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Join Our Healing Revolution!Dr. Brice E. Vickery (281)    Dr. Brice E. Vickery    Supernutrient Corporation Abortion and Its Costs - What's the "New Healthcare" Say about?Posted Thursday, September 03, 2009 (66 days 2 hours ago.) Viewed 13 times. We the "John Q Public" have trusted our representatives to come up with reasonable and effective laws to run our land. Most of us are too busy making a living to find out what bills etc. are going to affect us - until recently. Read here how we pay for "family Planning" and infanticide to the tune of about $38 millions in 5 years, just in the state of California in the 70's, and how they even screwed that up. It's time for us to wake up and "change the change!" California Department of Health Services, DAB No. 666 (1985) GAB Decision 666 June 28, 1985 California Department of Health Services; Ballard, Judith A.; Settle, Norval D. (John) Garrett, Donald F. Docket No. 84-162; ACN 10221-09 DECISION The California Department of Health Services appealed a decision of the Health Care Financing Administration (HCFA or Agency) disallowing $38,402,172 in federal financial participation (FFP) under the Medicaid program (Title XIX of the Social Security Act). The disallowance related to abortions which had been paid for between November 1, 1972 and June 30, 1977. The Medicaid rules applicable to the claimed services authorized 90% FFP for abortion services performed for family planning purposes and 50% FFP for other (medically indicated) abortion services. When the State made its original claim to HCFA for the abortion services in question, it mistakenly lumped together all of the services, whether they were for family planning or not and claimed them at the 90% level. The State's claiming error originated in procedures developed by the State's fiscal intermediary and was discovered during the audit that gave rise to a disallowance for abortion services covering 1977-78. /1/ Since the State is presently unable to identify which abortion services were for family planning purposes based on contemporaneous documentation, the Agency disallowed the additional 40% FFP for all of the abortions claimed by the State for the 1972-77 period. On appeal, the State argued that the three year period for retaining records for the services in question had expired, and that it could not therefore be subject to a disallowance on the basis that it had not documented the propriety of its claim. The Agency effectively conceded that the record retention period had expired but argued that the State's burden to document its claim continued to exist beyond the retention period because of the special circumstances of this case. We conclude that the disallowance must be upheld in part and reversed in part. As we discuss more fully below, the expiration of the record retention period cannot enable the State to retain (2) program funds which were not authorized by statute and which the State received solely by virtue of its erroneous claiming practices. The circumstances here, on the other hand, do not justify completely disregarding the expiration of record retention for contemporaneous documents and upholding the disallowance in full. Our middle ground approach is facilitated by the fact that a comparable basis exists on which to determine which abortion services were entitled to enhanced FFP for the period in question. In Decision No. 665, the Board resolved the last remaining issues leading to a determination of the amount of abortion services performed for family planning purposes for the 1977-78 period. Approximately 82% of the sampled cases for that period were for family planning and 18% were not. The parties at the hearing in this appeal concluded that the 1977-78 period would be the best available evidence for identifying what services in the earlier period were for family planning and agreed that there were no significant differences between the periods to make use of the later period inappropriate. Tr., pp. 12-18. Accordingly, our decision is to uphold that part of the instant disallowance that is not related to family planning services as determined by the State's experience in the 1977-78 period. Analysis This appeal involves the interaction of two basic rules of grant administration. This Board has repeatedly held that where a state claims a special, higher rate of FFP (in this case 90% for family planning services), it has the burden to both document the costs and show that the claim for higher reimbursement is proper. See, e.g., Decision No. 665 and the cases cited therein. Department regulations, on the other hand, limit the amount of time a grantee must retain documentation that would be necessary to support its claim. 45 CFR 74.21. Grantees need retain records for only three years following their claim for FFP or until an audit commenced within that three-year period has been resolved. /2/ The Board has previously considered the combined effect of these two rules and concluded that the expiration of the document retention period would not necessarily preclude a disallowance for failure to document costs where extenuating circumstances existed. Missouri Department of Social Services, Decision No. 395, February 28, 1983. The Board there noted that a grantee's burden to document costs "exists apart from the requirement to retain records, and under the regulation concerning retention of (3) records, there is no presumption that a grantee kept the records and retained them for the requisite period." Id. at 15. The Board then identified the compelling circumstances that served to preserve Missouri's burden beyond the document retention period: 1) some evidence in the record indicated that the Missouri officials may have failed to keep adequate supporting documentation to begin with and in any event the State had been unable to account for how or when its records were destroyed; 2) the State had been continually advised of the necessity to document its costs in order to receive an enhanced rate of FFP; and 3) at the very least, knowing of the Agency's concerns about documentation, the State should have contacted the Agency prior to any disposal of records. Id. at 15-16. The Agency argued that Missouri applies with equal force to the instant case. The Agency emphasized that California had been advised repeatedly of the need to document fully its claims for enhanced FFP and that California knew that "its claiming procedures were faulty and itself intended to retrieve documentation for the purpose of perfecting its claim." Agency's post-hearing brief, p. 1. We agree with the Agency that the State's burden to document family planning services extends beyond the record retention period at least to the extent that the State must use the best available methodology for determining how much of its claim was proper. The State here cannot use the document retention rules to avoid a disallowance altogether since the State would thereby gain a higher level of FFP than the law authorized for a significant number of abortion episodes (the 1977-78 experience indicates that this would be approximately 18% of total episodes). The State is clearly not blameless since its erroneous claiming practices brought about the problem. The State in fact agreed at the hearing that it should not receive a higher level of FFP for services than could be shown to be eligible for that level. Tr., P. 13. Having concluded that the burden to document persists to this degree, we decline to uphold the disallowance in full as proposed by the Agency. The records retention period for the services in question had already expired. Nevertheless, under the Agency's approach, the State would lose enhanced FFP for approximately 82% of the abortion episodes (as indicated by the experience for 1977-78) because it presently is unable to document those services with contemporaneous documents. The State argued, and we agree, (4) that the circumstances here are different in critical respects from those in Missouri. The parties submitted extensive documentation of correspondence and discussions between the Agency and the State to demonstrate what each side knew at various junctures concerning the State's claiming practices and the adequacy of its documentation. While there is evidence in the record that the State was seeking ways of differentiating more clearly between types of abortion in its documentation during the period of the disallowance and that the State knew of difficulties in its process for machine sorting family planning abortions, there is no evidence that the State did not maintain adequate documentation throughout the period which would have been sufficient to document what part of its claim was, in fact, for family planning services. Further, the State emphatically argued that neither the State nor HCFA recognized until 1980 that an error had caused a percentage of its abortion expenditures to be improperly claimed at 90% FFP. State's response to Agency's reply brief, pp. 2-3. In any event the nature and scope of the State's documentation responsibilities are clearly different from those involved in Missouri. As the State noted: . . . (T)his is not an isolated project or contract for which discrete records exist. These services are supported by the general computer records, microfilmed claims, beneficiary and provider profiles, and underlying medical records common to all Medi-Cal services. There is no reasonable method by which the Family Planning records (as opposed to the summaries used for claim preparation) can be separately retained. Nor is it possible simply to retain all records. The reason why provider records, actual provider claims, and detailed computer tapes are not retained much beyond the period required is that it is incredibly costly to do so. Thus, it is simply unreasonable to expect that the State would have stopped its normal disposal schedule for all Medi-Cal records, plus required all providers to retain their records, simply because claims for 90% FFP had been made. State's reply brief, pp. 15-16. Finally, to the extent that both parties learned after the retention period that there were problems with the State's claiming practices for the period in question (potentially giving rise to a disallowance), the Agency as well as the State should have acted diligently. While (5) in Missouri we emphasized the duty of the grantee to make inquiries to the Agency concerning ongoing documentation responsibilities beyond the retention period in specific circumstances, we also believe that the Agency has the responsibility to notify the State of an audit at the earliest possible time in order to give the State specific notice of what documents must be retained beyond the ordinary three-year period. Here the State had no notice from the Agency until August 18, 1980 that it could not follow its normal records retention cycle for the services claimed here. Agency's supplemental appeal file, item 33. Conclusion For the reasons described above, we uphold that portion of the disallowance that cannot be demonstrated to be for family planning purposes on the basis of the methodology and experience which the parties derived from a review of claimed abortion services for the 1977-78 period. /1/ That disallowance is the subject of a companion decision, California Department of Health Services, Decision No. 665, June 28, 1985, which we discuss in the text below. /2/ During the period subject to audit, this requirement was contained in substantially the same form in 45 CFR 74.20(a). Similar record retention requirements are found in 42 CFR 43.32 (then 45 CFR 205.145). OCTOBER 04, 1985 
Permalink Comments (0) The Obama "Door Knocker"Posted Sunday, November 16, 2008 (356 days 21 hours ago.) Viewed 192 times. Our corporation had been rapidly and consistently growing in the health and nutrition field with what are products of the highest standards and effectiveness. Some of our board members however noticing an almost supernatural mania for "things Obama" brought up the idea of capitalizing on this Obama Mania" for crass commercial profits, a departure from our dedicated health improvement base. A previous meeting which filled us with great expectations of thundering sales, and as the results of vast research into the existing products which have set astronomical records, even before the president elect has been formally installed. The count of various items such as memorial plates, coins, cards, poster, underwear, neckties, hats, jewelry, etc. exceeded over two hundred items. We had our infallible numbers cruncher - by exclusion and statistical magic, come up with the winning category - by far - The Obama Door Knocker! The Obama "change and hope" entered our boardroom as our mousy, mono-toned Mr. Numbers began his analysis - which transformed into a sales presentation. His eyes glistened (making them tremendous in his bottle glass glasses) and his usually flat tone - was vibrant! His opening words were "yes we can!" He proceeded to tell us that like Washington this face would be everywhere. Despite the new home building collapse this doorknocker would replace ALL existing doorknockers. Besides private homes, libraries, churches, even federal buildings would all want to replace Lincoln, F.D.R., Jackson, and places that Bush (one or both) would have gone. The boardroom was silent in awe of this newfound personage emerging as a butterfly from his cocoon (or whatever). He proceeded to say that it not only was a doorknocker but that the faithful could hang in the dining room, the living room, the bedroom, and anywhere where it could be a new novelty, the Obama Luck Piece! We could easily adapt it to be multiple towel hangars in the bathrooms. People with five bathrooms might order thirty or more! The person wishing the Obama Luck just had to knock twice making their wish at the same time. He added that we could give volume discounts to people who wished to hang the Obama Doorknocker in multiple rooms inside as well as outside the house. There was absolute silence for a long moment - then thunderous applause! Everyone stood up for our new and shining star. Vice president of sales looked to be a distinct possibility Shiwanda who had been taking the notes raised her hand. I nodded, and she quietly asked our new star, " How do you change a doorknocker into a towel holder?" "Easy Peasy", he replied, " We put a ring through his nose!" Shiwanda stood up - threw her notes and then her water glass in the direction of Mr. Numbers and stomped out of the meeting. After a longer silence Mr. Numbers said in his normal mouse like way, I guess the towel hangar idea should be scratched." More silence. Then Mr. MOR (Middle of the Road) spoke up and said. "There's more." I nodded to him and he said, "What color would it be?" This caused everyone to turn to everyone else when Mr. C (conservative) spoke up and said, "Why-- Black of course!" This caused Mr. L (liberal) to jump up and say," Don't you know anything? Don't you know about the famous Lawn Jockey? I asked in a very tired voice, "What about the Lawn Jockey and what the hell is it?" Turned out to be a very common lawn ornament that was originally black faced and then when racial animosity centered on it, owners were painting the face white. Some blacks said that it was a legend about one Jocko Graves, an African American who served with General George Washington when he crossed the Delaware and held his horses and a lantern so they could find their way back. He froze to death and Washington was so moved he had a statue cast of him holding his lantern, and had it installed at his Mount Vernon estate. After this discourse where even the black community was divided on this simple lawn ornament our normally orderly board room was pandemonium with Mr. C, Mr. L, and Mr. C standing, red faced, apoplectic, and screaming at one another at the top of their lungs. After letting this go on for some five minutes I slammed the water pitcher down on the desk so hard that it fragmented all over the room. Every one stopped. I said, " It is obvious that we are like the US legislators" We let greed and politics in the door and it is destroying us! We can't make up our minds and we are fiercely divided and worse- much worse- confused for the first time ever!" "We have gotten away from our mission and this will never, ever, happen here, to this company, again. This meeting is over."
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