Maryland begins to put a price on health-care exchange debacle

Maryland begins to put a price on health-care exchange debacle

By Jenna Johnson and Mary Pat Flaherty, Washington Post, Published: February 27

The cost to taxpayers of flaws in Maryland’s online health insurance exchange is coming into focus, with officials estimating at least $30.5 million in unnecessary Medicaid spending and conceding that they have no idea how much it will take to get a system that works.

The state has paid $65.4 million to the contractor hired to build the system and fired this week because of the protracted problems. Costs are likely to keep rising as Maryland figures out how to fix or replace the system.

Costs were outlined Thursday in a routine budget review presented to state lawmakers after months of outrage and political finger-pointing over the health-exchange debacle. Hopes of developing a site that would be a model for the nation have melted away as the exchange has become a major embarrassment for Democratic Gov. Martin O’Malley and Lt. Gov. Anthony G. Brown.

The review of the Maryland Health Benefit Exchange, by the legislature’s budget analysts, found that state spending on the site has exceeded expectations. The report says the state is seeking to tap $30 million from the federal government that was not to be allocated until later. Also, the rate of spending is unlikely to taper off next year, as planned, because of the problems.

“At this time, it is impossible to know if the funding” Maryland has appropriated and proposed for the health exchange “will be adequate to achieve what needs to be done,” the report concludes.

Maryland’s decision to build the complex online exchange on a tight deadline was a “high-risk undertaking” from the outset, budget officials wrote in their report. Maryland made the process more challenging by trying to add features — like a Medicaid renewal function — to the health insurance marketplace.

The report warns against overreaching and dallying as the state searches for solutions.

“It seems like we’re shooting in the dark,” Del. Adelaide C. Eckardt (R-Dorchester) said during a budget hearing Wednesday in Annapolis. “All that I see is more and more money being put into something when we don’t have a definite plan.” A second hearing was held Thursday.

Joshua M. Sharfstein, Maryland’s secretary of health and mental hygiene, tried to reassure lawmakers that the situation is getting better. Five months after the launch of the site, he said, state officials are in a position to evaluate the options.

Sharfstein said Eckardt’s “shooting in the dark” reference was once accurate. But, he said, “the lights are on. . . . We can use actual information about how different systems are doing in order to inform this decision.”

Among the system’s problems, according to health officials, it cannot identify Medicaid recipients who should be removed from the rolls because their income has increased.

To avoid dropping people incorrectly from the program, Maryland received a six-month extension to confirm the eligibility of recipients. Budget officials say the delay is expected to cost Maryland $17.8 million in unnecessary payments this fiscal year and $12.7 million in fiscal 2015, which begins in July.

The site has also been problematic for Medicaid applicants, who have struggled with “incorrect eligibility determinations, stuck cases, difficulties in choosing managed care organizations, as well as with sending enrollment data” to the federal Medicaid hub, according to the budget report.

Because of the challenges posed by the new health system, the federal government, which shares Medicaid costs with the states, had offered them all a three-month grace period beyond the deadline for confirming the eligibility of existing Medicaid recipients.

Maryland officials asked for twice as much time.

O’Malley was an early and enthusiastic supporter of the Affordable Care Act, legislation championed by President Obama. The governor wanted Maryland to be among the states building their own health insurance exchanges — 14 have done so — rather than relying on the federal site.

Despite high goals and expectations, however, the site has been beset by flaws that have hindered thousands of Marylanders seeking coverage. The exchange’s governing board this week fired Noridian Healthcare Solutions, the lead contractor, and state officials have said they reserve the right to sue or penalize Noridian and other firms that worked on the project.

The report says officials must decide quickly what to do about the broken health exchange and have five options: Fix the system; develop a new one; adopt technology that was successful in Connecticut, Kentucky or other states; join a multistate consortium; or use the federal marketplace.

State lawmakers have said health officials are leaning toward adopting another state’s technology or joining a consortium.

But those options “do not appear to specifically address” the need to quickly verify the income of existing Medicaid recipients, according to the report, which was prepared by Maryland’s Department of Legislative Services, a nonpartisan agency that advises the General Assembly on policy and budget decisions.

In addition, adopting Connecticut’s technology, for instance, would “likely take at least 9 to 12 months,” the report says. That means the exchange might not be working well in time for the next open enrollment period for buying health coverage, which starts Nov. 15.

Medicaid enrollment is always open.

“Not having a solid back-up plan could lead to a similar situation faced by the State in October,” the report states, referring to the Oct. 1 debut of the Maryland site, which crashed almost immediately.

The exchange was supposed to be completely built and functioning by the end of June, which would have shrunk the project’s budget substantially. The need to overhaul or replace the system upends that plan.

Maryland has received $182.2 million from the federal government to pay for the exchange, and those funds are supposed to cover expenses through the end of the year. Exchange officials recently asked state lawmakers for permission to use more than $30 million that was not supposed to be available until later. The money might be needed to make repairs to the exchange in the spring, officials said.

It is likely that Maryland will ask the federal government for more money, budget officials wrote in the report. The state might also try to redirect money that was intended to pay Noridian to help cover the costs of improving the system. Noridian has submitted invoices for $12.6 million more than what it has been paid.

Sharfstein told lawmakers that the state is working closely with federal health officials, who are “very aware of the challenges” Maryland faces.

“We are sharing our plans with them,” Sharfstein said, “and they have basically said that if what we are doing is sensible and necessary for the exchange, that they will do their best to continue to fund us.

“The key thing that this hinges on is the decision about which direction we go.”

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Major flaw in Maryland health site may mean $30 million in unnecessary Medicaid payments

Major flaw in Maryland health site may mean $30 million in unnecessary Medicaid payments

By Jenna Johnson and Mary Pat Flaherty, Washington Post, Thursday, February 27, 12:58 PM

A single flaw in Maryland’s troubled online health insurance system will cost the state an estimated $30.5 million in excess Medicaid payments over the next 18 months because the system cannot accurately identify recipients who should be removed from the rolls, a report by state budget officials said.

The money will pay for coverage for thousands of individuals who are enrolled in Medicaid but whose income likely has increased to the point that they no longer qualify for the subsidy, which helps cover health costs for low-income individuals.

Maryland’s system cannot check whether Medicaid recipients earn too much to re-qualify. Rather than remove people incorrectly, the state reached an agreement with federal officials to delay reviews and continue payments until the site is repaired.

The report provides the first look at the potential dollar cost of the debacle, after months of public outrage and political finger-pointing over who is to blame for the deeply flawed site, which crashed within minutes of its public debut Oct. 1. In addition to identifying the “potentially very costly” Medicaid flaw, the report also found “significant uncertainty” about how much money it will take to fix the health insurance marketplace and where that money will come from.

“It seems like we’re shooting in the dark,” Del. Adelaide C. Eckardt (R-Dorchester) said during a budget hearing after the report was released Wednesday. Another hearing is scheduled for Thursday afternoon in Annapolis.

Eckardt said that the more she learns about the exchange’s finances, the more concerned she is that the state is not being “good stewards of people’s money” during difficult economic times. “All that I see is more and more money being put into something when we don’t have a definite plan.”

Joshua Sharfstein, Maryland’s secretary of health and mental hygiene, insisted that the situation is getting better. Five months after the launch of the site, he said, state health officials are now in a position to evaluate their options, using data on how the current system is and is not working.

“When we started, it was a little bit like shooting in the dark,” Sharfstein said. “But the lights are on. . . . We can use actual information about how different systems are doing in order to inform this decision.”

In addition to the inability to verify the income of existing Medicaid recipients, the site has been problematic for new Medicaid applicants, who have struggled with “incorrect eligibility determinations, stuck cases, difficulties in choosing managed care organizations, as well as with sending enrollment data” to the federal Medicaid hub, the report said.

The report was prepared by Maryland’s Department of Legislative Services, a nonpartisan state agency that advises the General Assembly on policy and budget decisions. The 31-page analysis provides the first detailed public breakdown of exchange expenses thus far and the first indication of how much more the problems could cost taxpayers.

The federal government — which shares the costs of Medicaid with the state — has approved an extension in the deadline for reconfirming the eligibility of recipients. Budget officials say the delay will likely cost Maryland $17.8 million in unnecessary payments this fiscal year and $12.7 million in fiscal 2015, which begins in July.

The state could make all its Medicaid recipients reapply for coverage through the exchange. But many eligible recipients would likely fail to complete that process, state officials said, increasing the number of uninsured state residents and the amount of uncompensated health care.

Maryland was one of 14 states that built its own health-care exchange to offer health insurance under the President Obama’s Affordable Care Act, rather than relying on the federal site as part of the program. Gov. Martin O’Malley (D) signed an executive order to plan Maryland’s exchange a day after Obama signed the act into law, as a way of demonstrating his strong support for it.

Despite high goals and expectations, however, the site has been plagued with problems that have hindered thousands of Marylanders seeking health-care coverage. The exchange’s governing board voted this week to fire Noridian Healthcare Solutions, the contractor hired to build the system, and state officials have said they could sue Noridian or others to legally recover damages.

Maryland’s decision to build the complex exchange on a tight deadline was a “high risk undertaking” from the onset, budget officials wrote in their report. The state added to the risk when exchange officials decided to build a single system that would handle applications for both Medicaid and private health insurance plans. And the stakes grew even higher as exchange officials struggled to coordinate with other agencies and manage the project, especially when Noridian clashed with the subcontractor it had hired to handle most of the technical work.

The report said officials must decide quickly what to do about their broken health exchange. They have five options, it said: Fix the system; develop a new one; adopt technology that was successful in Connecticut, Kentucky or other states; join a multi-state consortium; or use the federal marketplace.

Lawmakers have said health officials are leaning toward adopting another state’s technology or joining a consortium. But those two options “do not appear to specifically address” the state’s need to quickly verify the income of existing Medicaid recipients, the budget report said.

In addition, adopting Connecticut’s technology would “likely take at least 9 to 12 months,” meaning the exchange might not be functioning well in time for the next open enrollment period, which starts Nov. 15.

“Not having a solid back-up plan could lead to a similar situation faced by the State in October 2013,” the report states.

Until exchange officials decide how they will fix or replace the system, budget officials said, “it is impossible to say with any certainty” if the funding currently appropriated for the exchange this year and proposed for next year is enough to cover everything that needs to be done.

The exchange was supposed to be fully built and functioning by the end of June, at which point the budget for the project was supposed to shrink substantially. The need to overhaul the system or replace it with something else changes that picture completely.

Maryland has received $182.2 million from the federal government to pay for the exchange, and those funds are suppose to cover expenses through the end of this year. The state has been spending the money earlier than planned, however, and officials recently asked lawmakers for permission to use more than $30 million that was not supposed to be available until later. The money might be needed to make repairs to the exchange this spring, officials said.

It is likely that Maryland will ask the federal government for more money, budget officials wrote in the report. The state may also try to redirect money that was intended to pay Noridian, and use it to cover the costs of getting the system working better in coming months.

Sharfstein told lawmakers that the state is working closely with federal health officials, who are “very aware of the challenges” Maryland faces.

“We are sharing our plans with them,” Sharfstein said, “and they have basically said that if what we are doing is sensible and necessary for the exchange, that they will do their best to continue to fund us.

“The key thing that this hinges on is the decision about which direction we go.”

D.C. health insurers now required to cover transgender therapies, including surgeries

D.C. health insurers now required to cover transgender therapies, including surgeries

By Mike DeBonis, Washington Post, Updated: February 27 at 1:21 pm

Health insurers doing business in the District will no longer be permitted to exclude transgender-related treatments, including gender reassignment surgery, from the policies they sell, Mayor Vincent C. Gray announced Thursday.

The order issued by city insurance regulators makes explicit that denying coverage for any medically necessary treatment “designed to alter an individual’s physical characteristics to those of the opposite sex” would violate already-existing city laws against discriminating on the basis of “gender identity or expression.” It also makes clear that gender dysphoria, formerly known as gender identity disorder, is a recognized medical condition and those diagnosed with it are “entitled to receive medically necessary benefits and services,” as defined by the World Professional Association for Transgender Health.

With the new policy, the District joins Connecticut, Vermont, California, Colorado and Oregon in explicitly requiring insurers to cover medically necessary procedures and therapies for transgender policyholders.

In a statement, Gray said the new action “places the District at the forefront of advancing the rights of transgender individuals.”

“These residents should not have to pay exorbitant out-of-pocket expenses for medically necessary treatment when those without gender dysphoria do not,” he said.

Amy Loudermilk of the Mayor’s Office of Gay, Lesbian, Bisexual and Transgender Affairs said D.C. residents have seen frequent issues getting their insurers to cover these kinds of treatments and procedures. Many of the denials involved surgeries, but others involved more basic procedures — such as breast cancer screening and gynecological exams for persons undergoing hormone therapy to transition from female to male.

“There’s not one particular insurance company that was worse than the others,” Loudermilk said. But “a significant number of people who are trying to transition have faced some obstacles. … They were getting denials at all different stages.”

The requirements apply to all health policies sold in the District, including Medicaid plans and subsidized plans offered through the city’s D.C. Health Link exchange.

New Poll Finds Gray Still Ahead Of Bowser, But Weakened By Scandal

New Poll Finds Gray Still Ahead Of Bowser, But Weakened By Scandal

Gray at 28%, Bowser at 20%

By: Patrick Madden
February 25, 2014

Most D.C. voters like the direction the city is going in, but also have doubts about Mayor Vincent Gray.

Candidate Support
Vincent Gray 28%
Muriel Bowser 20%
Jack Evans 13%
Tommy Wells 12%
Andy Shallal 6%
Vincent Orange 4%
Reta Jo Lewis 3%

A new poll finds that while Mayor Vincent Gray remains in the lead among a crowded field of challengers for D.C.’s top office, the scandal stemming from his 2010 campaign continues to color how residents view him.

A poll conducted by NBC4, WAMU 88.5, the Washington Informer and the Marist College Institute for Public Opinion is one of extremes. The majority of registered Democrats surveyed — 56 percent — approve of Gray’s job as mayor, yet 63 percent say that he doesn’t deserve re-election. Seventy percent say that he did something unethical or illegal during the 2010 campaign, but 74 percent say the city is headed in the right direction.

But with five weeks to go until the April 1 primary, Gray remains ahead of his competitors.

Among Democrats are who are likely to vote, Gray leads the crowded field with 28 percent. Bowser comes in second at 20, percent, while Council members Jack Evans (D-Ward 2) and Tommy Wells (D-Ward 6) are at 13 and 12 percent, respectively. Restaurant owner Andy Shallal claims six percent, Council member Vincent Orange (D-At Large) stands at four percent and 12 percent of respondents say they are undecided.

The numbers are consistent with a January poll from The Washington Post that put Gray ahead of his challengers, though Bowser, who was endorsed by the paper’s editorial board last week, has since gained ground.

"If you have an incumbent with a 56 percent approval rating and 74 percent of Democrats thinking the city is headed in the right direction, this would not be a contest," says Lee Miringoff, the director of the Marist College Institute for Public Opinion. "But when you look at whether people say they are more or less likely to vote as a result of this scandal, clearly the cloud is there over Gray’s candidacy."

The scandal refers to the federal investigation into Gray’s 2010 campaign. Four people associated with the campaign have pleaded guilty to crimes, and the investigation is ongoing. According to the poll, more than half of likely primary voters say they’re less likely to vote for Gray because of the campaign finance investigation.

The poll also shows a racial divide on how the scandal — and Gray’s support — is playing out.

Eighty-two percent of white voters say they’re less likely to vote for Gray because of the 2010 scandal, while only one-third of black voters say the same thing. Gray enjoys the support of 41 percent of black Democrats, contrasted with only 10 percent among whites. Bowser’s supporter is more evenly split — 23 percent from blacks, 18 from whites — while Wells and Evans draw largely from white residents.

And according to Democrats polled, 44 percent say the economy and jobs is the top priority when it comes to deciding how to vote, with ethics coming in second at 22 percent.

Miringoff says it’s a fluid race with interesting electoral dynamics, considering the incumbent’s strengths and weaknesses.

"It’s an advantage to Gray he can depend on his approval rating. District voters are pleased with the direction of the District, but the scandal is there and the opportunity is there clearly for Bowser to make a move in the closing weeks," he says.

Even if Gray does pull off a win on April 1, he won’t be assured a victory in the general election: the poll found that while 43 percent of voters say they would cast ballots for him in November, 40 percent say they won’t.

The poll surveyed 1,138 residents last week by phone — both landline and cell phone — and has a margin of error of plus or minus 3.6 percentage points. The margin of error for likely primary voters polled is larger, plus or minus 4.8 points.

All eight Democratic candidates will join us here at WAMU 88.5 on Wednesday evening for a special live D.C. Mayoral Candidate Forum, hosted by Kojo Nnamdi with WAMU reporters Kavitha Cardoza and Patrick Madden. The debate will air live from 7 to 9 p.m. on WAMU 88.5 and stream at WAMU.org.

Health care law’s small-business marketplace not attracting many small businesses

Health care law’s small-business marketplace not attracting many small businesses

By J.D. Harrison, Washington Post, Published: February 23

After a slow start, the pace of enrollment is starting to pick up on the health-care law’s new insurance marketplace for individuals and families, with more than 1 million people signing up for coverage last month, including strong showings in Maryland, Virginia and the District of Columbia.

It’s a very different story, though, for people trying to enroll through the insurance exchanges designed for small employers.

Small-business owners, who were supposed to gain more choices and cheaper rates from the new online-health-insurance portals, have been slow to select plans through marketplaces since the rollout started last fall. In part, some say, that is because luring employers to the marketplaces has taken a back seat to fixing technical problems and recruiting individuals and families.

As a result, businesses in many states have been left with an online-shopping portal that is only partially functional — if they have one at all.

Originally, the small-business exchanges were meant to offer an online-shopping platform where employers could sort through plans from insurers and offer one or several options to their employees. Employees would then select from the options their employer had chosen, and their rates would reflect any employer contribution. That’s a different process than the one used by the exchanges for individuals, where people can select a single plan to cover themselves and, in some cases, their families.

In the District, health officials launched both the individual and employer marketplaces on schedule in October, and after correcting a number of early problems with the site, enrollment on the individual exchange has started to pick up. More than 5,000 people have signed up for private insurance plans through the individual portal.

At the same time, fewer than 300 individuals have purchased a plan offered by their small business on the city’s new exchange, even though nearly 10,000 employers have created an online profile allowing them to shop for coverage.

“We have been very focused on the individual side, more so than on the small-group side,” Mila Kofman, executive director for the city’s health-insurance exchange, called DC Health Link, said in an interview. Her office did not have data available on how many companies were represented by the workers who have enrolled.

Deadlines may also play a role. Kofman noted that individuals have a limited window that closes at the end of March, during which to purchase coverage for the coming year, and those who fail to secure a health plan may be subject to a tax penalty under Affordable Care Act rules.

Conversely, employers can apply for coverage through the small-business exchange at any point during the year, and those that are eligible to shop for coverage (firms with fewer than 50 full-time workers) are by definition exempt from rules that will soon penalize companies that do not offer plans to their workers.

“I expect our small-business numbers to pick up significantly once we shift our internal focus from the individual exchange to the small-business exchange,” Kofman said. “It’s all about resources and deadlines.”

In Maryland, small-business enrollment has not started. State officials have pushed back the launch of an online insurance portal for small firms three times, first to January, then to April, then to November. Meanwhile, 30,000 people have signed up for private insurance plans on the individual exchange, about half of them in the past six weeks.

“Our priority has been to improve the user experience on the individual exchange,” Joshua Sharfstein, chairman of the Maryland Health Benefit Exchange, said in an interview.

Sharfstein said the state intends to allow employers to start enrolling in plans in April, but for the first six months they will have to purchase plans directly through insurers or brokers using paper applications — not quite the one-stop online shopping experience President Obama promised Marylanders during a speech last year at Prince George’s Community College.

Maryland is not the only state still struggling with its small-business marketplace.

Oregon has not yet launched an employer exchange, either, and Minnesota’s small-business site has reportedly been riddled with glitches. During the first few months in Kentucky, which has been lauded as a success in terms of overall enrollment, only 14 companies signed up on the small-business marketplace.

And in California, officials earlier this month pulled down the state’s small-business exchange Web site, admitting that it “was not meeting the needs of agents or small employers and needed improvements.”

Online enrollment on the federal exchange — which is available in states, including Virginia, where governors declined to set up their own exchanges — has been repeatedly delayed, too, most recently until November. Until then, employers in those 34 states will be in the same boat as small firms in Maryland, with access to new insurance plans only through brokers or insurance companies, and only by way of paper applications.

Muriel Bowser for District mayor

Muriel Bowser for District mayor

By Editorial Board, Washington Post, Published: February 20

IF THIS were an ordinary election year in the District of Columbia, we probably would back Mayor Vincent C. Gray (D) for reelection. His first term has had solid accomplishments. The city’s finances are robust. Crime is down. Schools are improving. People are moving in. Unemployment is creeping down.

Not all the progress is because of Mr. Gray. He had the good fortune to follow two mayors who put the city on sound footing. Anthony Williams (D) brought professionalism and fiscal responsibility to city government; Adrian M. Fenty (D) tackled the challenge of school reform with unmatched energy. Mr. Gray, to his credit, opted not to change direction; he instead built on those strong foundations.

Nowhere has that been more apparent than in school reform. It was a contentious issue in the 2010 primary fight between Mr. Fenty and Mr. Gray, but since taking office the mayor has been a stalwart supporter of school improvement. He made Kaya Henderson chancellor and Abigail Smith deputy mayor for education. Both had been part of the overhaul of public schools engineered by former chancellor Michelle A. Rhee, and both have proved to be effective leaders in their own right. Recent D.C. student test scores led the nation in improvement, and enrollment in both traditional and charter public schools is up, a testament to the efficacy of the administration’s approach to education.

But this is no ordinary reelection campaign. The crimes and other troubling circumstances that surround Mr. Gray’s campaign four years ago and his refusal to be forthcoming about those events, to the public or the federal prosecutor, strike us as close to disqualifying. If there were no other plausible candidate, voters might decide they had to ignore the cloud and vote for the incumbent. But the city is fortunate to have viable and attractive candidates contesting the April 1 Democratic primary, in which early voting begins March 17.

The contours of the scandal that marred Mr. Gray’s election and his early days in office are, by now, well-known. There was gadfly mayoral candidate Sulaimon Brown, who said the Gray campaign paid him cash and promised him a job for relentlessly attacking Mr. Fenty during the 2010 primary. Mr. Gray denied that charge, but Mr. Brown ended up with a $110,000-a-year position in the D.C. Department of Health Care Finance before the scandal blew up.

There was, according to U.S. Attorney Ronald C. Machen Jr., an illegal shadow campaign, allegedly funded with more than $650,000 from a prominent businessman with large city contracts — including one that was sweetened after Mr. Gray was elected. Four people associated with Mr. Gray’s campaign, including three long-time friends, pleaded guilty to campaign-related felonies in a federal investigation that is ongoing.

Mr. Gray has denied any wrongdoing; he has not been charged with a crime. Officials in his administration insist that the contract was changed on the merits and according to law. But Mr. Gray has been unwilling to discuss his activities or knowledge in any detail. He has declined to meet with federal investigators. Only when he decided to seek reelection did he offer any apology, and then he urged the city to move on.

Voters who remain troubled by that record face a wide array of alternatives, some more serious than others. Reta Jo Lewis, a former State Department official, and Andy Shallal, owner of Busboys and Poets, fall in the less-serious category. Their knowledge of city issues is thin. Mr. Shallal’s main focus seems to be to decry the economic forces that have contributed to his business’s success. Even less credible is Carlos Allen, whose main claim to fame was crashing a White House party in 2009.

Four members of the D.C. Council — Jack Evans (Ward 2), Muriel Bowser (Ward 4), Tommy Wells (Ward 6) and Vincent Orange (At Large) — offer more plausible candidacies. Mr. Wells brings refreshing passion to the subject of government ethics, but his talk of a walkable, livable city is more slogan than course of action for the District. Mr. Orange understands the needs of struggling neighborhoods but has shown questionable judgment, wavering principles and a troubling tendency to demagogue issues.

With 23 years on the council, Mr. Evans is an effective lawmaker who understands how to get things done. He is right to say that his work — both on the dais and behind the scenes — helped restore fiscal responsibility to city government and contributed to economic development projects that revitalized parts of the city, notably the Verizon Center and the baseball stadium. While we have disagreed with Mr. Evans on ethics issues, we have no doubt that he would be a capable manager. We believe, though, that he is lacking in a robust vision that speaks to all the needs of this changing city. He speaks with more passion about what he has accomplished than what he would do.

By contrast, Ms. Bowser has articulated an agenda that balances the need for continued economic growth with an understanding of the stresses growth can bring. We believe she would be a force for continued progress — in economic development, public safety and education — while working to help people and neighborhoods that might otherwise be left behind.

By training and temperament, Ms. Bowser is a student of governance, with a degree in public policy, experience working for Montgomery County government and involvement as an advisory neighborhood commissioner. In seven years on the council, she has been a thoughtful and pragmatic lawmaker who tries to identify problems before formulating solutions. She has supported school reform and understands the urgency of addressing remaining challenges, starting with improving the city’s middle schools. She steered an ethics reform package that many thought would not be approved by a council wary of changes that could upset its prerogatives. The ethics board that resulted is holding officials accountable and raising the bar on government conduct.

Ms. Bowser, a protege of Mr. Fenty, has ably served the needs of a ward that has high expectations of its representatives. She has shown spine in opposing legislation that for all its popularity would do the city harm. She is willing to admit her mistakes, open her mind to new ideas and surround herself with smart, capable staff. All are good traits for an executive, as is her penchant for getting up early and working until the job is done.

She is our choice to lead the city. We urge D.C. voters to select Muriel Bowser when they go to the polls on or before April 1.

Read more about this issue: The Post’s View: As D.C. faces challenges, it needs a mayor it can trust The Post’s View: The D.C. mayor’s race takes shape The Post’s View: Mayor Gray’s unsatisfying answer The Post’s View: Mayor Gray owes D.C. voters more than ‘I didn’t do anything’ The Post’s View: Mayor Gray delivers a chilling message to D.C. officials

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Top prosecutor announces ‘largest health care fraud takedown’ in D.C. history

Top prosecutor announces ‘largest health care fraud takedown’ in D.C. history

The Washington Times

Thursday, February 20, 2014

Bottom of Form

In what prosecutors describe as the "largest health care fraud takedown" in D.C. history, 25 people have been charged with bilking the city’s Medicaid program through schemes that mixed exaggerated symptoms and kickbacks with invoices for personal home care that wasn’t performed.

U.S. Attorney Ron Machen said Thursday agents fanned out across the city and surrounding area to make arrests and seize six luxury vehicles and 49 bank accounts, after a multi-year investigation uncovered Medicaid fraud "at epidemic levels."

Authorities also seized the large Maryland home of Florence Bikundi, who owned three home care agencies. She had been barred from participating in federal health care programs after her nursing license was revoked in Virginia in 2000, but prosecutors accused her of raking in $75 million from the D.C. and Maryland Medicaid programs, anyway, using another name to get back into the game.

Mr. Machen said authorities are still tabulating the millions of dollars stolen through another series of schemes, which prosecutors rooted out after a huge spike in personal home care claims from 2006 to 2013.

"We obviously had to look at it, and we uncovered a huge fraud in the process," Mr. Machen said.

Corrupt care providers teamed up with home health care beneficiaries who faked or exaggerated symptoms so they could obtain a prescription for additional care, authorities said. At times, these beneficiaries were coached on how to walk with a cane or describe their aches and pains.

In turn, these beneficiaries received cash payments for attesting that they received home care services — the more fraudulent hours prescribed, the greater the kickback, according to prosecutors.

Providers then billed Medicaid for these "services," completing the fraud.

"They had it down to a science," Mr. Machen said.

The alleged fraud is likely to raise new questions about safeguards against fraud among health entitlements such as Medicaid, which is funded by state and federal tax dollars.

Mr. Machen cast the issue as a burgeoning sector of corruption across the country, from Detroit to Miami, although Thursday’s indictments focused on the nation’s capital.

"An astonishing amount of money was stolen from the American taxpayer," said Valerie Parlave, assistant director in charge of the FBI’s Washington Field Office.

The investigation relied on undercover work and cooperating witnesses, which should serve as a warning to potential fraudsters, according to Mr. Machen.

"The next person you recruit into your scheme may be an undercover agent," he said. "The next phone call you make to recruit a bogus Medicaid beneficiary may be a recorded phone call by law enforcement."