Browsing articles in "World News"

Church And Clergy Have Fallen Out Of Favor, New Polls Show

Jul 19, 2019   //   by Administrator   //   World News  //  Comments Off on Church And Clergy Have Fallen Out Of Favor, New Polls Show

Two new polls provide more evidence that Americans are becoming less religious. Confidence in organized religion is down, and Americans are less and less inclined to seek guidance from clergy.

Godzilla Comes To Comic-Con In San Diego

Jul 19, 2019   //   by Administrator   //   World News  //  Comments Off on Godzilla Comes To Comic-Con In San Diego

Japan’s cinema legend Godzilla turns 65 this year. And for the first time, Japan’s Toho Studios will have a booth at Comic-Con to celebrate the giant monster.

James Earl Jones Returns As Mufasa In ‘Lion King’ Remake

Jul 18, 2019   //   by Administrator   //   World News  //  Comments Off on James Earl Jones Returns As Mufasa In ‘Lion King’ Remake

Noel King talks with film reviewer Claudia Puig, president of the Los Angeles Film Critics Association, about Disney’s latest live-action remake: “The Lion King.”

11-Year-Old Set Up Sidewalk Stand To Sell Beer. No, Not That Kind — Root Beer

Jul 18, 2019   //   by Administrator   //   World News  //  Comments Off on 11-Year-Old Set Up Sidewalk Stand To Sell Beer. No, Not That Kind — Root Beer

An 11-year-old in Brigham City, Utah, set up a sidewalk stand with a sign reading, “Ice Cold Beer.” Several concerned people called the cops, but they found a small “root” printed above the word beer.

‘Don’t Flush Drugs’: Police In Tennessee Town Warn Of ‘Meth-Gators’

Jul 17, 2019   //   by Administrator   //   World News  //  Comments Off on ‘Don’t Flush Drugs’: Police In Tennessee Town Warn Of ‘Meth-Gators’

Police in Loretto, Tenn., issued a warning to residents, asking them not to flush drugs down the toilet to avoid creating “meth-gators” and hyped-up ducks. They later said they were mostly joking.

John Paul Stevens, Retired Supreme Court Justice, Dies At 99

Jul 17, 2019   //   by Administrator   //   World News  //  Comments Off on John Paul Stevens, Retired Supreme Court Justice, Dies At 99

Retired Justice John Paul Stevens, who served on the United States Supreme Court for nearly 35 years, died Tuesday of complications following a stroke. He was 99 years old.

Yosemite Hotels Get Their Historic Names Back After Trademark Dispute

Jul 16, 2019   //   by Administrator   //   World News  //  Comments Off on Yosemite Hotels Get Their Historic Names Back After Trademark Dispute

After a years-long legal dispute, a historic hotel in Yosemite National Park will revert back to its original name — The Ahwahnee.

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After a years-long legal dispute, a historic hotel in Yosemite National Park will revert back to its original name — The Ahwahnee.

Ben Margot/AP

The names of several major hotels and camp villages at Yosemite National Park in California are being restored, after a years-long trademark dispute.

The Majestic Yosemite Hotel is back to its original name, The Ahwahnee. And a set of cabins that was temporarily called Half Dome Village now carries its historic name, Camp Curry.

“I’ve said from literally Day One that these names belong with these places, and ultimately belong to the American people,” Yosemite National Park spokesman Scott Gediman told the Los Angeles Times. “So to have this dispute resolved is huge.”

A legal settlement announced on Monday ends a dispute that started in 2015, when Yosemite didn’t renew the contract of its longtime concession provider, a subsidiary of major vendor Delaware North. Instead, it awarded a 15-year contract to Yosemite Hospitality, a subsidiary of the company Aramark.

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Delaware North sued. And as NPR’s Kirk Siegler reported at the time, it emerged that the company had trademarked the names of a number of the sites it managed.

To give up those trademarks, it was asking for a large sum – much larger than the National Park Service said they were worth. Delaware North wanted $50 million for the trademarks and service marks, Siegler reported. “No thanks, says Yosemite Hospitality — and the National Park Service. They put the value of the assets at just $3 million.”

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Under the terms of the settlement deal, Delaware North is transferring the trademarks and service marks to Aramark. And at the end of Aramark’s contract, “those trademarks and service marks will transfer at no cost to the National Park Service,” according to a statement from the NPS.

The U.S. government paid $3.84 million and Aramark paid $8.16 million to Delaware North, Gediman told the Times.

For the period where the names were changed, some of the landmarks just had plastic tarps with the new names covering the historic signs.

On Monday, Yosemite put two photos on Twitter. The first showed a plastic sign welcoming visitors to “Half Dome Village”; the second showed the plastic removed and the original wood sign welcoming visitors to “Camp Curry.”

The Ahwahnee was built in the 1920s in an effort to attract wealthier visitors to the park, according to the hotel’s website. The striking building draws from a diverse range of architecture and design traditions, including “Art Deco, Native American, Middle Eastern, and Arts Crafts Movement.”

The Wawona Hotel, which has been called the Big Trees Lodge since 2016, is also back to its original name. When it changed, former Wawona manager Monica Hubert told Siegler that “those names are all oriented towards the [Native American] tribes that were in Yosemite. … There’s reasons why they’re actually named those things.”

Records Show Medicare Advantage Plans Overbill Taxpayers By Billions Annually

Jul 16, 2019   //   by Administrator   //   World News  //  Comments Off on Records Show Medicare Advantage Plans Overbill Taxpayers By Billions Annually

Medicare Advantage plans, administered by private insurance firms under contract with Medicare, treat more than 22 million seniors — more than 1 in 3 people on Medicare.

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Medicare Advantage plans, administered by private insurance firms under contract with Medicare, treat more than 22 million seniors — more than 1 in 3 people on Medicare.

Roy Scott/Ikon Images/Getty Images

Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion over the past three years alone, but federal officials say they are moving ahead with long-delayed plans to recoup at least part of the money.

Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have.

Getting refunds from the health plans has proved daunting, however. Officials with the Centers for Medicare Medicaid Services repeatedly have postponed or backed off efforts to crack down on billing abuses and mistakes by the increasingly popular Medicare Advantage health plans offered by private health insurers under contract with Medicare. Today, such plans treat more than 22 million seniors — more than 1 in 3 people on Medicare.

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Now CMS is trying again, proposing a series of enhanced audits tailored to claw back $1 billion in Medicare Advantage overpayments by 2020 — just a tenth of what it estimates the plans overcharge the government in a given year.

At the same time, the Department of Health and Human Services Inspector General’s Office has launched a separate nationwide round of Medicare Advantage audits.

As in past years, such scrutiny faces an onslaught of criticism from the insurance industry, which argues the CMS audits especially are technically unsound and unfair and could jeopardize medical services for seniors.

America’s Health Insurance Plans, an industry trade group, blasted the CMS audit design when details emerged last fall, calling it “fatally flawed.”

Insurer Cigna Corp. warned in a May financial filing: “If adopted in its current form, [the audits] could have a detrimental impact” on all Medicare Advantage plans and “affect the ability of plans to deliver high quality care.”

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But former Sen. Claire McCaskill, a Missouri Democrat who now works as a political analyst, says officials must move past powerful lobbying efforts. The officials must hold health insurers accountable, McCaskill says, and demand refunds for “inappropriate” billings.

“There are a lot of things that could cause Medicare to go broke,” she says. “This would be one of the contributing factors. Ten billion dollars a year is real money.”

Catching overbilling with a wider net

In the overpayment dispute, health plans want CMS to scale back, if not kill off, an enhanced audit tool that, for the first time, could force insurers to cough up millions in improper payments they’ve received.

For more than a decade, audits have been little more than an irritant to insurers, because most plans go years without being chosen for review and often pay only a few hundred thousand dollars in refunds as a consequence. When auditors uncover errors in the medical records of patients the insurers were paid to treat, CMS has simply required a rebate for those patients for just the year audited — relatively small sums for plans with thousands of members.

The latest CMS proposal would raise those stakes enormously by extrapolating error rates found in a random sample of 200 patients to the plan’s full membership — a technique expected to trigger many multimillion-dollar penalties. Though controversial, extrapolation is common in medical fraud investigations — except for investigations into Medicare Advantage. Since 2007, the industry has successfully challenged the extrapolation method and, as a result, largely avoided accountability for pervasive billing errors.

“The public has a substantial interest in the recoupment of millions of dollars of public money improperly paid to health insurers,” CMS wrote in a Federal Register notice late last year announcing its renewed attempt at using extrapolation.

Penalties in limbo

In a written response to our questions, CMS officials said the agency has already conducted 90 of those enhanced audits for payments made in 2011, 2012 and 2013 — and expects to collect $650 million in extrapolated penalties as a result.

Though that figure reflects only a minute percentage of actual losses to taxpayers from overpayments, it would be a huge escalation for CMS. Previous Medicare Advantage audits have recouped a total of about $14 million — far less than it cost to conduct them, federal records show.

Though CMS has disclosed the names of the health plans in the crossfire, it has not yet told them how much each owes, officials said. CMS declined to say when, or if, they would make the results public.

This year, CMS is starting audits for 2014 and 2015, 30 per year, targeting about 5% of the 600 plans annually.

This spring, CMS announced it would extend until the end of August the audit proposal’s public comment period, which was supposed to end in April. That could be a signal the agency might be looking more closely at industry objections.

Health care industry consultant Jessica Smith says CMS might be taking additional time to make sure the audit protocol can pass muster.

“Once they have their ducks in a row,” she says, “CMS will come back hard at the health plans. There is so much money tied to this.”

But Sean Creighton, a former senior CMS official who now advises the industry for health care consultant Avalere Health, says payment error rates have been dropping because many health plans “are trying as hard as they can to become compliant.”

Still, audits are continuing to find mistakes. The first HHS inspector general audit, released in late April, found that Missouri-based Essence Healthcare Inc. had failed to justify fees for dozens of patients it had treated for strokes or depression. Essence denied any wrongdoing but agreed it should refund $158,904 in overcharges for those patients and ferret out any other errors.

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Essence also faces a pending whistleblower suit filed by Charles Rasmussen, a Branson, Mo., doctor who alleges the health plan illegally boosted profits by overstating the severity of patients’ medical conditions. Essence has called the allegations “wholly without merit” and “baseless.”

Essence started as a St. Louis physician group, then grew into a broader holding company in 2007, backed by prominent Silicon Valley venture capitalist John Doerr, with his brother Thomas Doerr, a St. Louis doctor and software designer. Neither would comment for this story.

How we got here

CMS uses a billing formula called a “risk score” to pay for each Medicare Advantage member. The formula pays higher rates for sicker patients than for people in good health.

Congress approved risk scoring in 2003 to ensure that health plans did not shy away from taking sick patients who could incur higher-than-usual costs from hospitals and other medical facilities. But some insurers quickly found ways to boost risk scores — and their revenues.

In 2007, after several years of running Medicare Advantage as what one CMS official dubbed an “honor system,” the agency launched “Risk Adjustment Data Validation” audits. The idea was to cut down on the undeserved payments that cost CMS nearly $30 billion over the past three years.

The audits of 37 health plans revealed that, on average, auditors could confirm just 60% of the more than 20,000 medical conditions CMS had paid the plans to treat.

Extra payments to plans that had claimed some of its diabetic patients had complications, such problems with eyes or kidneys, were reduced or invalidated in nearly half the cases. The overpayments exceeded $10,000 a year for more than 150 patients, though health plans disputed some of the findings.

But CMS kept the findings under wraps until the Center for Public Integrity, an investigative journalism group, sued the agency under the Freedom of Information Act to make those results public.

Despite the alarming findings, CMS conducted no audits for payments made during 2008, 2009 and 2010 as they faced industry backlash over CMS’ authority to conduct them, and the threat of extrapolated repayments. Records released through the FOIA lawsuit show some inside the agency also worried that health plans would abandon the Medicare Advantage program if CMS pressed them too hard.

CMS officials resumed the audits for 2011 and expected to finish them and assess penalties by the end of 2016. That has yet to happen, amid the continuing protests from the industry. Insurers want CMS to adjust downward any extrapolated penalties to account for coding errors that exist in standard Medicare. CMS stands behind its method — at least for now.

At a minimum, argues AHIP, the health insurers association, CMS should back off extrapolation for the 90 audits for 2011-13 and apply it for 2014 and onward. Should the agency agree, CMS would write off more than half a billion dollars that could be recovered for the U.S. Treasury.

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

Lessons Learned Helped Louisiana Minimize Barry’s Damage

Jul 15, 2019   //   by Administrator   //   World News  //  Comments Off on Lessons Learned Helped Louisiana Minimize Barry’s Damage

When Hurricane Barry came ashore over the weekend, it did not do as much damage as feared, But it tested a number of systems and hurricane protection entities put in place after previous storms.

Protesters In Puerto Rico Call For The Governor To Resign

Jul 15, 2019   //   by Administrator   //   World News  //  Comments Off on Protesters In Puerto Rico Call For The Governor To Resign

Text messages of Gov. Ricardo Rosselló private communication with cabinet members leaked and show derisive, profanity-laced messages about political foes.

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  • NPT: 2019-07-20 09:36 AM
  • EDT: 2019-07-19 11:51 PM
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