lately.

What’s torquing your wrench? Mark your favorite in this week’s poll.

Minkoff settlement funded

The Cape Cod Times reported this morning that the Town of Sandwich issued a check for $165,000 to fund a settlement reached in January in its lawsuit with Maxine Minkoff, former assistant superintendent.

She was hired in June 2009 and notified of her firing on November 20, 2009, though she remained on the payroll on “administrative leave” at least through the end of 2009. The 2009 town annual report (which covers the calendar year) places her earnings at $68,750. Her annual salary was $125,000.

The firing was blamed on a 2% reduction in Chapter 70 aid and a circuit breaker funding cut totaling nearly $650,000, which was unanticipated when the fiscal year 2010 budget was finalized.

At the time, Superintendent Johnson said that it came down to a choice between laying off teachers or laying off Minkoff. The school committee voted 5-2 to confirm ending Minkoff’s contract, with Sherry Marshall and Jessica Linehan voting not to pull the trigger.

The settlement is being paid $80,000 by the town and $85,000 by the town’s insurance company. No one has speculated about the effect this settlement may have on the town’s insurance premium, but it’s probably wise for the insurance company to wait until after the current superintendent’s case is resolved before recalculating the policy premium.

John Kennan, Sandwich selectman candidate

I am seeking re-election to the Board of Selectmen on May 5, 2011. As your selectman I have worked hard for our community encouraging more communication between the Board of Selectmen, School Committee, and Finance Committee. I understand the unique needs of our community and will continue to work tirelessly with and for you to promote a financially healthy community that can support families, seniors and businesses.

Many of you know that for years I have advocated for economic development in Sandwich. While I understand that economic development is no panacea, I do believe it is our most important step on the pathway to a 21st Century Sandwich. As your current Selectman and President of the Sandwich Economic Initiative Corporation, I am dedicated to the proposition that with proper planning and economic development, we will broaden our tax base and enjoy job creation. I also believe that with proper planning, support and a commitment by the community, we will enjoy the benefits of access to the arts and culture, public space, recreation, social interaction, authenticity and a distinctiveness that will be the envy of our surrounding communities.

I believe in our community. I believe in collaboration and a continuum of dedicated leadership and will continue to serve you well in an open and honest way as I do now.

I can be reached either by telephone or e-mail to discuss your concerns and as always I am available to meet with you in person.

I look forward to hearing from you.

John Kennan
Tel. 508-833-1857
E-mail: jgkesquire@comcast.net

NSTAR extends herbicide moratorium on Cape Cod

For Immediate Release

For more information:
Caroline Allen: (617) 424-2460
Michael Durand: (508) 441-5831
Evening and weekends: (617) 541-7888

NSTAR Extends Herbicide Moratorium on Cape Cod

(BOSTON – March 2, 2011) NSTAR is extending its voluntary moratorium on herbicide use through 2011, demonstrating once again the company’s commitment to working cooperatively with the Cape Cod Commission and other local officials. This latest extension will allow sufficient time for the completion of a comprehensive study to quantify and ultimately reduce herbicide and pesticide use by all users on Cape Cod.

“NSTAR is unwavering in our commitment to provide safe, reliable electricity to our customers and we firmly believe our Integrated Vegetation Management Program is the best way to do that,” said Steve Sullivan, NSTAR’s Director of Planning, Scheduling and Contractor Services. “However, we also take very seriously our role as good corporate citizens and this moratorium extension further demonstrates our willingness to working toward a Cape-wide reduction of herbicide use.”

“NSTAR has been a strong working partner during the past year demonstrating a commitment to a full and informed community process aimed at protecting drinking water supplies on Cape Cod,” said Paul Niedzwiecki, Executive Director of the Cape Cod Commission. “The extension of the moratorium is a natural result of the County's ad-hoc committee review.”

In addition to improved mapping of private wells in 2010, progress has also been made in identifying the primary sources of herbicide and pesticide use on Cape Cod. Results to date confirm NSTAR’s IVM program represents a very small portion of the total Cape-wide herbicide use, though there’s more work to be done in documenting and sharing all of the facts. Therefore, NSTAR supports the commissioning of a comprehensive year-long study that further investigates the sources and effects of herbicide and pesticide use on the Cape and establishes guidelines toward its reduction. To lessen the appearance of undue influence on the study, NSTAR will not provide funding and will have only limited involvement in it.

With this latest extension of its voluntary herbicide moratorium comes the need for NSTAR to resume clear-cut mowing on Cape Cod rights-of-way in 2011. Federal regulations require utilities to demonstrate their compliance with strict standards set forth after the Northeast blackout of 2003. Though integrated vegetation management programs are recognized nationwide as the best practice for right-of-way maintenance to meet ecological and reliability standards, clear-cut mowing will be NSTAR’s only viable option on Cape Cod this year. Work is underway to finalize the company’s plans to resume mowing and details will be shared with the affected towns as soon as they are available.

NSTAR is the largest Massachusetts-based, investor-owned electric and gas utility. The company transmits and delivers electricity and natural gas to 1.4 million customers in Eastern and Central Massachusetts, including more than one million electric customers in 81 communities and 300,000 gas customers in 51 communities. For more information, visit http://www.nstar.com/.

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Driving for charity: February 2011 - Ma Otis Pantry

I made a campaign promise, at the urging of Matt Pitta, WXTK Radio news director, to pass through my state representative travel per diem to a local charity each month. Unlike most of us who do not get paid to commute, legislators receive payments based on the distance they must drive to the Statehouse. My per diem is $45. Click here to see Who gets paid to drive to work?

February’s per diem payment of $270 represents six trips to the Statehouse and I am happy to donate that amount to Ma Otis Pantry. This organization provides emergency food service to any military member or military family regardless of branch or rank.

A fundraiser for Ma Otis Pantry is being held on Wednesday, March 9th from 5:00 to 7:00pm at the Cape Codder Resort in Hyannis. Please attend or consider contributing to this important organization.

To find out more about Ma Otis Pantry and to make a contribution, please visit http://www.maotispantry.org/ or call Michelle at (508) 524-8144.

Glenn Paré, Sandwich selectman candidate

I am running for Selectman because I believe we need to take action on many of the issues we face as a Town. Watching from the sidelines, it seems that our elected leadership continues to defer taking actions that are necessary because these actions might not be popular.

It might seem reasonable to continue to study and re-study every issue, but sooner or later we need move forward. We cannot continue to defer our building maintenance and infrastructure issues. We have to address public safety -- the need for new facilities and the need to boost staffing and resources. Nobody wants to have to cut the school budget because salaries and health benefits are now out of hand. Nobody wants to say "no" to a new library, or "no" to a council on aging building. Nobody wants to close down the historic Wing School.... But we do need to take action to keep Sandwich the great Town it can be.

I am running so I can try to address the issues rather than continuing to defer them. Make a decision, take a vote "yes or no", and then move on. When we come together, we can actually get things done.

I promise to be fair-minded and honest. You might not always agree with me, but we can always be frank with each other and try to work out what is best. Political points of view are important, but we need to put ideology aside to work together, to do what is best for Sandwich and the burdened taxpayers.

Please feel free to contact me with your concerns, your opinions, or even a good joke now and then. Call me at home at 508-833-3554 or email anytime at pareglenn@comcast.net.

I hope that you will support me in my effort to move Sandwich along and get some of the pressing things done.

Thanks,

Glenn Paré