Medicare disadvantage dismissed

NY Daily News

A Manhattan judge ruled Thursday that Mayor Adams’ administration cannot slap a financial penalty on retired municipal workers who opt out of the city’s controversial new Medicare plan, marking a major win for a group of retirees who fought the health insurance switch in court for months.

The effort by the administration to levy a $191 monthly fee on retirees who want to keep their current coverage instead of enrolling in the new Medicare Advantage Plan runs counter to longstanding local administrative law, Manhattan Supreme Court Justice Lyle Frank wrote in a decision.

The law in question, Frank continued, requires the city to “pay the entire cost of health insurance coverage for city employees, city retirees and their dependents.” Any attempt to impose a premium or other cost for coverage is thereby illegal, he ruled.

“This court holds that this is the only reasonable way of interpreting this section,” the judge wrote.

Frank’s decision caps a heated court battle between the city and a group of retired city workers that began last year under former Mayor Bill de Blasio’s administration.

In announcing the plan last fall, de Blasio’s administration presented Medicare Advantage as a fiscal boon that would save taxpayers hundreds of millions of dollars every year because it is subsidized by the federal government at a higher rate. At the same time, the administration maintained the new plan would provide the city’s roughly 250,000 Medicare-aged retirees with health coverage that’s comparable to what they’re currently receiving.

But the NYC Organization of Public Service Retirees, a group of ex-cops, firefighters and other retired workers, sued over the move, charging that the new plan would result in inferior coverage, including by imposing complex new preauthorization rules for specific medical procedures.

After vowing on the campaign trail to make sure the new plan wouldn’t be a “bait and switch” for retired workers, Adams announced last month that he would move ahead with implementing it as envisioned by de Blasio, angering retirees who said he was going back on his promise by keeping the $191 penalty in place.

 

Adams sells out city retirees

NY Daily News 

Mayor Adams ordered his administration Sunday to move ahead with implementing a controversial new Medicare plan for retired city workers, angering some retirees who have for months contended it could water down their benefits.

The Medicare Advantage Plus plan, first unveiled by former Mayor Bill de Blasio last fall as a cost-saving alternative to the city’s current retiree coverage, will maintain “premium-free” insurance for the roughly 250,000 ex-municipal workers who stand to benefit, Adams said in a statement.

“That is why after a careful and thorough review by my administration, I am announcing my support for this plan,” he said. “I believe the new program will be in the best interest of retirees and the city’s taxpayers, who stand to save $600 million annually.”

At the same time, Adams said he feels for those retirees who have expressed fear that the new plan could curtail access to certain care.

“As a blue-collar mayor and someone who himself will collect municipal retiree benefits, I am sympathetic to those who have voiced concerns about how this plan will affect their coverage,” said Adams, a retired NYPD captain. “Our administration will continue to work to assuage these concerns before and after the plan is implemented.”

 

The Blaz abolishes municipal workers medicare

  

 

CBS New York

Ex-assembly member charged for pill mill participation

From CBS 2:

More than a dozen people have been arrested and charged in a prescription drug ring in Brooklyn, and a doctor is the alleged ringleader.

As CBS2’s Dave Carlin reported, nurses and even a former New York state assemblyman were also caught up in the bust, dubbed “Operation Avalanche.”

Allegedly, the multimillion-dollar scheme involved thousands of medically unnecessary prescriptions, and shady patient tests and treatments to defrauded Medicare and Medicaid.

Also charged is former Coney Island, Brooklyn Assemblyman Alec Brook-Krasny, 59. He is in Israel and has not surrendered.

Investigators said he allegedly directed a lab he is now affiliated with to alter drug test results.

Flushing doctor pleads guilty to Medicare fraud

From the NY Post:

An octogenarian Queens doctor who let patients dance at his clinic, then passed it off as therapy to scam Uncle Sam, pleaded guilty yesterday.

Ho Yon Kim, 86, of Flushing, pleaded guilty in Brooklyn federal court to conspiring to commit health-care fraud.

Brooklyn federal prosecutors say that Kim also rewarded patients with massages, facials and free lunches at his practice to thank them for letting him use their Medicare numbers to submit some $11.7 million worth of false claims on his behalf.

Further, the feds say Kim administered unnecessary electro-stimulation therapy and physical therapy to patients — and billed the government for services that were never performed.

Kim will face up to 10 years in prison when he is sentenced.

No date has been set for his sentencing.

An old, familiar problem

From NBC:

The operator of a Queens medical practice specializing in radiological exams was arrested by FBI and Secret Service agents early Thursday on charges of filing more than $30 million in false Medicare and Medicaid billings, prosecutors tell NBC 4 New York.

Ting Huan Tai, 34, was taken into custody from his apartment on the 58th floor of a luxury high-rise building in Lower Manhattan. Agents executed a search warrant at Tai’s apartment and seized his 2008 Lamborghini and several bank accounts containing millions of dollars, law enforcement sources said.

According to court papers, Tai became the operator of United Medical Diagnosis (UMD), based in Flushing, in May 2010 after the departure of the former owner. Between May 2010 and May 2012, Tai and his employees submitted bills to Medicare and Medicaid for more than $30 million for radiological services never performed. The bills used the identity of the radiologist and former owner of UMD without his knowledge or consent, sources said.

Prosecutors say Tai used money from the scheme to pay personal expenses, including credit card bills and rent.

Flushing docs busted for phony Medicare claims

From the NY Post:

A bunch of crooked Queens doctors paid their patients to take ballroom dance lessons in their clinic basement -- and then masqueraded the sessions as legitimate physical therapy in fraudulent Medicare claims, sources told The Post.

The scheming doctors also rewarded patients with massages, facials and free lunches in their Flushing practices for helping them submit a staggering $11.7 million worth of false claims, officials said.

Among those charged were Ho Yon Kim, 85, a physician, and his son, Gilbert Kim, 59, who served as the office manager, as well as a chiropractor and another doctor.

The Kims also administered unnecessary electro-stimulation therapy and physical therapy to patients -- and even billed for completely fabricated services that were never performed, officials said.

The Kims’ alleged schemes were unveiled yesterday after FBI agents teamed with investigators from the Department of Health and Human Services to arrest a dozen people in a sweep of raids across New York, charging them with participating in several unrelated health-care fraud rings, officials said. None of the patients who helped in the scheme have been charged publicly.

Time for public employees to pay their fair share

From the NY Post:

Amid its budget crisis, the city is on track to lay off teachers, close fire companies, cut social services and impose other sacrifices. Yet such reductions could be avoided if the city reformed its unusually costly commitments for retiree health-insurance and brought them in line with those of other public-sector employers.

Retired city employees can remain on the city's health insurance without paying any part of the basic premium; when they enroll in Medicare, the city reimburses the cost of their Part B premiums. By contrast, health insurance for retirees is rarely offered in the private sector. And in most states, retired public employees must pay a substantial share of the premium.

Providing this benefit for New York City retirees is a big and growing burden on local taxpayers. Retiree health insurance cost $1.5 billion in the current year and is projected to be $2.2 billion by 2015 -- a growth of 50 percent in just four years.

Some City Council members have suggested tapping into the city's Retiree Health Insurance Trust fund to avert the cuts, but that's the wrong end of the right solution. Tapping into the trust would simply take away money that is already set aside to help address existing retiree health-insurance obligations. What's needed is to change those obligations, which have already created a $70 billion unfunded liability.

That's something that the city can do in collaboration with municipal labor unions -- because, unlike public pensions, which are protected by the state Constitution, retiree health-insurance benefits are not guaranteed.

Feds bust Armenian gang for Medicare fraud

From Fox 5:

A vast network of Armenian gangsters and their associates used phantom health care clinics and other means to try to cheat Medicare out of $163 million, the largest fraud by one criminal enterprise in the program's history, U.S. authorities said Wednesday.

Federal prosecutors in New York and elsewhere charged 73 people. Most of the defendants were captured during raids Wednesday morning in New York City and Los Angeles, but there also were arrests in New Mexico, Georgia and Ohio.

The scheme's scope and sophistication "puts the traditional Mafia to shame," U.S. Attorney Preet Bharara said at a Manhattan news conference. "They ran a veritable fraud franchise."

Unlike other cases involving crooked medical clinics bribing people to sign up for unneeded treatments, the operation was "completely notional," Janice Fedarcyk, head of the FBI's New York office, said in a statement. "The whole doctor-patient interaction was a mirage."

The operation was under the protection of an Armenian crime boss, known in the former Soviet Union as a "vor," prosecutors said. The reputed boss, Armen Kazarian, was in custody in Los Angeles.

Bharara said it was the first time a vor — "the rough equivalent of a traditional godfather" — had been charged in a U.S. racketeering case.

Kazarian, 46, of Glendale, Calif., and two alleged ringleaders — Davit Mirzoyan, 34, also of Glendale, and Robert Terdjanian, 35, of Brooklyn — were named in an indictment charging racketeering conspiracy, bank fraud, money laundering and identity theft.

Medicare scam in Brooklyn

From the NY Post:

Keep those lips zipped, comrade -- and help us rip off Uncle Sam for $72 million!

A Brooklyn medical office used a Soviet-era propaganda poster to tell Russian-immigrant patients to keep quiet about kickbacks they were getting for letting doctors submit thousands of bogus Medicare claims in their names, federal prosecutors revealed yesterday.

"Don't gossip!" warned the Russian-language poster that prominently hung in the "kickback room" of the Bay Medical office on Bay Parkway -- where patients literally lined up for illegal payoffs of a couple of a hundred dollars or so each.

But not everyone kept their mouths shut.

Federal authorities got several people to rat out the alleged scam and yesterday arrested dozens of doctors, employees and patients of Bay Medical and other Medicare "mills" elsewhere in Brooklyn and in Miami, Detroit, Houston and Baton Rouge, La.

It is the largest Medicare-fraud prosecution ever, totaling $251 million in funds swindled from the federal health-insurance program.

Featuring a large drawing of a woman holding an index finger to her lips, the not-so-helpful poster reads: "Keep your eyes open. These days even the walls have ears. Chatter and gossip go hand in hand with treason."

Those threats helped Bay Medical steal $72 million by submitting fraudulent claims, prosecutors said.