CHILDREN'S HOSPITAL SETTLES FALSE CLAIMS ACT ALLEGATIONS; WILL PAY $12.9 MILLION

FROM:  U.S. JUSTICE DEPARTMENT
Monday, June 15, 2015

Children's Hospital to Pay $12.9 Million to Settle False Claims Act Allegations
Children’s Hospital, Children’s National Medical Center Inc. and its affiliated entities (collectively CNMC) have agreed to pay $12.9 million to resolve allegations that they violated the False Claims Act by submitting false cost reports and other applications to the components and contractors of the Department of Health and Human Services (HHS), as well as to Virginia and District of Columbia Medicaid programs, the Department of Justice announced today.  CNMC is based in Washington, D.C., and provides pediatric care throughout the metropolitan region.

“The false reporting alleged in today’s settlement deprived the Medicare Trust Fund of millions of taxpayers’ dollars,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “Such conduct wastes critical federal health care program funds and drives up the costs of health care for all of us.”

“The integrity of federal health care programs depends on honest and accurate reporting from the hospitals and other health care providers that receive hundreds of billions of tax dollars every year,” said Acting U.S. Attorney Vincent H. Cohen Jr. of the District of Columbia.  “This settlement demonstrates our commitment to defending the integrity of the system and ensuring that taxpayer money goes to meet the most critical health care needs.  We will continue to work with whistleblowers like the former employee who came forward in this case to battle waste, fraud and abuse that fuel the skyrocketing cost of health care.”

According to the settlement agreement, CNMC misstated information on cost reports and applications in two distinct manners to HHS.  This false information was used by HHS and Medicaid programs to calculate reimbursement rates to CNMC.  The United States contended that CNMC misreported its available bed count on its application to HHS’ Health Resources and Services Administration under the Children’s Hospitals Graduate Medical Education (CHGME) Payment Program.  The CHGME Payment Program provides federal funds to freestanding children’s hospitals to help them maintain their graduate medical education programs that train pediatric and other residents.  The United States further contended that CNMC filed cost reports misstating their overhead costs, resulting in overpayment from Medicare and the Virginia and District of Columbia Medicaid programs.

The settlement resolves allegations brought in a lawsuit filed under the qui tam or whistleblower provisions of the False Claims Act by James A. Roark Sr., a former employee of CNMC.  Under the act, a private citizen can sue on behalf of the United States and share in any recovery.  The United States is entitled to intervene in the lawsuit, as it did here.  As part of the resolution, Mr. Roark will receive $1,890,649.98.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $24.3 billion through False Claims Act cases, with more than $15.3 billion of that amount recovered in cases involving fraud against federal health care programs.

This matter was handled by the U.S. Attorney’s Office of the District of Columbia with assistance from the Civil Division’s Commercial Litigation Branch and the HHS’ Office of Inspector General.

DOJ, HHS, ANNOUNCE OVER $27.8 BILLION RECOVERED COMBATING HEALTH CARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT
Thursday, March 19, 2015
Departments of Justice and Health and Human Services Announce Over $27.8 Billion in Returns from Joint Efforts to Combat Health Care Fraud
Administration Recovers $7.70 for Every Dollar Spent on Health Care-Related Fraud and Abuse

More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced today.  The government’s health care fraud prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars in Fiscal Year (FY) 2014 from individuals and companies who attempted to defraud federal health programs, including programs serving seniors, persons with disabilities or those with low incomes.  For every dollar spent on health care-related fraud and abuse investigations in the last three years, the administration recovered $7.70.  This is about $2 higher than the average return on investment in the HCFAC program since it was created in 1997.  It is also the third highest return on investment in the life of the program.

“As the innovative and collaborative work of the Health Care Fraud and Abuse Control Program proceeds, more taxpayer money is being recovered, more criminals are facing justice, and more fraud is being punished, prevented and deterred,” said Attorney General Eric Holder.  “The extraordinary return on investment we've obtained speaks to the skill, the tenacity, and the inspiring success of the hardworking men and women fighting on behalf of the American people.  And with these outstanding results, we are sending the unmistakable message that we will not waver in our mission to pursue fraud, to protect vulnerable communities, and to preserve the public trust.”

“Eliminating fraud, waste and abuse is a top priority for the Department of Health and Human Services,” said HHS Secretary Sylvia Burwell.  “These impressive recoveries for the American taxpayer demonstrate our continued commitment to this goal and highlight our efforts to prosecute the most egregious instances of health care fraud and prevent future fraud and abuse.  New enrollment screening techniques and computer analytics are preventing fraud before money ever goes out the door.  And together with the continued support of Congress and our partners at the Department of Justice, we’ve cracked down on tens of thousands health care providers suspected of Medicare fraud – all of which are helping to extend the life of the Medicare Trust Fund.”

The recoveries announced today reflect a two-pronged strategy to combat fraud and abuse.  Under new authorities granted by the Affordable Care Act, the administration continues to implement programs that move away from “pay and chase” to preventing health care fraud and abuse in the first place.  In addition, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), run jointly by the HHS Office of the Inspector General and the Justice Department, is changing how the federal government fights certain types of health care fraud.  These cases are being investigated through "real-time" data analysis in lieu of a prolonged subpoena and account analyses, resulting in significantly shorter periods of time between fraud identification, arrest and prosecution.

Increased funding from the administration and Congress has allowed HHS and the Justice Department to build on early successes of the Medicare Strike Force by expanding into nine geographic territories – Miami, Los Angeles, Detroit, Houston, Brooklyn, New York, Southern Louisiana, Tampa, Florida, Chicago and Dallas.  Since its inception, Strike Force prosecutors filed more than 963 cases charging more than 2,097 defendants who collectively billed the Medicare program more than $6.5 billion; 1,443 defendants pleaded guilty and 191 others were convicted in jury trials; and 1,197 defendants were sentenced to imprisonment for an average term of approximately 47 months.  Through the Strike Force and other efforts, in FY 2014 alone, the Justice Department opened 924 new criminal health care fraud investigations.  Federal prosecutors filed criminal charges in 496 cases involving 805 defendants.  A total of 734 defendants were convicted of health care fraud‑related crimes during the year.

Another powerful tool in the effort to combat health care fraud is the federal False Claims Act.  In 2014, the Justice Department’s Civil Division and the U.S. Attorneys’ Offices obtained $2.3 billion in settlements and judgments from civil cases involving fraud and false claims against federal health care programs such as Medicare and Medicaid.  Since January 2009, the Justice Department has recovered more than $15.2 billion in cases involving health care fraud.  These amounts reflect federal losses only.  In many of these cases, the department was instrumental in recovering additional billions of dollars for state health care programs.  In FY 2014, the department continued its enforcement of the civil False Claims Act and the Federal Food, Drug and Cosmetic Act, and opened 782 new civil health care fraud investigations.

The Centers for Medicare & Medicaid Services (CMS) is also adopting a number of preventive measures to combat fraud and abuse.  Provider enrollment is the gateway to billing the Medicare program, and CMS has put critical safeguards in place to make sure that only legitimate providers are enrolling in the program.  The Affordable Care Act required a CMS revalidation of all existing 1.5 million Medicare suppliers and providers under new screening requirements.  CMS will have requested revalidations by March 2015.  As a result of this and other proactive initiatives, CMS has deactivated 450,000 enrollments and revoked nearly 27,000 enrollments to prevent certain providers from re-enrolling and billing the Medicare program.  Both of these actions immediately stop billing.  A provider with deactivated billing privileges can reactivate at any time, and a revoked provider is barred from re-entry into Medicare for a period ranging from one to three years.  CMS has also issued a regulation requiring prescribers of Part D drugs to enroll in Medicare and undergo screening.

CMS also continued the fiscal 2014 temporary moratoria on the enrollment of new home health or ambulance service providers in six fraud hot spots: Miami, Chicago, Dallas, Houston, Detroit and Philadelphia (which includes some counties in New Jersey).  This extension will allow CMS to continue its actions to suspend payments or remove providers from the program before allowing new providers into potentially over-supplied markets.

Similar to the technology used by credit card companies, CMS is using its Fraud Prevention System to apply advanced analytics to all Medicare fee-for-service claims on a streaming, national basis.  The Fraud Prevention System identifies aberrant and suspicious billing patterns which in turn trigger actions that can be implemented swiftly to prevent payment of fraudulent claims.  In the second year, the system saved $210.7 million, almost double the amount identified during the first year of the program.

$840 MILLION INITIATIVE ANNOUNCED BY HHS SECRETARY BURWELL

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

FOR IMMEDIATE RELEASE

October 23, 2014

HHS Secretary announces $840 million initiative to improve patient care and lower costs

New initiative will support networks that help doctors access information and improve health outcomes

Health and Human Services Secretary Sylvia M. Burwell today announced an initiative that will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated health care systems. These applicants could include group practices, health care systems, medical provider associations and others. This effort will help clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs. Strategies could include:
Giving doctors better access to patient information, such as information on prescription drug use to help patients take their medications properly;
Expanding the number of ways patients are able communicate with the team of clinicians taking care of them;
Improving the coordination of patient care by primary care providers, specialists, and the broader medical community; and
Using electronic health records on a daily basis to examine data on quality and efficiency.

“The administration is partnering with clinicians to find better ways to deliver care, pay providers and distribute information to improve the quality of care we receive and spend our nation’s dollars more wisely,” said Secretary Burwell.  “We all have a stake in achieving these goals and delivering for patients, providers and taxpayers alike.”

Through the Transforming Clinical Practice Initiative, HHS will invest $840 million over the next four years to support 150,000 clinicians. With a combination of incentives, tools, and information, the initiative will encourage doctors to team with their peers and others to move from volume-driven systems to value-based, patient-centered, and coordinated health care services. Successful applicants will demonstrate the ability to achieve progress toward measurable goals, such as improving clinical outcomes, reducing unnecessary testing, achieving cost savings and avoiding unnecessary hospitalizations.

The initiative is one part of a strategy advanced by the Affordable Care Act to strengthen the quality of patient care and spend health care dollars more wisely. For example, the Affordable Care Act has helped reduce hospital readmissions in Medicare by nearly 10 percent between 2007 and 2013 – translating into 150,000 fewer readmissions – and quality improvements have resulted in saving 15,000 lives and $4 billion in health spending during 2011 and 2012.

Building upon successful models and programs, such as the Quality Improvement Organization Program, Partnership for Patients with Hospital Engagement Networks, and Accountable Care Organizations, the initiative provides opportunities for participating clinicians to collaborate and disseminate information. Through a multi-pronged approach to technical assistance, it will identify existing health care delivery models that work and rapidly spread these models to other health care providers and clinicians.

“This model will support and build partnerships with doctors and other clinicians across the country to provide better care to their patients. Clinicians want to spend time with their patients, coordinate care, and improve patient outcomes, and the Centers for Medicare & Medicaid Services wants to be a collaborative partner helping clinicians achieve those goals and spread best practices across the nation,” said Patrick Conway, M.D., deputy administrator for innovation and quality and CMS chief medical officer.

Practice Transformation Networks. CMS will award cooperative agreements to group practices, health care systems, and others that join together to serve as trusted partners in providing clinician practices with quality improvement expertise, best practices, coaching and assistance. These practices have successfully achieved measurable improvements in care by implementing electronic health records, coordinating among patients and their families, and performing timely monitoring and interventions of high-risk patients to prevent unnecessary hospitalization and readmissions. Practice Transformation Networks will work with a diverse range of practices, including those in rural communities and those that provide care for the medically underserved.

Support and Alignment Networks. CMS will award cooperative agreements to networks formed by medical professional associations and others who would align their memberships, communication channels, continuing medical education credits and other work to support the Practice Transformation Networks and clinician practices. These Support and Alignment Networks would create an infrastructure to help identify evidence-based practices and policies and disseminate them nationwide, in a scalable, sustainable approach to improved care delivery.

By participating in the initiative, practices will be able to receive the technical assistance and peer-level support they need to deliver care in a patient-centric and efficient manner, which is increasingly being demanded by health care payers and purchasers as part of a transformed care delivery system. Participating clinicians will thus be better positioned for success in the health care market of the future - one that rewards value and outcomes rather than volume.

HHS RELEASES INFORMATION ON EBOLA FACTS

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

This week, the Centers for Disease Control and Prevention (CDC) announced the first confirmed case of Ebola diagnosed in the United States in a person who traveled from West Africa.

There’s all the difference in the world between the U.S. and parts of Africa where Ebola is spreading. The United States is prepared, and has a strong health care system and public health professionals who will make sure this case does not threaten our communities. As CDC Director Dr. Frieden has said, "I have no doubt that we will control this case of Ebola, so that it does not spread widely in this country."

Although Ebola is a highly destructive disease, it is not a highly contagious disease.

Here are the facts you should know about Ebola:
What is Ebola? Ebola virus is the cause of a viral hemorrhagic fever disease. Symptoms include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, and abnormal bleeding. Symptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8-10 days is most common.

How is Ebola transmitted? Ebola is transmitted through direct contact with the blood or bodily fluids of an infected symptomatic person or though exposure to objects (such as needles) that have been contaminated with infected secretions.

Can Ebola be transmitted through the air? No. Ebola is not a respiratory disease like the flu, so it is not transmitted through the air.

Can I get Ebola from contaminated food or water? No. Ebola is not transmitted through food in the United States. It is not transmitted through water.

Can I get Ebola from a person who is infected but doesn’t have any symptoms? No. Individuals who are not symptomatic are not contagious. In order for the virus to be transmitted, an individual would have to have direct contact with an individual who is experiencing symptoms or has died of the disease.

HHS SAYS $212 MILLION WILL BE GOING TO PREVENT CHRONIC DISEASES

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

September 25, 2014

HHS announces nearly $212 million in grants to prevent chronic diseases
Funded in part by the Affordable Care Act, grants focus on preventing tobacco use, obesity, diabetes, heart disease, and stroke

Health and Human Services Secretary Sylvia M. Burwell today announced nearly $212 million in grant awards to all 50 states and the District of Columbia to support programs aimed at preventing chronic diseases such as heart disease, stroke and diabetes.  Funded in part by the Affordable Care Act, the awards will strengthen state and local programs aimed at fighting these chronic diseases, which are the leading causes of death and disability in the United States, and help lower our nation’s health care costs.

A total of 193 awards are being made  to states, large and small cities and counties, tribes and tribal organizations, and national and community organizations, with a special focus on populations hardest hit by chronic diseases. The Centers for Disease Control and Prevention will administer the grants.

“These grants will empower our partners to provide the tools that Americans need to help prevent chronic diseases like heart disease, stroke, and diabetes,” said Secretary Burwell. “Today’s news is important progress in our work to transition from a health care system focused on treating the sick to one that also helps keep people well throughout their lives.”

The goals of the grant funding are to reduce rates of death and disability due to tobacco use, reduce obesity prevalence, and reduce rates of death and disability due to diabetes, heart disease, and stroke.

“Tobacco use, high blood pressure, and obesity are leading preventable causes of death in the United States,” said CDC Director Tom Frieden, M.D., M.P.H. “These grants will enable state and local health departments, national and community organizations, and other partners from all sectors of society to help us prevent heart disease, cancer, stroke, and other leading chronic diseases, and help Americans to live longer, healthier, and more productive lives.”

This is one of many ways the Affordable Care Act is improving access to preventive care, and coverage for people with pre-existing conditions. Under the Affordable Care Act, 76 million Americans in private health insurance have gained access to preventive care services without cost-sharing and issuers can no longer deny coverage to anyone because of a pre-existing condition.

Chronic diseases are responsible for 7 of 10 deaths among Americans each year, and they account for more than 80 percent of the $2.7 trillion our nation spends annually on medical care.

HHS ANNOUNCES 77 NEW HEALTH INSURERS WILL ENTER MARKETPLACE IN 2015

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

New Report: Health Insurance Marketplace will have 25 percent more issuers in 2015

77 new health insurance issuers means greater choice and competition for consumers

A report released by the Department of Health and Human Services shows that consumers will have more choices as they shop for quality, affordable coverage on the Health Insurance Marketplace in 2015, because there will be a net 25 percent increase in the number of issuers offering Marketplace coverage in 2015.  In total, 77 new issuers will offer Marketplace coverage.

“When consumers have more choices, we all benefit,” said Secretary Sylvia M. Burwell.  “In terms of affordability, access, and quality, today’s news is very encouraging.  It’s a real sign that the Affordable Care Act is working.”

Today’s report examines preliminary data from 36 states run or fully supported by the federal government (Federal Marketplace) plus eight states operating State-based Marketplaces, and finds that a larger set of insurance issuers will offer plans in the Marketplaces in 2015.  Specifically:

In the 44 states for which we have data, 77 issuers will be newly offering coverage in 2015.

The Federal Marketplace states alone will have 57 more issuers in 2015; a 30 percent net increase over this year.

The eight State-based Marketplaces where data is already available will have a total of six more issuers in 2015, a ten percent net increase over this year.
Four of the 36 states in the Federal Marketplace will have at least double the number of issuers they had in 2014.

In total, 36 states of the 44 will have at least one new issuer next year.   And some of the nation’s largest insurance companies will be offering coverage in more than a dozen new states, joining the hundreds of insurance companies already participating in the Marketplace.
The report’s findings are preliminary.

Today’s report demonstrates that the Marketplace is working to increase competition and lower costs for consumers.  Previous estimates have found a correlation between greater competition and lower costs.  Specifically, an increase of one issuer in a rating area is associated with a 4 percent decline in the second-lowest cost silver plan premium, on average.  In 2014, consumers in regions with larger numbers of issuers were able to access a wider range of choices.

$99 MILLION IN GRANTS ANNOUNCED TO IMPROVE MENTAL HEALTH SERVICES FOR YOUNG PEOPLE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVIES 

September 22, 2014

Contact: SAMHSA Press Office

240-276-2130

HHS announces $99 million in new grants to improve mental health services for young people

Health and Human Services Secretary Sylvia M. Burwell announced today $99 million to train new mental health providers, help teachers and others recognize mental health issues in youth and connect them to help, and increase access to mental health services for young people. These funds were included in the President and Vice President’s Now Is the Time plan to reduce gun violence by keeping guns out of dangerous hands, increasing access to mental health services, and making schools safer.

“The Administration is committed to increasing access to mental health services to protect the health of children and communities,” said Secretary Burwell. “Today, I am pleased to announce another step the Department is taking to help ensure that our young people have access to the mental health services they need to reach their full potential.”

The Obama Administration has taken a number of steps to reduce the barriers that too often prevent people from getting the help they need for mental health and other behavioral health problems. The historic expansion of insurance coverage for mental health and substance abuse services made possible by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act will help make mental health services more affordable and accessible for tens of millions of Americans.

Today, the Department of Health and Human Services is announcing the following awards:

More than $34 million to train just over 4000 new mental health providers, including:

$30.3 million to expand the mental health workforce through 100 new grants to training programs to train new mental health and substance abuse health professionals who treat children, adolescents, and young adults with, or at risk for, a mental health or substance use disorder.

$2.7 million for 5 new grants to support youth Minority Fellowship Programs to increase access to mental health services for youth and young adults in America.
$1.6 million for 2 new grants to support addiction counselor Minority Fellowship Programs to increase access to substance abuse treatment services for youth in America.

More than $48 million to support teachers, schools and communities in recognizing and responding to mental health issues among youth, creating safe and secure schools and promoting the mental health of students in communities across the country through 120 new Project AWARE (Advancing Wellness and Resilience in Education) grants to state and local educational agencies.

$16.7 million to support 17 new Healthy Transitions grants, to improve access to treatment and support services for youth and young adults ages 16 to 25 that either have, or are at high risk of developing, a serious mental health condition.
To see the lists of award winners, visit

www.hrsa.gov/about/news/2014tables/behavioralworkforce/

http://beta.samhsa.gov/sites/default/files/fy14-grant-awards-nitt.pdf

HHS SPONSORS DEVELOPMENT OF NEXT-GEN PORTABLE VENTILATOR FOR PUBLIC HEALTH EMERGENCIES

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

September 17, 2014

HHS spurs innovation to develop next-generation portable ventilator
Low-cost, user-friendly ventilators needed for pandemics, routine care
The U.S. Department of Health and Human Services will sponsor the advanced development of a next-generation portable ventilator to help fill the need for portable, low-cost, user-friendly and flexible ventilators in a pandemic or other public health emergency. The new ventilator will be developed under a three year, $13.8 million contract with Philips Respironics of Murrysville, Pennsylvania.

The project will be overseen by the Biomedical Advanced Research and Development Authority (BARDA) within the HHS Office of the Assistant Secretary for Preparedness and Response.

“In pandemics and other emergencies, doctors must have medicines, vaccines, diagnostics, and critical equipment such as mechanical ventilators at the ready in order to save lives,” said BARDA Director Robin Robinson, Ph.D.
In a severe influenza pandemic and potentially in other public health emergencies, a large number of severely ill patients would require mechanical ventilation. This number could overwhelm the capacity of the health care system to provide such care, both in the number of ventilators available and staff trained to operate them.

“An affordable portable ventilator will help us meet the needs of critically ill patients during a public health emergency, whether due to a naturally occurring pandemic or an act of bioterrorism.”

– BARDA Director Robin Robinson, Ph.D.

The innovative ventilator in development will leverage advanced technology to reduce the size and cost and will be designed in a way that doctors, nurses and other health professionals can operate without special training. The next-generation ventilator also will be designed to be manufactured quickly to meet a surge in the number of patients who need ventilators if more ventilators are needed than could be stockpiled.

Under today’s contract, the ventilator will be required to meet the needs of everyone from infants to the elderly. To make the new ventilator suitable for stockpiling, the portable equipment must be low-cost. Ventilators with all the required features currently cost from $6,000 to $30,000 per unit.

Under today’s agreement, Philips Healthcare will develop a next-generation ventilator that could be stockpiled by the federal government, including accessories for children and elderly patients. The contract includes an option to purchase 10,000 completely kitted, initial production ventilators for $32.8 million.

In addition to aiding in response to a public health emergency, the next-generation ventilator in development can have important implications for routine care. The modernized features, agility, and ease of use can improve patient care for triage in the field or advanced treatment in the hospital.

HHS is the principal federal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

The Office of the Assistant Secretary for Preparedness and Response (ASPR) leads HHS in preparing the nation to respond to and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security.

Within ASPR, the Biomedical Advanced Research and Development Authority (BARDA) develops and procures medical countermeasures – vaccines, medicines, diagnostics and medical equipment – that address the public health and medical consequences of chemical, biological, radiological, and nuclear (CBRN) accidents, incidents and attacks, pandemic influenza, and emerging infectious diseases.

HHS PREPARING TO DEPLOY HEALTH PROFESSIONALS TO COMBAT EBOLA IN WEST AFRICA

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

FOR IMMEDIATE RELEASE

September 16, 2014

U.S. Public Health Service Commissioned Corps to help treat Ebola patients in Liberia

A team of specialized officers from the U.S. Public Health Service Commissioned Corps is being prepared to deploy to manage and staff a previously announced U.S. Department of Defense hospital in Liberia to care for health care workers who become ill from Ebola.

The U.S. Public Health Service Commissioned Corps is part of the U.S. Department of Health and Human Services. The Commissioned Corps is an elite uniformed service with more than 6,800 full-time, highly qualified public health professionals, serving the most underserved and vulnerable populations domestically and abroad.

Sixty-five Commissioned Corps officers, with diverse clinical and public health backgrounds, will travel to Liberia to provide direct patient care to health care workers. In addition to their professional expertise, these officers will undergo further intensive training in Ebola response and advanced infection control.

“The Commissioned Corps are trained and ready to respond to public health crises and humanitarian missions,” said Acting Surgeon General Rear Admiral Boris Lushniak, M.D., M.P.H, who provides operational command of the Commissioned Corps. “The dedicated officers have the skills to make a significant impact in one of the international community’s most devastating public health emergencies.”

HHS is working with the Obama administration, the Department of Defense, the U.S. Agency for International Development, the World Health Organization and other domestic and international partners to more rapidly address the expanding West African Ebola outbreak.

The additional officers will join other Commissioned Corps officers deployed in West Africa with the Centers for Disease Control and Prevention. Members of the service have been co-leading disaster response teams and supporting outbreak investigation and control activities of the CDC.

With an approximately 50 percent death rate in the outbreak, there is concern about the stress on the health care workforce and health care system, including the loss of health care workers caring for the sick. There is an increasing need for extra resources, and the Commissioned Corps is playing a critical role in the response to that need.

The added Commissioned Corps officers will treat ill health care workers and continue efforts to build capacity for additional care.

The Commissioned Corps is one of the seven uniformed services and is the only service solely committed to protecting, promoting and advancing the health and safety of the nation.  Members often served on the front lines in public health emergency and crisis situations, including 9/11, the 2010 Haiti earthquake, Superstorm Sandy and the tragic shooting in Newtown, Connecticut.

HHS ANNOUNCES $60 MILLION IN NAVIGATOR GRANT AWARDS TO HELP CONSUMERS EXAMINE HEALTH CARE OPTIONS

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

HHS announces $60 million to help consumers navigate their health care coverage options in the Health Insurance Marketplace

The Affordable Care Act is working for millions of Americans who are able to access quality health coverage at a price they can afford, in large part because of the efforts of in-person assisters in local communities across the nation.  People shopping for and enrolling in coverage through the Health Insurance Marketplace can get local help in a number of ways, including through Navigators.

Health and Human Services Secretary Sylvia M. Burwell today announced $60 million in Navigator grant awards to 90 organizations in states with federally-facilitated and state partnership Marketplaces.  These awards support preparation and outreach activities in year two of Marketplace enrollment and build on lessons learned from last year.

“In-person assisters have an impact on the lives of so many Americans, helping individuals and families across the country access quality, affordable health coverage,” said Secretary Burwell.  “We are committed to helping Americans get covered and stay covered with in-person assistance in their own communities.”

According to a recent outside survey, a variety of assisters, including Navigators, in both state-based and federally-facilitated Marketplaces were responsible for helping an estimated 10.6 million consumers apply for coverage in Marketplace plans, Medicaid, or the Children’s Health Insurance Program (CHIP) during the first Open Enrollment period.  Assisters tend to help those consumers in communities with the most challenging or complicated enrollments, and according to another poll, Latinos in particular valued the assistance of in-person help.  Navigators provide unbiased information to consumers about the Marketplace and other public programs in a way that recognizes the cultures of the communities they serve. Navigators were selected to receive these awards through a competitive grant process based on their ties with the communities they will be serving and other standards such as effectiveness and program integrity.

In addition to helping eligible individuals and their families enroll in coverage, Navigators help consumers compare their health coverage options including helping them determine whether they are eligible for public programs such as Medicaid and CHIP and guide consumers- many of whom have never had insurance before- on accessing and using their new coverage, among other important functions.

These awards build on lessons learned from the first year of Marketplace operations.

Navigator grantees must maintain a physical presence in the Marketplace service-area, so that consumers can easily access face-to-face assistance.
Navigator grantees are required to be trained on and comply with strict security and privacy standards to ensure that consumers’ personally identifiable information (PII) is protected, as was the case last year. In no case will Navigators obtain a consumer’s PII without the consumer’s consent.
In addition to quarterly and annual reporting, Navigators will also be required to submit to HHS weekly progress reports detailing their progress and activities in the communities they serve.
Based on feedback from the assister community, HHS is incorporating new elements into this year’s required training, such as a course on advanced Marketplace issues with detailed information on topics such as how to help college-age students enroll in coverage and re-enrollment.  HHS is committed to providing Navigators with on-going technical assistance and training opportunities throughout the year.
In addition to Navigators, Marketplaces make other resources available to consumers to help them access Marketplace coverage, such as certified application counselors, non-navigator assistance personnel (also known as in-person assisters), and agents and brokers. Consumers in federally-facilitated and state partnership Marketplaces can visit Find Local Help to find assistance in their area.

MILLIONS OF U.S. CHILDREN NOT RECEIVING PREVENTIVE CARE SERVICES

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Millions of children not getting recommended preventive care

Millions of infants, children and adolescents in the United States did not receive key clinical preventive services, according to a report published by the Centers for Disease Control and Prevention (CDC) in today’s Morbidity and Mortality Weekly Report (MMWR) Supplement.

Clinical preventive services are various forms of important medical or dental care that support healthy development. They are delivered by doctors, dentists, nurses and allied health providers in clinical settings. These services prevent and detect conditions and diseases in their earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and expensive medical care.
The CDC report focuses on 11 clinical preventive services: prenatal breastfeeding counseling, newborn hearing  screening and follow-up, developmental screening, lead screening, vision screening, hypertension screening, use of dental care and preventive dental services, human papillomavirus vaccination, tobacco use screening and cessation assistance, chlamydia screening and reproductive health services.

The findings offer a baseline assessment of the use of selected services prior to 2012, before or shortly after implementation of the Affordable Care Act. Sample findings include:

In 2007, parents of almost eight in 10 (79 percent) children aged 10-47 months reported that they were not asked by healthcare providers to complete a formal screen for developmental delays in the past year.

In 2009, more than half (56 percent) of children and adolescents did not visit the dentist in the past year and nearly nine of 10 (86 percent) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.
Nearly half (47 percent) of females aged 13-17 years had not received their recommended first dose of HPV vaccine in 2011.

Approximately one in three (31 percent) outpatient clinic visits made by 11-21 year-olds during 2004–2010 had no documentation of tobacco use status; eight of 10 (80 percent) of those who screened positive for tobacco use did not receive any cessation assistance.

Approximately one in four (24 percent) outpatient clinic visits for preventive care made by 3-17 year olds during 2009-2010 had no documentation of blood pressure measurement.

“We must protect the health of all children and ensure that they receive recommended screenings and services. Together, parents and the public health and healthcare communities can work to ensure that children have health insurance and receive vital preventive services,” said Stuart K. Shapira, M.D., Ph.D., chief medical officer and associate director for science in CDC’s National Center on Birth Defects and Developmental Disabilities. Increased use of clinical preventive services could improve the health of infants, children and teens and promote healthy lifestyles that will enable them to achieve their full potential.”
The report reveals large disparities in the receipt of clinical preventive services. For example, uninsured children are not as likely as insured children to receive these services and Hispanic children were less likely than non-Hispanic children to have reported vision screening.

The Affordable Care Act expands insurance coverage, access and consumer protections for the U.S. population and places a greater emphasis on prevention. Through implementation of the Affordable Care Act, new opportunities exist to promote and increase use of these valuable and vital services. This report is the second of a series of periodic reports from CDC to monitor and report on progress made in increasing the use of clinical preventive services to improve population health.

“The Affordable Care Act requires new health insurance plans to provide certain clinical preventive services at no additional cost – with no copays or deductibles," said Lorraine Yeung, M.D., M.P.H., medical epidemiologist with CDC’s National Center on Birth Defects and Developmental Disabilities. “Parents need to know that many clinical preventive services for their children, such as screening and vaccination, are available for free with many health plans.”
CDC has a long history of monitoring the use of clinical preventive services to provide public health agencies, health care providers, healthcare organizations and their partners with information needed to plan and implement programs that increase use of these services and improve the health of the U.S. population. CDC documents the potential benefits of selected clinical preventive services for infants, children and adolescents; the challenges related to their underuse; and effective collaborative strategies to improve use.

CDC is the nation's health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic. CDC increases the health security of our nation.

HHS TOUTS 10.3 MILLION NEWLY COVERED WITH HEALTH CARE

FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICES 

New Study: 10.3 million gained health coverage during the Marketplace’s first annual open enrollment period

Health and Human Services Secretary Sylvia M. Burwell announced today the release of a new study, published in the New England Journal of Medicine, estimating that 10.3 million uninsured adults gained health care coverage following the first open enrollment period in the Health Insurance Marketplace. The report examines trends in insurance before and after the open enrollment period and finds greater gains among those states that expanded their Medicaid programs under the Affordable Care Act.

“We are committed to providing every American with access to quality, affordable health services and this study reaffirms that the Affordable Care Act has set us on a path toward achieving that goal,” said Secretary Burwell. “This study also reaffirms that expanding Medicaid under the Affordable Care Act is important for coverage, as well as a good deal for states. To date, 26 states plus D.C. have moved forward with Medicaid expansion. We’re hopeful remaining states will come on board and we look forward to working closely with them.”

According to the authors’ findings, the uninsured rate for adults ages 18 to 64 fell from 21 percent in September 2013 to 16.3 percent in April 2014. After taking into account economic factors and pre-existing trends, this corresponded to a 5.2 percentage-point change, or 10.3 million adults gaining coverage. The decline in the uninsured was significant for all age, race/ethnicity, and gender groups, with the largest changes occurring among Latinos, blacks, and adults ages 18-34 – groups the Administration targeted for outreach during open enrollment.

Coverage gains were concentrated among low-income adults in states expanding Medicaid and among individuals in the income range eligible for Marketplace subsidies. The study finds a 5.1 percentage point reduction in the uninsured rate associated with Medicaid expansion, while in states that have not expanded their Medicaid programs, the change in the uninsured rate among low-income adult populations was not statistically significant.

Today’s study also looks at access to care, and finds that within the first six months of gaining coverage, more adults (approximately 4.4 million) reported having a personal doctor and fewer (approximately 5.3 million) experienced difficulties paying for medical care.

Today’s study does not include data from before 2012, as coverage was changing rapidly during this period. This means the results do not include the more than 3 million young adults who gained health insurance coverage through their parents’ plans.

The analysis builds on previous studies by reviewing a larger sample size and taking into account changes in the economy and pre-existing trends in insurance coverage. Using survey data from the Gallup-Healthways Well-Being Index for January 1, 2012, through June 30, 2014, the authors analyzed changes in the uninsured rate over time. This is also the first study to associate reductions in the uninsured rate with state-level statistics on enrollment in the Marketplaces and Medicaid under the Affordable Care Act, as described in HHS enrollment reports, and to assess the impact of the improved coverage on access to care.

WHITE HOUSE FACT SHEET ON PROGRESS OF HIV/AIDS STRAGEGY

FROM:  THE WHITE HOUSE 

FACT SHEET: Progress in Four Years of the National HIV/AIDS Strategy

On July 15, 2010, President Obama released the first comprehensive National HIV/AIDS Strategy, which envisions that “the United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

The goals of the Strategy are to reduce new HIV infections; increase access to care and improve health outcomes for people living with HIV; and reduce HIV-related disparities and health inequities.  Achieving these goals requires partnerships and coordination among Federal agencies, state and local governments, community-based organizations, and health care settings.

To further the implementation of the Strategy, last year, President Obama signed an Executive Order establishing the HIV Care Continuum Initiative, which outlines the pathway to accelerate and optimize health outcomes for those living with HIV.  This update outlines just some of the major accomplishments and progress made over the last four years towards achieving the Strategy’s goals and highlights new action steps taken today. 

New actions to support the National HIV/AIDS Strategy: 

• Today, to support the goals of the Strategy, the Department of Health and Human Services (HHS) announced the availability of $11 million in funding to enhance Community Health Centers’ HIV efforts in communities highly impacted by HIV, especially among racial and ethnic minorities.  This initiative, funded through the Affordable Care Act and the Secretary’s Minority AIDS Initiative Fund, aims to build sustainable partnerships between public health and health centers to help achieve the goals of the Strategy.
• Additionally today, the Department of Justice (DOJ) released a Best Practices Guide to Reform HIV-specific Criminal Laws to Align with Scientifically Supported Factors. As noted in the National HIV/AIDS Strategy, many states have criminal laws that have not keep pace with our current understanding of best public health practices for preventing and treating HIV and that, instead, may make people less willing to get tested, disclose their status, and undermine the public health goals of promoting HIV screening and treatment. This guide is intended to share best practices for aligning criminal law with the public health goal of reducing HIV-related stigma.

Implementing the National HIV/AIDS Strategy:

Reducing new HIV infections over the last four years: Ensuring that individuals know their HIV status is a critical step to reducing HIV infections.  People who don't know they are infected miss an opportunity to access the life-sustaining care and treatment that can now lead to normal life-expectancy. Undiagnosed individuals can also unknowingly pass the virus on to others. 

• HIV testing: Screening all persons between 15 and 65 years of age is now a grade “A” recommendation of the independent United States Preventive Services Task Force. This means that, as of April 2014, new health plans under the Affordable Care Act must offer HIV screening without cost sharing.
• The number of people who know their HIV status increased:  The overall number of people with HIV who know their HIV status increased to 84.2% in 2010, approaching the Strategy goal of 90% by 2015.  Serostatus awareness was 90% or higher among persons 45 year or older and among injection drug users. 

• Reduction in new HIV infections in some sub-populations:  Black women saw a 21% reduction in new HIV infections from 2008 to 2010.  In 2010, there was a 22% reduction in new HIV infections among injection drug users. However, there has been a 12% increase in new HIV infections among men who have sex with men (MSM) and 22% increase among young MSM aged 13 to 24. The Administration is committed to enhancing outreach to young, black, gay males.
• Reduced transmission of HIV: One of the most successful scientific advances in HIV prevention, treatment as prevention, shows that people living with HIV who have a suppressed viral load due to effective HIV treatment, reduce their HIV transmission risk by up to 96%.
• Pre-exposure prophylaxis (PrEP): In May 2014, the Centers for Disease Control and Prevention (CDC) released clinical practice guidelines on HIV risk and eligibility for PrEP use.
• Research for an effective vaccine and cure: An effective vaccine remains a critical component of any long-term strategy.  In 2014, the President announced that the National Institutes of Health (NIH) is redirecting $100 million for development of new therapies toward a cure and will continue to strive to be on the forefront of new discoveries.  

Increasing access to care and improving health outcomes over the last four years: To end the epidemic, in addition to providing prevention strategies, access to health insurance coverage and other key supports are essential. 

• Making coverage affordable: The Affordable Care Act has expanded access to affordable health insurance coverage for millions of Americans, including thousands living with HIV.  Thanks to the Affordable Care Act, people can no longer be denied coverage based on pre-existing conditions, including HIV.  The Administration will continue to focus on the Ryan White HIV/AIDS Program and Affordable Care Act coordination.

• Housing for people living with HIV: Since 2010, over 56,000 people with HIV receive housing assistance from the Housing Opportunities for Persons with AIDS (HOPWA) program annually. In keeping with the goals of the Strategy, the President’s Fiscal Year 2015 Budget proposes modernizing HOPWA’s funding formula to better reflect the current state of the epidemic.
• Increasing access to life-saving HIV treatment: Thanks to targeted investments by the Administration, waiting list for the AIDS Drug Assistance Program (ADAP) have been nearly eliminated from a high of over 9,000 in 2011.
• Commitment to ensuring access to care for people living with HIV: Together, the Affordable Care Act and the Ryan White HIV/AIDS Program are improving and expanding access to care for people living with HIV/AIDS.  Federal leaders have taken steps to ensure this collaboration, including providing guidance to Ryan White grantees to help them effectively interact with new coverage provided under the Affordable Care Act, and strengthening Ryan White data and information to improve program management.  

Reducing health disparities over the last four years: Gay and bisexual men, transgender women, and Black and Latinos continue to bear significant disproportionate burden of new HIV infections and poorer health outcomes. Black gay youth aged 13 to 24 have been identified in the National HIV/AIDS Strategy as a principal group facing HIV/AIDS-related health disparities. 

• Improving care continuum outcomes among people of color: In 2012, HHS funded a $44 million Care and Prevention in the United States (CAPUS) demonstration project to reduce HIV and AIDS-related morbidity and mortality among racial and ethnic minorities in eight cities.  This project focuses efforts on improving outcomes along the HIV care continuum.
• Addressing the concerns of the communities most affected:  In June 2014, Office of National AIDS Policy (ONAP) held listening sessions in areas most impacted by the epidemic in the southern United States (Jackson, Columbia, and Atlanta).  Additionally, ONAP convened a meeting at the White House focusing on HIV and the southern United States, and will host another meeting to address HIV and gay men, particularly young black MSM, in fall 2014. 
• Reducing stigma and discrimination: In May 2014, CDC launched the latest communication campaign under its Act Against AIDS initiative: “Start Talking. Stop HIV.” aiming to eliminate stigma and discrimination and promote open communication between gay and bisexual men about a range of HIV prevention strategies. Additionally, DOJ launched ADA.gov/AIDS, a portal for individuals to directly report cases of HIV-related discrimination.
• Integrating behavioral health for people at high risk: The Substance Abuse and Mental Health Services Administration (SAMHSA) piloted a number of the Minority AIDS Initiative Continuum of Care programs focused on integrating HIV medical care into behavioral health programs designed for racial and ethnic minority populations also at high risk for behavioral health disorders and HIV. 

Achieving a more coordinated national response over the last four years: The National HIV/AIDS Strategy recognizes that a core principle of reaching its identified quantitative targets requires Federal agencies to coordinate efforts, along with coordinating across State and local government and the private sector.

• Intersection of violence against women and girls, HIV/AIDS, and gender-related health disparities: In 2012, President Obama signed a memorandum forming a Federal working group and directing agencies to coordinate efforts on these key issues.  Federal agencies and community partners are investing time and resources to provide co-screening for HIV and intimate partner violence as well as learn more about the benefits of trauma informed care. 
• Implementing common core indicators: In 2012, HHS approved a set of seven common core indicators to monitor HHS-funded prevention, treatment, and care services in an effort to standardize data collection and grantee reporting requirements, thereby reducing burdens and increasing efficiency.
• Public-private partnerships to facilitate access to HIV treatment: In 2012, a convening of funders by HHS and the MAC AIDS Fund led to the development ofHarborPath, an online portal for health care providers to help connect uninsured individuals with HIV to access medications and/or medication assistance programs through a streamlined common application.
• Investing in future research:  NIH expanded their investment in research to address gaps and opportunities in the HIV Care Continuum, including investigations of the effectiveness of methods to identify HIV-infected people earlier and to link them to care; community-level interventions to expand HIV testing and treatment; interventions to improve HIV outcomes among substance users; and evaluation of innovative network approaches for HIV testing and referral for persons in the correctional system. 

Toward the Goals of the National HIV/AIDS Strategy:

The Administration, led by Office of National AIDS Policy and HHS Office of HIV/AIDS and Infectious Disease Policy, in partnership with other Federal agencies, state and local governments, communities and people living with HIV, have made tremendous progress in addressing HIV/AIDS in the United States over the last four years. Together, we are committed to accelerating our efforts to reach the Strategy’s goals and, eventually, attain an AIDS-free generation. Smart investments and collaborations will provide opportunities to scale up effective efforts so that every community affected by HIV can contribute to achieving the goals of the Strategy.

FOUR GUILTY PLEAS FOR PATIENT RECRUITERS ENGAGED IN HEALTHCARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Thursday, July 10, 2014

Four Patient Recruiters Plead Guilty in Miami for Roles in $20 Million Health Care Fraud Scheme

Four patient recruiters pleaded guilty in connection with a $20 million health care fraud scheme involving Trust Care Health Services Inc. (Trust Care), a defunct home health care company.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Acting Special Agent in Charge Ryan Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office made the announcement.

At a hearing today before U.S. District Judge Darrin P. Gayles of the Southern District of Florida, Estrella Perez, 57, and Solchys Perez, 34, both pleaded guilty to conspiracy to commit health care fraud, and Abigail Aguila, 40, pleaded guilty to conspiracy to defraud the United States and receive health care kickbacks.   Sentencing for all three defendants is set for Sept. 18, 2014 in front of Judge Gayles.   On June 17, 2014, another co-defendant, Monica Macias, 52, pleaded guilty to conspiracy to defraud the United States and receive health care kickbacks before U.S. Magistrate Judge Chris M. McAliley of the Southern District of Florida.  Sentencing for Macias is set for Sept. 10, 2014 before Judge Gayles.

According to court documents, the defendants worked as patient recruiters for the owners and operators of Trust Care, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.   Trust Care was operated for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

The defendants recruited patients for Trust Care and solicited and received kickbacks and bribes from the owners and operators of Trust Care in return for allowing the agency to bill the Medicare program on behalf of the recruited Medicare patients.   These Medicare beneficiaries were billed for home health care and therapy services that were not medically necessary and/or were not provided.

Estrella Perez and Solchys Perez also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for providing home health and therapy prescriptions, plans of care, and medical certifications for their recruited patients.   Co-conspirators at Trust Care then used these prescriptions, plans of care and medical certifications to fraudulently bill the Medicare program for home health care services.

From approximately March 2007 through at least January 2010, Trust Care submitted more than $20 million in claims for home health services.   Medicare paid Trust Care more than $15 million for these fraudulent claims.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.   This case is being prosecuted by Trial Attorneys A. Brendan Stewart and Anne P. McNamara of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 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.

HHS SAYS $100 MILLION AVAILABLE TO SUPPORT NEW HEALTH CENTER SITES

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HHS announces the availability of $100 million in Affordable Care Act funding to expand access to primary care through new community health centers
HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015. New health center sites will increase access to comprehensive, affordable, high quality primary health care services in the communities that need it most.  Later today, Secretary Burwell will also visit a Community Health Center in Decatur, Georgia to talk with its health care professionals about the important work they are doing to connect the community with high quality primary care.

“In communities across the country, Americans turn to their local Community Health Center for vital health care services that help them lead healthy, productive lives,” said Secretary Burwell.  “That’s why it’s so important that the Affordable Care Act is supporting the expansion of health centers.”

The investment announced today will add to the more than 550 new health center sites that have opened in the last three years as a result of the Affordable Care Act.  Today, nearly 1,300 health centers operate more than 9,200 service delivery sites that provide care to more than 21 million patients in every State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.  Health centers are also playing a critical role in helping the public learn about new coverage opportunities under the Affordable Care Act, by conducting outreach and enrollment activities that link individuals to affordable coverage options available through the Health Insurance Marketplace.

“Since last fall, health centers have provided enrollment assistance to more than 4.7 million people across the country,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. “We are pleased that the Affordable Care Act is supporting the establishment of additional health center sites to provide expanded opportunities for the newly insured to receive care.”

DOD, HHS DISCUSS HOUSING MORE UNACCOMPANIED CHILDREN ENTERING U.S.

FROM:  U.S. DEFENSE DEPARTMENT 

DoD Officials Discuss Housing More Unaccompanied Children

By Jim Garamone

DoD News, Defense Media Activity

WASHINGTON, July 8, 2014 – Defense Department officials are in discussions with Department of Health and Human Services officials to house more children who have entered the United States unaccompanied, Pentagon Press Secretary Navy Rear Adm. John Kirby said today.

During a Pentagon news conference, Kirby said the department is processing requests right now from HHS to house more children.

“I wouldn’t put an exact number on it, because that's still in discussion,” the admiral said.

Three bases already are housing these unaccompanied children – Fort Sill, Oklahoma; Lackland Air Force Base, Texas; and Naval Base Ventura, California. Currently, DoD facilities can accommodate 2,375 of these children.
The facilities being used are excess to DoD needs, Kirby said. “We’re providing access to certain facilities that were already vacant and not being used and are, therefore, available, and in the first three cases are relatively close to the border itself,” he said.

Defense Secretary Chuck Hagel supports the mission, the admiral said, and is assured that housing these young people will not impinge on troops. “He understands the importance of making sure that these children get the care that they need once they get inside the country,” Kirby said.

HHS owns this mission, and while DoD is providing the facilities, “we are not responsible for the children themselves,” the press secretary said.

The original agreement between DoD and HHS places a 120-day cap on the time the children can be housed on the bases. Lackland has housed the children for about two months, and Kirby would not speculate on whether that cap will be extended. “It’s certainly something that could be discussed,” he said.
HHS will reimburse DoD for the facilities, Kirby said.

Some 60,000 unaccompanied children could enter the United States this year, officials said. For many, transnational criminal networks play a role in getting them to the United States.

In addition, officials said, these transnational criminal networks create much of the instability that causes many of these children to flee from Central and South America. The networks smuggle humans, drugs and weapons for a price.
The threat these groups pose cannot be countered solely by the military, officials noted, adding that Marine Corps Gen. John F. Kelly, commander of U.S. Southern Command, and Homeland Security Secretary Jeh Johnson are working together on the threat.

HHS HAS NEW DATA, TOOLS TO INCREASE HOSPITAL UTILIZATION TRANSPARENCY

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

HHS releases new data and tools to increase transparency on hospital utilization and other trends

Data can help improve care coordination and health outcomes for Medicare beneficiaries

With more than 2,000 entrepreneurs, investors, data scientists, researchers, policy experts, government employees and more in attendance, the Department of Health and Human Services (HHS) is releasing new data and launching new initiatives at the annual Health Datapalooza conference in Washington, D.C.

Today, the Centers for Medicare & Medicaid Services (CMS) is releasing its first annual update to the Medicare hospital charge data, or information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. The data trove on CMS’s website now includes inpatient and outpatient hospital charge data for 2012, and new interactive dashboards for the CMS Chronic Conditions Data Warehouse and geographic variation data. Also today, the Food and Drug Administration (FDA) will launch a new open data initiative. And before the end of the conference, the Office of the National Coordinator for Health Information Technology (ONC) will announce the winners of two data challenges.

“The release of these data sets furthers the administration’s efforts to increase transparency and support data-driven decision making which is essential for health care transformation,” said HHS Secretary Kathleen Sebelius.

“These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located,” said Bryan Sivak, HHS chief technology officer. “This information can be used to improve care coordination and health outcomes for Medicare beneficiaries nationwide, and we are looking forward to seeing what the community will do with these releases. Additionally, the openFDA initiative being launched today will for the first time enable a new generation of consumer facing and research applications to embed relevant and timely data in machine-readable, API-based formats."

2012 Inpatient and Outpatient Hospital Charge Data

The data posted today on the CMS website provide the first annual update of the hospital inpatient and outpatient data released by the agency last spring. The data include information comparing the average charges for services that may be provided in connection with the 100 most common Medicare inpatient stays at over 3,000 hospitals in all 50 states and Washington, D.C. Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for those items or services.

With two years of data now available, researchers can begin to look at trends in hospital charges. For example, average charges for medical back problems increased nine percent from $23,000 to $25,000, but the total number of discharges decreased by nearly 7,000 from 2011 to 2012.

In April, ONC launched a challenge – the Code-a-Palooza challenge – calling on developers to create tools that will help patients use the Medicare data to make health care choices. Fifty-six innovators submitted proposals and 10 finalists are presenting their applications during Datapalooza. The winning products will be announced before the end of the conference.

Chronic Conditions Warehouse and Dashboard

CMS recently released new and updated information on chronic conditions among Medicare fee-for-service beneficiaries, including:

Geographic data summarized to national, state, county, and hospital referral regions levels for the years 2008-2012;

Data for examining disparities among specific Medicare populations, such as beneficiaries with disabilities, dual-eligible beneficiaries, and race/ethnic groups;
Data on prevalence, utilization of select Medicare services, and Medicare spending;

Interactive dashboards that provide customizable information about Medicare beneficiaries with chronic conditions at state, county, and hospital referral regions levels for 2012; and Chartbooks and maps.

These public data resources support the HHS Initiative on Multiple Chronic Conditions by providing researchers and policymakers a better understanding of the burden of chronic conditions among beneficiaries and the implications for our health care system.

Geographic Variation Dashboard

The Geographic Variation Dashboards present Medicare fee-for-service per-capita spending at the state and county levels in interactive formats. CMS calculated the spending figures in these dashboards using standardized dollars that remove the effects of the geographic adjustments that Medicare makes for many of its payment rates. The dashboards include total standardized per capita spending, as well as standardized per capita spending by type of service. Users can select the indicator and year they want to display. Users can also compare data for a given state or county to the national average. All of the information presented in the dashboards is also available for download from the Geographic Variation Public Use File.

Research Cohort Estimate Tool

CMS also released a new tool that will help researchers and other stakeholders estimate the number of Medicare beneficiaries with certain demographic profiles or health conditions. This tool can assist a variety of stakeholders interested in specific figures on Medicare enrollment. Researchers can also use this tool to estimate the size of their proposed research cohort and the cost of requesting CMS data to support their study.

Digital Privacy Notice Challenge

ONC, with the HHS Office of Civil Rights, will be awarding the winner of the Digital Privacy Notice Challenge during the conference. The winning products will help consumers get notices of privacy practices from their health care providers or health plans directly in their personal health records or from their providers’ patient portals.

OpenFDA

The FDA’s new initiative, openFDA, is designed to facilitate easier access to large, important public health datasets collected by the agency. OpenFDA will make FDA’s publicly available data accessible in a structured, computer readable format that will make it possible for technology specialists, such as mobile application creators, web developers, data visualization artists and researchers to quickly search, query, or pull massive amounts of information on an as needed basis. The initiative is the result of extensive research to identify FDA’s publicly available datasets that are often in demand, but traditionally difficult to use. Based on this research, openFDA is beginning with a pilot program involving millions of reports of drug adverse events and medication errors submitted to the FDA from 2004 to 2013. The pilot will later be expanded to include the FDA’s databases on product recalls and product labeling.

HHS SECRETARY ANNOUNCES DELIVERY SYSTEM REFORM FOR HEALTH CARE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

New funding gives states and innovators tools and flexibility to implement delivery system reform

Health and Human Services Secretary Kathleen Sebelius today announced new delivery system reform efforts made possible by the Affordable Care Act that offer states and innovators tools and flexibility to transform health care. 

HHS announced twelve prospective recipients receiving as much as $110 million in combined funding, ranging from an expected $2 million to $18 million over a three-year period, under the Health Innovation Awards program to test innovative models designed to deliver better care outcomes and lower costs.  Examples include projects to provide better care for dementia patients, improve coordination between specialists and primary care physicians, and to improve cardiac care. Round two of the Health Care Innovation Awards program focuses on four priority areas: rapidly reducing costs for patients with Medicare and Medicaid; improving care for populations with specialized needs; testing improved financial and clinical models for specific types of providers, including specialists; and linking clinical care delivery to preventive and population health.  The twelve prospective recipients will test models in all four categories and spanning 13 states.  Additional prospective recipients will be announced in the coming months.

Also today, HHS made up to $730 million available as part of the State Innovation Model initiative to help states design and test improvements to their public and private health care payment and delivery systems.  Project goals are to improve health, improve care, and decrease costs for consumers, including Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries.

“As a former governor, I understand the real sense of urgency states and local communities feel to improve the health of their populations while also reducing health care costs, and it’s critical that the many elements of health care in each state – including Medicaid, public health, and workforce training – work together,” Secretary Sebelius said.  “To help, HHS will continue to encourage and assist them in their efforts to transform health care.

“These efforts will strengthen federal, state, and local partnerships, encourage broad stakeholder engagement, and capitalize on federal resources to ensure greater transformation of delivery of health care services,” said Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner.

The twelve innovative projects announced today represent the first batch of prospective recipients for round two of Health Care Innovation Awards program funding.  In 2012, 107 organizations located in urban and rural areas, all 50 states, the District of Columbia and Puerto Rico received awards through round one of the initiative.  

As part of the State Innovation Model initiative, states, territories and the District of Columbia can apply for either a Model Test award to assist in implementation or a Model Design award to develop or enhance a comprehensive State Health Care Innovation Plan.   Up to 12 states will be chosen for state-sponsored Model Testing awards ($700 million available) and up to 15 states will be chosen for state-sponsored Model Design work ($30 million available).

Examples of ongoing state-led health care innovations include development of advanced primary care networks supported by statewide health information technology systems and models that coordinate care seamlessly across providers.  The second round of the State Innovation Models will continue to support and advance this good work.

U.S.-EU HAVE SUCCESS FIGHTING ANTIMICROBIAL RESISTANCE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

US and EU progress in fight against antimicrobial resistance

International collaboration critical for combating global health crisis

The U.S. Department of Health and Human Services (HHS) and the European Commission released today the first progress report of the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR).  The report renews the commitment of U.S. and European Union (EU) health authorities to pursue specific goals in their joint battle against antimicrobial resistance, a complex, dynamic and multi-faceted concern not bound by borders.  The report also summarizes the advancements made during the first TATFAR implementation period of 2011-2013.

TATFAR was created following the 2009 U.S.-EU presidential summit with the goal of improving cooperation between the U.S. and the EU in three key areas: (1) appropriate therapeutic use of antimicrobial drugs in medical and veterinary communities, (2) prevention of health care- and community-associated drug-resistant infections, and (3) strategies for improving the pipeline of new antimicrobial drugs.

“The partnership offers a unique perspective to tackle antimicrobial resistance worldwide,” said Jimmy Kolker, HHS Assistant Secretary for Global Affairs.  “We hope that the positive outcomes of this partnership will serve as a global model as we continue to work on this critical issue.”

TATFAR identified and adopted 17 recommendations for collaborations between the U.S. and the EU. Implementation of the recommendations has been carried out through increased communication, regular meetings, joint workshops, and the exchange of information, approaches, and best practices.  Moving forward, one new and 15 existing recommendations will serve as the basis for partner agencies in the U.S. and the EU to focus on areas where common actions can deliver the best results in prevention and control of antimicrobial resistance. In 2013 it was decided to renew TATFAR for another two-year term.

“Antimicrobial resistance is a priority of the European Commission, and international cooperation is key in addressing this serious cross border and global health threat.  I am positive that our renewed commitment to TATFAR can make a tangible contribution in the area of global health security,” said John F. Ryan, Acting Director for Public Health in the European Commission.

Notable outcomes of TATFAR activities during 2011-2013 include:

Adoption of procedures for timely international communication of critical events that might indicate new resistance trends with global public health implications;
Publication of a report on the 2011 workshop, “Challenges and solutions in the development of new diagnostic tests to combat antimicrobial resistance” to the TATFAR website; and Joint presentations to the scientific community to increase awareness about the available funding opportunities on both sides of the Atlantic.
Studies estimate that drug-resistant infections result in at least 25,000 deaths in 29 countries in Europe and 23,000 deaths in the U.S. every year.  In addition to the toll on human life, antimicrobial-resistant infections add considerable and avoidable costs to health care systems.  Antimicrobial resistance costs the EU and the U.S. billions every year in avoidable health care costs and productivity losses.

In the U.S. and in the EU, significant progress in reducing specific types of infections has been made.  However, the global problem of antimicrobial resistance continues to escalate. Therefore, the original mandate of the taskforce that ran through 2013 has been extended for at least two additional years.

Forthcoming publications from the taskforce during 2014 that will provide a foundation for specific joint collaborative actions include:

A report summarizing the strategies hospitals in the U.S. and EU should include as part of their programs to improve antimicrobial prescribing practices;
A joint publication summarizing the existing methods for measuring antimicrobial use in hospital settings;
A joint publication describing the need for new vaccines for healthcare-associated infections (HAIs); and
A joint publication comparing the results of the U.S. and EU point prevalence surveys, which are used to estimate the burden of HAIs in each population.

STOLEN LAPTOPS AND ACCOUNTABILITY FOR NON-ENCRYPTED COMPUTERS UNDER HIPAA

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

April 22, 2014

Stolen laptops lead to important HIPAA settlements

Two entities have paid the U.S. Department of Health and Human Services Office for Civil Rights (OCR) $1,975,220 collectively to resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.  These major enforcement actions underscore the significant risk to the security of patient information posed by unencrypted laptop computers and other mobile devices.

“Covered entities and business associates must understand that mobile device security is their obligation,” said Susan McAndrew, OCR’s deputy director of health information privacy. “Our message to these organizations is simple: encryption is your best defense against these incidents.”

OCR opened a compliance review of Concentra Health Services (Concentra) upon receiving a breach report that an unencrypted laptop was stolen from one of its facilities, the Springfield Missouri Physical Therapy Center.  OCR’s investigation revealed that Concentra had previously recognized in multiple risk analyses that a lack of encryption on its laptops, desktop computers, medical equipment, tablets and other devices containing electronic protected health information (ePHI) was a critical risk.  While steps were taken to begin encryption, Concentra’s efforts were incomplete and inconsistent over time leaving patient PHI vulnerable throughout the organization. OCR’s investigation further found Concentra had insufficient security management processes in place to safeguard patient information. Concentra has agreed to pay OCR $1,725,220 to settle potential violations and will adopt a corrective action plan to evidence their remediation of these findings.

OCR received a breach notice in February 2012 from QCA Health Plan, Inc. of Arkansas reporting that an unencrypted laptop computer containing the ePHI of 148 individuals was stolen from a workforce member’s car.  While QCA encrypted their devices following discovery of the breach, OCR’s investigation revealed that QCA failed to comply with multiple requirements of the HIPAA Privacy and Security Rules, beginning from the compliance date of the Security Rule in April 2005 and ending in June 2012.  QCA agreed to a $250,000 monetary settlement and is required to provide HHS with an updated risk analysis and corresponding risk management plan that includes specific security measures to reduce the risks to and vulnerabilities of its ePHI.  QCA is also required to retrain its workforce and document its ongoing compliance efforts.