McHenry County Blog

A press release from State Senator Pam Althoff:

Senate Week in Review: April 1 – 5, 2013

SPRINGFIELD, IL – Despite the state’s ongoing credit woes, improved market conditions allowed Illinois to achieve a near record-low interest rate on construction bonds sold April 2. But that good news was tempered by a report from the University of Illinois showing that the state’s economic growth continues to lag behind the rest of the nation and has slowed after three years of improvements, State Sen. Pamela Althoff (R-Crystal Lake) said.

In other legislative news:

• Local governments are raising concerns about a proposal from Gov. Pat Quinn to reduce the their share of state income tax revenues;
• The Quinn administration has begun implementing a revised early-release program for prisoners, after suspending the practice more than three years ago;
• The state is beginning to accept health insurance proposals for inclusion in the Illinois health insurance exchange which will be established as part of the federal Affordable Care Act, commonly known as Obamacare; and
• In a pair of editorials the Chicago Tribune first asks, if scrubbing 13,700 ineligible persons from the Medicaid rolls was “low-hanging fruit,” why did the state wait for an outside consultant before taking action? The publication then urges lawmakers to carefully consider the options before adding hundreds of thousands of new recipients to the Medicaid program.

State Sells Construction Bonds

Illinois sold a total of $800 million in bonds for construction projects on April 2, getting a 3.92% interest rate on $450 million of tax-exempt bonds, which matches a 20-year low the state received in Jan. 2012. On the second set of bonds, Illinois received a 4.97% rate on $350 million in taxable bonds, which was better than the 5.29% the state received in Jan. 2012 on similar bonds.

Despite the relatively low rates, Illinois continues to pay a higher interest rate than states with better credit ratings.

State’s Recovery in Peril?

Warning signs are showing up in the state’s economy, according to a University of Illinois “flash index” released at the beginning of April. The index showed that while the state’s economy continues to expand, the rate of that expansion slowed slightly in March.

The University’s report coincides with the latest unemployment report, which showed unemployment is higher in 10 out of 12 metropolitan areas, when comparing Feb. 2013 to Feb. 2012. Statewide, unemployment rose to 9.5% in February, from 9% the previous month and 8.9% in February, 2012.

Local Governments Worried about Revenue Sharing

Governor Quinn has suggested that the state could help close its budget gap by freezing local revenue sharing dollars at the same level as 2012. Not surprisingly, a number of municipalities are gearing up to oppose the plan.

Recently, Arlington Heights officials warned they would lose as much as $863,000 in increased funding if the plan is adopted. The Quinn administration estimates the freeze would reserve about $68 million for the state budget and amount to about $5.30 per resident for each municipality. However, the Illinois Municipal League, which represents many city governments, has put the cost at closer to $11.50 per resident and says it would allow the state to divert $148 million.

Quinn Resumes Early Release

In late March, the state’s Department of Corrections released the first inmates under a revised early release program. It was the first early release in three years.

Early release of prisoners had been suspended after the Associated Press uncovered a series of problems in late 2009 and early 2010. At the time, it was revealed that under a controversial “Meritorious Good Time-Push” program the Department of Corrections was releasing prisoners, including some with a history of violent crimes, after an average stay of just 16 days.

The revised program grants non-violent offenders up to 180 days of early release credit if they meet specified criteria.

First Steps toward Health Exchanges

Insurance companies have begun submitting plans to a state review panel in anticipation of the launch of the federal Affordable Care Act, sometimes known as “Obamacare.”

A key component of the federal healthcare law is the establishment of insurance “exchanges” designed to offer individuals and small businesses one-stop shopping for health insurance. Insurance plans are to be available for comparison beginning Oct. 1 and coverage would start in 2014.

The state expects up to 400 different plans will be submitted for review and possible inclusion on the health exchange website. However, some of the state’s largest insurance companies are still weighing whether or not to participate in the Illinois exchange. Plans available through the exchange will be required to meet a base level of coverage and meet strict financial restrictions. The state estimates it will be September before the website goes live and consumers can begin comparing plans.

Medicaid Reform and Expansion

In a pair of recent editorials, the Chicago Tribune took a look at the state’s efforts to remove ineligible recipients from the state Medicaid program and then warned lawmakers not to rush to approve a massive Medicaid expansion.

The first editorial summarized early results of an audit ordered under bi-partisan Medicaid reforms adopted in 2012.

The Tribune wrote: “The initial results of this audit are … astonishing: Of the first 20,500 recipients screened by an outside contractor, the auditors recommend that 13,709 be removed from the rolls. Yes, that’s two-thirds of the first group screened, flagged as ineligible to receive their current Medicaid benefits.”

The editorial references a statement from the Department of Healthcare and Family Services Director Julie Hamos that this represented “low-hanging fruit,” because the individuals had already been red-flagged as suspicious.

So, the Tribune editorial asks:

“Why didn’t state officials pluck this low-hanging fruit long ago?”

The second editorial looks at a major Medicaid expansion contained in Senate Bill 26, which passed the Senate in February with no Republicans supporting it. The bill is currently before the Illinois House.

Although the federal government is expected to pick up the bulk of the cost for the expansion, the state’s Dept. of Healthcare and Family Services (HFS) has indicated the cumulative cost to the state could exceed $2.9 billion by 2020. The measure voluntarily expands the state’s Medicaid program eligibility to nearly 350,000 additional individuals, who are between the ages of 19 and 64 who are under 138% of the Federal Poverty Level.

A press release from the U.S. Attorney’s Office:

NINE DEFENDANTS, INCLUDING TWO OWNERS OF A HOME HEALTH CARE AGENCY AND TWO PHYSICIANS, INDICTED FOR ALLEGEDLY PAYING AND RECEIVING KICKBACKS FOR MEDICARE PATIENT REFERRALS

CHICAGO — Two owners of a home health care agency in suburban Skokie and two physicians were among nine defendants indicted on federal charges for paying and receiving kickbacks in exchange for the referral of Medicare patients for home health care services, federal law enforcement officials announced today.

Defendants Ana Nerissa Tolentino, a registered nurse, and Frederick Magsino, both part owners of Rosner Home Healthcare, Inc., and Edgardo Hernal, a former Rosner employee, allegedly conspired to pay kickbacks to six co-defendants for the referral and retention of Medicare patients that enabled Rosner to bill Medicare.

Also indicted were

• Emmanuel Nwaokocha and Masood Syed, both physicians;
• Jenette George, who operated Ttenej Senior Referral Agency which provided senior citizens with referrals to home health agencies; and
• Jennifer Holman, who was an office manager at a doctor’s office.

Co-defendants Titis Jackson and Carla Phillips-Williams were marketers of Rosner’s services.

The 27-count indictment was returned by a federal grand jury last Thursday.

Tolentino, 43,of Morton Grove; Magsino, 59, of Morton Grove; Nwaokocha, 59, of Skokie; Syed, 53, of Mt. Prospect; Jackson, 36, of Chicago; George, 59,of Chicago; and Phillips-Williams, 42, of Chicago, were initially arrested and charged in criminal complaints in late July of this year.

All seven were released on bond. Hernal, 55, of Westchester, and Holman, 53, of Chicago, were charged for the first time in the indictment.

All nine defendants will be arraigned in U.S. District Court on dates to be determined.

Three defendants — Tolentino, Magsino, and Hernal — were charged with one count of conspiracy to pay illegal kickbacks for Medicare patient referrals. Eight of the nine defendants were charged with two or more counts of violating the anti-kickback statute.

The indictment was announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services, Office of Inspector General; and William C. Monroe, Acting Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation.

According to the indictment between January 2008 and July 2012, Tolentino, Magsino, and Hernal conspired with others to pay kickbacks and bribes to

• doctors, such as Nwaokocha and Syed;
• marketers, such as Jackson, George, and Phillips-Williams;
• medical office employees, such as Holman;
• nurses, and
• others to refer Medicare patients to Rosner.

The three defendants charged with conspiracy allegedly paid kickbacks to increase Rosner’s patient census and to enrich Rosner and themselves.

The amount of kickbacks varied but generally ranged from $300 to $600 for each new patient’s completion of five home health visits in one cycle, and ranged between the same amounts for the repeat admission of a previous patient in a new cycle of home health care.

According to the previously filed complaints, Medicare paid Rosner approximately $13 million for claims submitted for home health services between January 2008 and January 2012. Neither the complaints nor indictment allege how much of Rosner’s total Medicare billings were fraudulent.

The complaints charged that between March and July 2012 alone, the following co-defendants received the amount of kickbacks listed:

• Nwaokocha, $4,800;
• Syed, $1,500;
• Jackson, $24,000;
• George, $13,500; and
• Phillips-Williams, $3,000.

Conspiracy and each count of violating the anti-kickback statute carry a maximum penalty of five years in prison and a $250,000 fine. If convicted, the Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.

The government is being represented by Assistant U.S. Attorney Halley Guren.

The public is reminded that an indictment is not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

The case falls under the umbrella of the Medicare Fraud Strike Force, which expanded operations to Chicago in February 2011, and is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Nearly five dozen defendants have been charged in health care fraud cases since the strike force began operating in Chicago last year. Since June 2012, 16 defendants, including owners of other Chicago area home health care agencies and several other physicians, have been indicted in unrelated cases alleging Medicare referral kickback schemes.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Monday another mailing from “Independent” Dee Beaubien arrived in 52nd State Rep. District mailboxes.

It was again financed by House Speaker Mike Madigan’s Illinois Democratic Party.

This oversized post card takes on Medicaid fraud, which has been at the 10% level since I served in the Illinois House in the 1970′s.

The back has a photo of a Caribbean island.

When I opened my mailbox Saturday, what did appear but another big postcard from the man who wants to be my future Congressman, Peter Roskam.

You can see it below:

The Skinners get back from vacation and what appeared in the mailbox?

Along with the other accumulated mail were two postcards from Congressman Peter Roskam, the incumbent in the current 6th Congressional District who seeks to represent the newly-Madiganized 6th District.  (It now goes from Roskam’s hometown of Wheaton to the northwest all the way to the northwestern corner of Algonquin Township. That’s the point where Algonquin, Grafton, Dorr and Nunda Townships meet.

The subject of both was Medicare fraud.)

The first has a big hammer labeled “Medicare Fraud” that has smashed the glass in a frame of a photo of an older couple.

Saying such fraud costs $60 billion a year, Roskam promotes his “FAST Act.” (“FAST” standing for “The Fighting Fraud and Abuse to Save Taxpayer Dollars Act.”)

The postcard says that 10% of Medicare expenditures are fraudulent or abuse.

Roskam says “cutting edge technology will reduce fraudulent payments to less than .01%.”

It’s endorsed by AARP and Citizens Against Government Waste and “supported by the White House and Republicans and Democrats in Congress.”

The second (or maybe it was the first) postcard about Medicare waste talks about $50 million of Medicare fraud.

That’s a bit strange, since the other one claimed waste to be $60 million.

The address side has a crumpled up dollar bill, plus the message that one out of ten Medicare dollars “is wasted due to fraud and abuse.”

The State is in a fiscal pit brought on, I would argue, by far too many people not willing to vote, “No.”

Perhaps someone other than I voted “No” more often in the Illinois General Assembly, but I doubt it.

I know that when the Illinois Conservative Union was keeping track of budget votes in the 1970′s I voted to appropriated less money than anyone else. (Ask John Curry, who did the tallies.)

And I didn’t vote for Governor George Ryan’s Illinois FIRST bonding program for which my 14-year son will still be paying off, if he doesn’t leave Illinois to avoid that and other burdens, when he is in his late 20′s. A lot of that money went to pay for asphalt, a road surface that needs replacement about every five years and most assuredly should not be financed with 25-year bonds.

But in the fairly large vote to cut welfare’s medical benefits last week, State Rep. Jack Franks cast a vote against reform by voting “No.”

Voting in favor in the House, as explained in this press release, was State Rep. Mike Tryon.

Kent Gaffney did not vote.

State Senator Pam Althoff and Dan Duffy also supported the changes.

A press release from State Rep. Mike Tryon:

Tryon Votes to Cut $1.6 Billion from Medicaid

SPRINGFIELD – Members of the Illinois House took historic action on Thursday to cut nearly $1.6 billion from the State’s $11 billion Medicaid program.

Rep. Mike Tryon (R-Crystal Lake) voted in favor of Senate Bill 2840 and said a key component of the bill is an effort to address waste and fraud by making sure those receiving Medicaid benefits are truly eligible.

“It is estimated that approximately 300,000 people are currently on the Medicaid rolls who are not eligible,” said Tryon.

“Whether they do not meet the income eligibility requirements, no longer live in Illinois, have died or have aged out of the All Kids program, we will use an independent contractor to scrub the rolls of those who are improperly receiving benefits. This alone is expected to save taxpayers $350 million.”

According to Tryon, the bill also provides for a much more-fair rate reduction for hospitals (3.5%). Critical Access and Safety Net Hospitals are exempted from the rate reduction.

In addition, Senate Bill 2840 will:

• Roll Back the Blagojevich expansion of Family Care by reducing the eligibility limit for parents to $30,000 for a family of four
• Imposes a $10 co-pay for emergency room visits
• Requires a $3.60 co-pay on all services and a $2 co-pay for generic medications
• Limits prescription coverage to four prescriptions per month without doctor certification or need or specialty drug/condition exception
• Eliminates funding for adult chiropractic services

“A great deal of time and care was taken to make sure that services will be there for those most in need,” said Tryon. “We were able to preserve these fundamental services while freeing up at least $1.6 billion that can be used to pay down our backlog of bills.”

A press release from the U.S. Attorney’s Office:

CHICAGO AREA MAN CHARGED IN $1 MILLION MEDICARE FRAUD SCHEME

CHICAGO — A south suburban resident who purported to provide psychotherapy services to Medicare patients was charged with participating in a $1 million health care fraud scheme, the Departments of Justice and Health and Human Services announced today.

The defendant, Bryan Day, 42, of Richton Park, who is not a licensed medical professional, operated and was part owner of Charm Development LLC, located in Chicago Heights, which purported to provide psychotherapy services to patients, primarily in nursing homes and long-term care facilities.

Day was charged with six counts of health care fraud in an indictment returned by a federal grand jury last week and announced today by Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Regional Office of the HHS-OIG; and Robert D. Grant, Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation.

Day is scheduled to be arraigned at 1:30 p.m. May 14 before U.S. District Judge Virginia Kendall in Federal Court in Chicago.

The indictment alleges that between January 2008 and June 2009 Day submitted fraudulent claims to Medicare totaling $1,078,733, and caused Medicare to pay approximately $438,852.

Day allegedly submitted claims for individual psychotherapy services purportedly performed by Doctor A, knowing that Doctor A did not provide the services claimed.

In addition, the claims included services that were purportedly provided at times when Doctor A was not present at Charm and not licensed by the State of Illinois.

The claims also included services that were purportedly provided by Doctor A after Doctor A was no longer employed by Charm, and Day allegedly submitted Medicare claims for services purportedly rendered by Doctor A in excess of 24 hours a day.

According to the indictment, Doctor A was licensed to practice medicine in Illinois until July 31, 2008, and Doctor A was employed by Charm from May 2005 until February 2009.

The indictment seeks forfeiture of approximately $438,852.

The government is represented by Assistant U.S. Attorney Michael J. Chmelar.

Each count of health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine, or an alternate fine totaling twice the loss or twice the gain, whichever is greater. If convicted, the Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.

An indictment contains merely charges and is not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

The case is part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that led to charges against 108 individuals for their alleged participation in schemes to collectively submit more than $455 million in fraudulent claims to Medicare.

This takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.

“The results we are announcing today are at the heart of an Administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

The Medicare Fraud Strike Force operations, which expanded to Chicago in February 2011, are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Approximately three dozen defendants have been charged in health care fraud cases since the strike force began operating in Chicago last year.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

A press release from Cliff Surges, who is running against Karen McConnaughay for the State Senate in south central McHenry County and Kane County:

Cliff Surges calls for Medicaid system reform as Illinois heads for crisis

The present facts of the Illinois Medicaid system are staggering. The state is pushing Medicaid payments off to future budgets which has caused a backlog of $1.8 billion of unpaid bills to medical providers. A recent Civic Federation report has projected the backlog could reach $21 billion by the year 2017. This is on top of the cost of covering 2.7 million citizens currently in the system.

“We need to transform our existing system with concrete changes,” Cliff stated. “The integrity of the eligibility process needs to be enhanced.”

Surges is calling for immediate action following the forensic audit in progress, to eliminate fraud and waste in the system. Other action items include:

• A stricter proof of income level and Illinois residency, along with a periodic re-eligibility test
• Reducing adult eligibility to 133% of the federal poverty level, down from the current 185%
• Moving from a “fee for service” system to a care coordination system
• A shift to more than 50% of recipients in managed care by 2015

“This system is dysfunctional and broken. The wasted money and resources need to be spent on helping the truly needy, thereby improving Medicaid’s disastrous health outcomes,” Cliff said.

Surges is a Senate candidate in the 33rd district [running against Karen McConnauhay].

Obamacare is a financial disaster and ticking time bomb for states like Illinois.

The reason is simple.

Illinois didn’t get a Cornhusker Kickback, like Nebraska, written into Obamacare.

Called the Affordable Health Care Act, the name of the legislation is an oxymoron because it’s unaffordable.

An enormous part of the cost of Obamacare was thrown onto the states.

Anyone thinking a gigantic new entitlement is going to be free that covers an additional 30 million people likely thinks Democrats obey the Illinois State Constitution when it requires balanced budgets.

Or that Blago is innocent and wrongly convicted.

The explosion of higher Illinois costs occurs in 2014 when millions more people get free medical coverage. It happens when the eligibility for Medicaid increases by raising the income level for “free” by 33%.

It’s expected to increase Medicaid enrollment by as much as 25%.

In 2008, Illinois spent $13.9 billion on Medicaid of which the Feds paid for $6.6 billion. That means state governments paid $7.3 billion. An increase of 25 percent is about $2 billion, if you express it in 2011 costs.

About a third of the Democrats’ 67% income tax increase will be consumed by the future costs of Obamacare.

Aren’t you glad Melissa Bean voted for Obamacare and all of the newspapers endorsed her?

Fortunately voters were smarter than newspaper editors and elected Joe Walsh.

What Governor Quinn isn’t saying is how much money is being spent on setting up an Illinois Obamacare bureaucracy and if Illinois has stopped spending doing this, now that two Federal judges have ruled the entire law is unconstitutional. (No, Quinn is hoping that the two Federal judges that gave it an OK prevail.)

Adding $2 billion of Obamacare costs onto an Illinois that’s broke is what happens when a Chicago Democrat becomes President.

I guess in 2012 our teleprompter-in-chief can run for re-election in the suburbs on spending a third of our income tax increase on $2 billion of higher Medicaid costs for Illinois.

There may be some Democrats and members of the Madigan family privately praying that Obamacare is thrown out by the U.S. Supreme Court.

Coincidentally Dick Durbin will be up for re-election in 2014, the year the higher Medicaid costs for Obamacare kicks in.

More free benefits without Illinois having the money to pay for them.

This is Durbin’s path to re-election.

Let the Madigan family figure out how to raise more taxes to pay for it.

Obamacare is an unfunded federal mandate to Illinois. It explains why Dick Durbin was such a cheerleader.