#Anti-Kickback Statue

[nationallawreview]

FCA Enforcement & Compliance Digest — Fall 2024 False Claims Act Newsletter

Welcome to the Fall 2024 issue of “FCA Enforcement & Compliance Digest,” our quarterly newsletter in which we compile essential updates on False Claims Act (FCA) enforcement trends, litigation, agency guidance, and compliance tips. We bring you the most recent and significant insights in an accessible format, concluding with our main takeaways — aka “And the Fox Says…” — on what you need…

[mr-camhed]

Name: Tailgater

Age: 4.64 million years

Gender: male

Faction: Decepticon

Assigned Forces: Decepticon army, 212th Urban Assault Battalion, Karashni squad

Role: lieutenant

Motto: "What's more suitable for relaxation after battle than cleaning up trash after war?"

Personality: Tailgater is a really nasty piece of work. He does not hesitate to aim a sniper Rifle at medics and rockets at civilians. To him, murdering non-combatants, medics and even wounded, no matter The species or allegiance, is an incomparable kind of relaxation. However, this caused him to lose his chances of promotion as The act of killing potential prisoner, recruit, logistics personnel and even fellow officers just because they aren't carrying weapon in the opens is still frowned upon even by Decepticons, and the frustration he had accumulated would be then be unleashed upon more combatants and his own men, which only worsens his chances.

Alternate mode: Tailgater transforms into a navy Blue first Generation Audi A8 Sedan.

Appearance: Tailgater is about 6.7meters tall and has a transformation scheme similar to Bayverse Que/Wheeljack. His headsculpt is similar to that of Energon Kickback, with a faceplate similar to Bruticus Maximus. His robot mode part's main color is gray, with rare accents of teal and silver.

Weaponry: Taigater is rather strong, but is only of average intelligence. Under vehicle mode, Tailgater has a top speed of 274 kilometres per hour, and has a notable advantage on durability and acceleration, but his handling suffered from a soft suspension. And under both vehicle and robot mode, his headlights can emit a concentrated beam of energy that can disable and even melt optical equipments, a Machine gun mounted on his front fender/shoulder and a missile launcher on his outside shin/rear fenders and two mine launchers on The back of his shins/both side of his rear bumper. In robot mode, Tailgater also has a variety of weaponry provided to him by Bulwark or his unnamed benefactor including electromagnetic sniper rifle with a variety of ammunition such as anti armor fragmentation shot, heavy duty missile launcher with a variety of warheads such as scraplet, cosmic rust and other biochemical warheads, railgun scattergun, plasma assault rifle, nucleon bomb and so on.

Character Biography: Tailgater from Rodion was a forged from a high caste house. He has been a bully since he was a sparkling, and the tolerance from his guardians due to his status only boldens him. However, he was forcibly sent to the military school when he wounded a Senator in a prank go wrong, and was regarded as a good team leader although he is slightly bad in discipline and may be a promising member of the military. However, Tailgater would later be kicked out from the academy as the fall guy when he and a group of his fellow cadets started a bar fight with several recently unemployed miners transported back from Messetine that ended in The death of a cadet, several miners (many of whom were shot by the police when they responded or later died in custody due to "unknown circumstances", while several were shot and killed by Tailgater and his fellow cadets when things seems to go bad for them) and an innocent bystander that was thrown down to the streets below by his fellow cadet Onslaught for getting into his way.

Luckily for Tailgater, he was approached by Zeta, the Senator he had wounded before, to work for him in clearing out people they considered troublesome. He would be responsible of or at least taken part of incidents such as the attack on Rodion Police station, The Institute Conspiracy, the assassination of Sentinel Prime and probably the most notorious incident, The False flag Raid on The great Archives and attempted assassination of Orion Pax, in which he was responsible for leading the other thugs in attacking the archive while disguised as Decepticon Terrorists and flush Orion Pax to an area where he can be sniped by a prepositioned assassin.

Tailgater took this job with a Machine gun and glee, as Orion has been a thorn in his side since The bar fight where he dared to arrest him and his cohorts for "putting those dirty obsolete peasants into their place", and takes testimony from the miners instead of them; and also obstructs him whenever he was helping the Senate to "make Cybertron a better place" by cleaning out factors of social instability and trash parasites, even almost catching them after their assassination of Sentinel Prime and forced them to hide in the sea of rust after their getaway transport crashed and flipped over.

However, despite Tailgater and the goons were able to drive Orion pax to the designated area through massacring archivists, security, other staff and even occasional visitors of the archive, blocking Alternate exits with arson, explosives and traps, and left graffitis and gruesome display of corpses to make the blame on the Decepticons more convincing, the assassin would hesitate at her shot and failed to kill the intended target; which Tailgater just decided to do by himself. So under the cover of his fellow thug Timereckon, he bursted into The room, and opened fire on Orion while he was mourning The Death of his friend, mentor and Head archivist Codexa. However, Orion would fight back, killing Timereckon when he was rammed into a wall by Pax in truck mode, and crushed to death, before Pax was shot up and gravely wounded by Tailgater.

Unfortunately for Tailgater, before he could finish his goal, he was tackled by Ariel(who has been friend with Orion pax since they were in the emergency department together, at The time was a volunteer assistant archivist alongside Pax and would later become the leader of Autobot operations in Decepticon occupied areas of Cybertron during The war, although it is nothing beyond speculation that they were romantically involved), who was able to knock him over, and before he could attempt to draw his sidearm or knife, the other survivors would also gang up on him and knocking his lights out by beating, kicking, and bludgeoning him with furnitures and even his own Machine gun. And with Orion Pax escaped and out of The reach of the Senate, Tailgater was once again a scapegoat, this time he was tried as a Decepticon Terrorist and sentenced to death.

However, before the execution could be carried out, the prison facility he was held in was raided by the Decepticons who were breaking out several felons they were looking to recruit into their ranks, including Monstructor Six, Bludgeon and Shockwave. Many more prisoners and even guards(such as the Combaticons who were fellow cadets with Tailgater) would join the Decepticon Cause that day, including Tailgater. Afterwards, he would participate in many raids against the Senate and Cybertronian Infrastructures.

He was also present during the Kaon Riots where he participated in the massacre of Senators and their associates, and witnessed the Death of Zeta Prime in the hands of Megatron, the subsequent fight between Megatron and Orion Pax which saw Orion Badly wounded by Megatron's fusion cannon before being resurrected before being chosen by the Matrix of Leadership to become the new Prime.

He would then be a part of the battle of Nyon which signified the beginning of the Great war, and the early stages of the war.

However, he was forced to leave the Frontline when he shot and killed a Decepticon staff officer in the aftermath of the battle of Sherma Bridge where he mistaken the officer as an Autobot Medic which he had previously blinded, and was reassigned to the Deception Prison Colony of Styx, and later Fort Straxus in Darkmount and the Grindcore Prison Camp by the time if the Simanzi Massacre as a perimeter guard and sometimes(not enough in his own opinion) executioner.

Fortunately for him, by the time of the attack on Kimia Station, he was allowed back to the frontline where he was a part of the 212th Urban Assault Battalion where he was Assigned over several Genericons, Vehicons and a Couple of Seekers as a squad that participated in the battle of Karash where they wreaked havoc on the Autobots' logistics and local population's support, which earned them the title of Karashni Squad. He would then rope another Decepticon named Bulwark who was an Armorer into his squad, and by the conclusion of the Earth Campaign where Megatron announced his surrender to the Autobot Authorities, the end of the war and Dissolution of Decepticon and its Causes, Tailgater was among the ones that refused to admit defeat and continued to wage war on Autobots, Neutrals, Decepticons who had accepted defeat, and biological lifeforms. However, this time, he seems to have begun working for a mysterious benefactor who he seems to have known from way back…

Weakness: Tailgater has no notable physical Weakness except for the headlights and his handling which suffered from a soft suspension; but his constant misbehavement and tendency to draw enemies makes his subordinates less and less willing to follow his command.

Commentary: you won't understand how may times Hellsite sh*t itself and lost my progress on this. It just refuses to save progress after he got in jail for some reason. write anything about him joining the Deception, save, and "something went wrong". Anything else, "saved successfully". Fuck you, Tumblr

[molsons112000]

So you can only go back between 2 and 4 years for a wrongful death claim. But if they actively covered it up and are actively covering it up, then you can go back further. But if it wasn't discovered, then the statue of limitation applies. But if they actively didn't cover up and continue to do the cover up then you can go back as far back as the cover up....

So you have to look into fraud and abuse and concealment laws. To see if you can go back farther than the above mentioned statue of limitations.

Office of Inspector General (.gov)

https://oig.hhs.gov › compliance

Fraud & Abuse Laws | Office of Inspector General - HHS.gov

The five most important Federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician ...

Missing: kicking ‎| Show results with: kicking

The Law Offices of John Day, P.C.

https://www.johndaylegal.com › 42...

§42.8 Fraudulent Concealment Exception to Medical ...

§ 29-26-116(a)(3) provides that regardless of when a plaintiff discovers the cause of action, no cause of action may be brought after three years

So yes, it's true, you can Sue for anything. But do you have standing and does the court consider it frivolous? Meaning are you the person negatively affected And is there really any substantial harm? And this is why we have small claims court. So whatever small claims court considers the minimum. Anything less is considered frivolous.

Quora

https://www.quora.com › Can-I-su...

Can I sue for incompetence?

Yes, you can. You can sue for anything you like, at least in the US. The question is whether you stand any chance of winning the lawsuit.

So yes, sewing for incompetence means that they did it because they didn't have the ability to Do it correctly. Now melpractice means they knew they couldn't do it correctly and still did it. Meaning you're trying to see if it was perceived negligence.They knew better or it was just negligence because they were incompetent but they didn't know they were incompetent. So it wasn't wilful.

The statute of limitations for filing a lawsuit varies depending on the type of legal claim. For example, the statute of limitations for personal injury in California is two years from the injury, or one year from the date the injury was discovered if it wasn't discovered right away. In Texas, the statute of limitations for medical malpractice claims is two years, but there is also a ten-year statute of repose. Some states extend the statute of limitations for patients who were infants or minors when they were harmed. 

courts.ca.gov

Statute of Limitations - getting_started_selfhelp

Nolo

Medical Malpractice Lawsuits and the Statute of Limitations - Nolo

So, the patient in this example has a total of 6 years to file a lawsuit after the injury was inflicted. "Infancy" and "Minority" Tolling for Young Patients. Some states also extend the statute of limitations for patients who were infants and/or minors when they were harmed, either: for a certain number of years after the malpractice occurred, or. until the patient reaches the age of majority (18 years old). For example, let's say an OBGYN injures a patient in utero. If this happened in a state with a 10 year infancy toll, then the infant will likely have until they're 10 years old to file the lawsuit.

Buzbee Law Firm

How Long Do You Have to Sue a Doctor After Surgery? - Texas Personal Injury Law Firm - Buzbee Law Firm - Just Win

To win a malpractice case against a lawyer, you must prove that they: Failed to use reasonable skill, Breached their duty, and Caused damages. 

Some common reasons for a malpractice claim include:

Failure to apply the law correctly

Poor strategy

Inadequate research

Failure to file required papers

Procrastination

Fraud 

You should not sue your lawyer unless:

They are truly bad and violate your legal rights

They commit malpractice

You have another advocate who has shown interest in the case 

So, if somebody has a sexually transmitted disease or any contagious disease, but they have no idea they have it and then it gets transmitted to you that is done by accident. But if they have the ability to take annual physicals, they Nicole's, they have mandatory screening for sexually transmitted diseases, then it is wilful negligence. So this is very important on what the government requires health insurance companies to put in place like screening at every annual physical for sexually transmitted diseases. Because if it's an add on and you don't have any signs then you're doing it by accident... Then you have to prove a reasonable man standard. Meaning a reasonable person would have every so often Got a test for sexually transmitted diseases. But if they didn't have any signs and a reasonable person wouldn't have screened or wouldn't have screened for so many years.Then it's hard to be able to claim that they did something to intentionally harm you.... And that means they're not liable.... Since ignorance of the law is no reason to break the law and the government didn't make it a requirement to get Checked for all forms of contagious diseases. Then again, it's not their fault. But this means they have no signs of illness.... If they had signs of illness and they neglected those signs of illness then it is their fault.... So the prudent man...

The reasonable person standard, also known as the reasonable man rule, is a legal definition that judges the conduct of others by comparing it to what a hypothetical reasonable person would do in similar circumstances. In legal terms, "reasonable" means ordinary. A reasonable person is someone who: Obeys the law, Doesn't put themselves or others in danger, and Minimizes risk when it's unavoidable. 

Forbes

Reasonable Person Standard: Legal Definition & Examples

Sep 19, 2022 — If it's decided that a reasonable person would have acted with more care or caution than the defendant, the defendant behaved negligently and is responsible for the harm caused. What characteristics make someone reasonable? Acting reasonably depends on the circumstances, but there are certain characteristics that the objective reasonable person has. The reasonable person: Obeys the law. Does not put themselves or others in danger. Minimizes danger or risk when it is unavoidable. Is the reasonable person test fair?

Wikipedia

Reasonable person - Wikipedia

In law, a reasonable person, reasonable man, or the man on the Clapham omnibus, is a hypothetical person whose character and care conduct, under any common set of facts, is decided through reasoning of good practice or policy.

Adam S. Kutner, Injury Attorneys

What is a Reasonable Person Standard

The legal definition reasonable person standard hinges on what's considered typical behavior. In legal terms, 'reasonable' means ordinary. The court considers the usual behavior of an average person under the same circumstances. Persons who meet or exceed an expected typical response aren't negligent. Those who fail to meet the standard for typical behavior are negligent.

scielo.org.za

Part 14. Negligence versus Malpractice: The "Reasonable Man ...

1.1 The "Reasonable Man Rule" By definition, "a person has acted negligently if they have departed from the conduct expected of a reasonably prudent person acting under similar circumstances. The hypothetical reasonable person provides an objective by which the conduct of others is judged".

If a defendant's actions are considered less careful than a reasonable person's, they are considered negligent and are responsible for any harm caused. For example, in one case, a farmer was held liable for burning down his neighbor's cabin with a haystack after the jury found his actions were objectively unreasonable. 

The reasonable person standard can vary depending on the circumstances. For example, a court might define a reasonable standard for medical professionals based on the training and experience of other medical professionals in the same position. The standard is also modified for children and minors. 

Now the prudent man standard....

The prudent man rule, also known as the prudent investor rule, is a standard that states that fiduciaries should manage trust investments as a prudent person would. This means that trustees should:

Consider the long-term health of investments

Avoid speculative ventures

Observe how men of prudence, discretion, and intelligence manage their own affairs

Consider the probable income and safety of the capital to be invested 

Law.Cornell.Edu

prudent person rule | Wex - Law.Cornell.Edu

The prudent-person rule, also known as the prudent investor rule, holds that a fiduciary may only invest in securities that a reasonable person would purchase—evaluated from the perspectives of probable income and probable safety, under precedent in Harvard College v.

Franke Beckett LLC

Estates | Trusts | Annapolis, Maryland Law Office

Study.com

Prudent Man & Prudent Investor Rule: Uses & Impact - Study.com

To unlock this lesson you must be a Study.com Member. Lesson. The Prudent Man Rule. The Prudent Man Rule is based on a ruling from Harvard College vs. Amory, an 1830 Massachusetts estate law case. A wealthy Massachusetts resident named John McLean left his estate to his wife, and had the funds managed by a trustee. After his wife died, part of funds went to Harvard College, as he requested. But when Harvard received the money, they noticed the estate had lost value under the trustee's supervision. They charged that the trustee had invested the money speculatively.

The rule originated in the 1830 Massachusetts estate law case Harvard College v. Amory. In the case, Harvard College charged that a trustee had invested funds speculatively after the death of a wealthy Massachusetts resident, causing the estate to lose value. 

The prudent man rule is an objective standard that doesn't consider how any one individual owner may have acted. It sets the appropriate interest rate based on what a reasonably prudent person would have invested to produce a reasonable rate of return. 

Generative AI is experimental. For legal advice, consult a professional.

So you have to check different components of the law to see if you have standing and if it is considered substantial enough for a lawsuit meaning not frivolous...

The small claims court is any value under ten thousand dollars and maybe up to a penny. Sometimes you can get a settlement of a dollar.

10,000

FAQ: How small is a small claims case?

JurisdictionGeneral Small Claims LimitHawaii5,000Idaho5,000Illinois10,000Indiana10,00048 more rows

Oct 19, 2023

https://www.ncsc.org › faq-how-s...

FAQ: How small is a small claims case? - NCSC

10,000

FAQ: How small is a small claims case?

JurisdictionGeneral Small Claims Limit Hawaii 5,000 Idaho 5,000 Illinois 10,000 Indiana 10,000

48 more rows

Oct 19, 2023

https://www.ncsc.org › faq-how-s...

FAQ: How small is a small claims case? - NCSC

A frivolous claim, often called a bad faith claim, refers to a lawsuit, motion or appeal that is intended to harass, delay or embarrass the opposition. A claim is frivolous when the claim lacks any arguable basis either in law or in fact Neitze v.

https://www.law.cornell.edu › wex

frivolous | Wex | US Law | LII / Legal Information Institute

A frivolous lawsuit is a lawsuit that is unreasonable, outlandish, or has no chance of winning in court. It can also be a motion or appeal that is intended to delay, harass, or embarrass the opposing party. 



Law.Cornell.Edu

frivolous | Wex | US Law | LII / Legal Information Institute



Lorenzo and Lorenzo

Defending Against Frivolous Lawsuits in Florida

A claim is considered frivolous if it:

Has no arguable basis in fact or law

Has clearly baseless factual contentions

Is based on a legal theory that is undeniably meritless

Is uncivil or harassing to the court

Claims extreme remedies

Involves a request for an exaggerated amount of monetary damages 

Some reasons people file frivolous lawsuits include: To avoid blame for an accident, To waste time and money, To encourage bad publicity, and To manipulate the legal system. 

If a court decides a claim is frivolous, they can:

Dismiss the case

Order the party who filed the claim and their attorney to pay reasonable expenses

Order the litigant to pay a civil fine 

Frivolous lawsuits can have negative effects, including:

Taking up court time and resources

Having a negative impact on the lives of those being sued

Hurting the overall economy

Financial loss

Legal fees

Attorney fees

Stress

Fines

Countersuits 

Generative AI is experimental. For legal advice, consult a professional.

[cohenlawfirmpll]

Legal Guidance for DSOs: Insights from a DSO Lawyer

Introduction

Dental Service Organizations (DSOs) play a significant role in the modern dental industry, providing support services to dental practices and helping dentists streamline operations, improve efficiency, and enhance patient care. As DSOs continue to grow and evolve, they face various legal challenges and considerations that require careful navigation and expertise. In this guide, we'll explore the legal landscape for DSOs and provide insights from a DSO lawyer on key legal considerations, best practices, and strategies for success in the dental industry.

Understanding the Role of DSOs in Dentistry

DSOs are companies that provide a range of administrative, operational, and business support services to dental practices, including billing and collections, human resources management, marketing and advertising, procurement, IT support, and regulatory compliance. By outsourcing these non-clinical functions to a centralized management organization, dentists can focus on delivering high-quality patient care while benefiting from economies of scale, shared resources, and professional expertise.

Legal Considerations for DSOs

As DSOs continue to expand and operate across multiple states and jurisdictions, they face various legal considerations and regulatory requirements that can impact their operations, structure, and compliance obligations. Some key legal considerations for DSOs include:

Regulatory Compliance: DSOs must comply with federal, state, and local laws and regulations governing the operation of dental practices, healthcare providers, and business entities. This includes regulations related to healthcare fraud and abuse, anti-kickback laws, Stark Law, HIPAA, state dental practice acts, and corporate practice of dentistry laws.

Corporate Structure: DSOs must carefully structure their corporate entities and ownership arrangements to comply with state laws and regulations governing the ownership and operation of dental practices. This may involve structuring DSOs as management companies, professional corporations, or limited liability companies (LLCs), and ensuring that ownership interests are held by licensed dentists or qualified investors.

Contractual Relationships: DSOs must establish clear contractual relationships with affiliated dental practices, including management services agreements (MSAs), employment agreements, lease agreements, and vendor contracts. These contracts should clearly define the rights, responsibilities, and obligations of each party and address key legal issues such as compensation, termination, indemnification, and dispute resolution.

Licensing and Credentialing: DSOs must ensure that all affiliated dental practices and providers are properly licensed, credentialed, and compliant with state licensing requirements. This includes verifying the licensure status of dentists, hygienists, and other dental professionals, maintaining accurate records of licenses and certifications, and ensuring compliance with state dental board regulations.

Patient Privacy and Data Security: DSOs must comply with HIPAA regulations governing the privacy and security of protected health information (PHI) and implement robust policies, procedures, and safeguards to protect patient data from unauthorized access, use, or disclosure. This includes implementing secure electronic health record (EHR) systems, conducting regular risk assessments, and providing staff training on HIPAA compliance.

Best Practices for DSOs

In light of these legal considerations, DSOs can adopt several best practices to ensure compliance, mitigate risk, and promote success in the dental industry. Some key best practices for DSOs include:

Establishing a Compliance Program: Implement a comprehensive compliance program that includes policies, procedures, training, and monitoring to ensure adherence to applicable laws, regulations, and industry standards. This program should be overseen by a designated compliance officer and regularly reviewed and updated to address emerging risks and changes in the regulatory landscape.

Conducting Due Diligence: Conduct thorough due diligence reviews of affiliated dental practices to assess their compliance with regulatory requirements, financial stability, and operational integrity. This may include reviewing practice financials, licensure status, billing practices, patient records, and prior legal issues.

Providing Legal Education and Training: Provide ongoing legal education and training to DSO staff, affiliated dentists, and practice employees on key legal issues, compliance requirements, and best practices. This may include training on HIPAA compliance, fraud and abuse laws, coding and billing practices, and contractual obligations.

Implementing Risk Management Strategies: Implement risk management strategies to identify, assess, and mitigate legal and operational risks facing the DSO and affiliated dental practices. This may include conducting regular risk assessments, implementing internal controls and monitoring systems, and obtaining appropriate insurance coverage.

Seeking Legal Counsel: Consult with experienced legal counsel specializing in healthcare law and dental practice management to address legal issues, navigate regulatory requirements, and ensure compliance with applicable laws and regulations. Legal counsel can provide valuable guidance, advice, and representation on a wide range of legal matters affecting DSOs.

Insights from a DSO Lawyer

As a DSO lawyer, I have worked closely with DSOs and dental practices to address legal challenges, navigate regulatory requirements, and promote compliance with applicable laws and regulations. Through my experience, I have gained valuable insights into the legal considerations and best practices for DSOs operating in the dental industry.

One of the key insights I have learned is the importance of proactive compliance efforts and risk management strategies. By investing in a robust compliance program, conducting thorough due diligence reviews, and providing ongoing legal education and training, DSOs can mitigate legal and operational risks and promote a culture of compliance within their organizations.

Additionally, I have found that maintaining open communication and collaboration with affiliated dental practices is essential for success. By establishing clear contractual relationships, maintaining transparent communication channels, and fostering positive relationships with dentists and practice staff, DSOs can build trust, promote alignment, and achieve mutual goals.

Conclusion

Navigating the legal landscape for DSOs requires careful attention to detail, proactive compliance efforts, and collaboration with experienced legal counsel. By understanding the legal considerations, adopting best practices, and seeking insights from a DSO lawyer, DSOs can navigate legal challenges, mitigate risks, and promote success in the dynamic and evolving dental industry.

[berniesrevolution]

THE INTERCEPT

A large trove of documents furnished exclusively to The Intercept Brasil reveals serious ethical violations and legally prohibited collaboration between the judge and prosecutors who last year convictedand imprisoned former Brazilian President Luiz Inácio Lula da Silva on corruption charges — a conviction that resulted in Lula being barred from the 2018 presidential election. These materials also contain evidence that the prosecution had serious doubts about whether there was sufficient evidence to establish Lula’s guilt.

The archive, provided to The Intercept by an anonymous source, includes years of internal files and private conversations from the prosecutorial team behind Brazil’s sprawling Operation Car Wash, an ongoing corruption investigation that has yielded dozens of major convictions, including those of top corporate executives and powerful politicians.

In the files, conversations between lead prosecutor Deltan Dallagnol and then-presiding Judge Sergio Moro reveal that Moro offered strategic advice to prosecutors and passed on tips for new avenues of investigation. With these actions, Moro grossly overstepped the ethical lines that define the role of a judge. In Brazil, as in the United States, judges are required to be impartial and neutral, and are barred from secretly collaborating with one side in a case.

Other chats in the archive raise fundamental questions about the quality of the charges that ultimately sent Lula to prison. He was accused of having received a beachfront triplex apartment from a contractor as a kickback for facilitating multimillion-dollar contracts with the state-controlled oil firm Petrobras. In group chats among members of the prosecutorial team just days before filing the indictment, Dallagnol expressed his increasing doubts over two key elements of the prosecution’s case: whether the triplex was in fact Lula’s and whether it had anything to do with Petrobras.

These two questions were critical to their ability to prosecute Lula. Without the Petrobras link, the task force running the Car Wash investigation would have no legal basis for prosecuting this case, as it would fall outside of their jurisdiction. Even more seriously, without proving that the triplex belonged to Lula, the case itself would fall apart, since Lula’s alleged receipt of the triplex was the key ingredient to prove he acted corruptly.

Operation Car Wash is one of the most consequential political forces in the history of Brazilian democracy and also one of the most controversial. It has taken down powerful actors once thought to be untouchable and revealed massive corruption schemes that sucked billions out of public coffers.

The probe, however, has also been accused of political bias, repeated violations of constitutional guarantees, and illegal leaks of information to the press. (A separate article published today by The Intercept reveals that the Car Wash prosecutors, who long insisted that they were apolitical and concerned solely with fighting corruption, were in fact internally plotting how to prevent the return to power by Lula and his Workers’ Party).

The successful prosecution of Lula rendered him ineligible to run in the 2018 presidential election at a time when all polls showed that the former president was the clear frontrunner. As a result, Operation Car Wash was scorned by Lula’s supporters, who considered it a politically motivated scheme, driven by right-wing ideologues masquerading as apolitical anti-corruption prosecutors, in order to prevent Lula from running for president and to destroy the Workers’ Party.

But on the Brazilian right, there was widespread popular support for the corruption probe, the team of prosecutors, and Moro. The yearslong corruption probe transformed Moro into a hero both in Brazil and around the world, a status that was only strengthened once he became the man who finally brought down Lula.

After the guilty verdict from Moro was quickly affirmed by an appellate court, Lula’s candidacy was barred by law. With Lula out of the running, the far-right candidate Jair Bolsonaro shot up in the polls and then handily won the presidency by defeating Lula’s chosen replacement, former São Paulo Mayor Fernando Haddad.

(Continue Reading)

[deulwight-blog]

Dear Internet: How I'd Stop SOPA

It is the first step because your physical dependence on alcohol must be overcome before any other kind of rehab will be effective. Alcohol and drug rehabilitation is also known as “drug rehab” which covers all the terms used for medical treatment which includes the psychoactive substances like street drugs and prescription drugs like alcohol, amphetamines or cocaine and heroin. In most states, there are laws that make it illegal to possess and distribute controlled substances such as drugs. The fact is that scammers are constantly evolving and inventing newer and cleverer ways to get you to willingly give them money. As there are pet pharmacies available to give you those Frontline pet medications, you should be aware of the producing company's reputation (that's if they are trusted to provide the best medicines). Although electronic razors are good, they do have shortcomings too. Large authorities such as Food and Drug Administration (FDA), United Nations (UN) and World Health Organization (WHO) have already been involved, creating their own awareness programs and raid operations. Some companies have a phone or chat representative contact the customer and they ask a few questions. CSU Los Angeles’ Method in Health care Billing and Coding equips students to recognize how to code wellness care companies for 3rd occasion coverage reimbursement, an exceptionally quickly -expanding job in present-day overall economy. His main areas of research are health and medicine like Singulair. Attorneys counseling health care providers must also remain mindful of the Federal anti-kickback statute and State laws regarding self-referrals. The group practice must consist of a single legal entity operating primarily for the purpose of being a physician group practice in any organizational form recognized by the State in which the group practice achieves its legal status. Over The Counter (OTC) Analgesics or pain killers are drugs that act at different levels of the pain transmission pathway. This can mean that the affected area is treated directly and you may not need as much pain relief, or any at all. According to the DEAs Office of Diversion Control, states can use the data to identify problems and determine the extent of any diversion or abuse. In Australia, the use of anti-venom has greatly reduced the number of deaths. Serums are designed to work in conjunction with moisturizers and some will be for nighttime use only, others will be twice daily. 2. Various Medicinal Herbs - there are lots of herbs that are especially effective natural nootropics for example Gurana (Paullinia cupana), Reishi (Ganoderma lucidum), Ginseng (Panax quinquefolius) and Yohimbe (Pausinystalia yohimbe) among numerous others. There are several sites that offer the directions on how to read a pattern. Formal applications of review are supplied by neighborhood schools, private universities, and on-line analyze courses. They all are using glycerine. • Make an evaluation of the ingredients that are used in both. These rogue sites looks normal but actually they sell medication illegally, canadian pharcharmy online which mostly contains fatal measurements of active ingredients. 250 million internal program to “disrupt rogue online pharmacies,” as part of a deal to end shareholder litigation over its alleged placement of advertisements offering to sell prescription drugs from outside the United States, Reuters reports. Keep in mind that vitamin C does not replace and should not be used to replace any antibiotics or other prescription drugs used for bladder infections. My immediate instinct was to throw the prescription away; in no way did I want all those chemicals inside me, potentially doing untold long term damage to my body. What if you need a prescription? 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Building on the expanding “male grooming” market, the concept of “Man Aisle” has become a more recent development. FROM CONCEPT TO POINT OF SALE. The old glass type with the kink is not recommended for young children. In terms of product placement, Old Spice deodorant can be found at almost any retail establishment. You can buy Salamol online and save money. But I prefer to buy them bottled! What is a Sports Nutrition Degree? Mansfield University offers a Bachelor’s degree in Nutrition with a specialty in Sport Nutrition. Now this is one good reason why the quality of the parts of your shaver is important. But, when one shops online, the privacy concern is not to be concerned about. Thanks, This is very interesting for my first rootbeer brew. Twenty years ago, people did not really consider mold to be dangerous. You should look for a laser comb that has the most lasers, making it easier to cover the entire scalp.

[whatisonthemoon]

A Statement from the Revolutionary Movement in the Philippines on Gloria Macapagal-Arroyo

Gloria Macapagal-Arroyo is another post-Marcos president in the Philippines who made false promises and murdered activists and organizers. There was sufficient evidence against the former president over the misuse of P366 million in charity intelligence funds.

Gloria Macapagal-Arroyo has been a friend of the Unification Movement for awhile now, meeting with Sun Myung Moon and Hak Ja Han in 2005. She was recently a speaker at Hak Ja Han’s Think Tank 2022 Rally of Hope.

Gloria Macapagal-Arroyo’s Strong Republic is Fast Crumbling from Within – NDFP (August 2, 2003)

The underground National Democratic Front of the Philippines (NDFP) today expressed support to the group of junior military officers and men who have attempted to launch a coup d’etat and demanded the resignation of President Gloria Macapagal-Arroyo and Defense Secretary Angelo Reyes.  The NDFP said the military rebellion was brought about by the “anti-people, undemocratic and corrupt military organization wherein ordinary soldiers and junior officers are used as cannon fodders.”

BY BULATLAT.COM

The NDFP, an alliance of revolutionary organizations including the Communist Party of the Philippines (CPP) and New People’s Army (NPA), said in a statement it showed that the president’s “Strong Republic” is fast collapsing.

It said it was not at all surprised by the restiveness among soldiers.

“While generals and other high-ranking officials wallow in luxuries and kickbacks as well as profit from criminal activities such as illegal drugs trade and kidnapping, ordinary soldiers die in the field – and for what? Trifling and delayed wages and benefits, defending a corrupt and rotten regime,” it said.

CPP statement

Gregorio “Ka Roger” Rosal, CPP spokesman, on the other hand said the CPP agrees with the aim of the Magdalo group to overthrow the “rotten” government and military command. He said however that the CPP does not agree with the military dissenters’ agenda and methods.

Rosal said the National Recovery Program which the group is advancing is “just a fascist and reactionary factional agenda of 1980s coup leader and now senator Gregorio Honasan.” He said the senator is simply taking advantage of the soldiers’ grievances to gain political mileage.

The CPP further said that “the action in Makati…shows the depths of rottenness to which the puppet military establishment, Arroyo government and ruling system has utterly and deplorably sunk.”

Isolated

The NDFP said the soldiers’ dissent signals the isolation of the Macapagal-Arroyo government from the people.

It noted that “For her own soldiers – indoctrinated for years to follow the chain of command and defend the status quo – to reject her indicates the grave isolation of the Arroyo regime.”

NDFP also said that Macapagal-Arroyo’s declaration of state of rebellion would not solve the crisis in the military or its own isolation.

Caution

The two groups offered advice and warnings to the Magdalo group. The NDFP said the military rebels must guard against being used by politicians for the latter’s personal ambitions, obviously referring to Honassan, ousted president Joseph Estrada and other anti-Arroyo politicians.

It also said that to be more effective, the military rebels should link their struggle with the broad masses.

Meanwhile, Rosal called on them to "further deepen their understanding of why the AFP is on a losing course and why the revolutionary people’s war is on the correct and winning course and is widely supported by the people."   It also urged them to "emulate the tradition of Lt. Crispin Tagamolila and join the revolutionary movement or find ways to coordinate and cooperate with the revolutionary movement." Tagamolila defected from the AFP and  joined the NPA in the 1970s.

[tanadrin]

Tagging @theunitofcaring because you may find this of interest, though it’s tangential to your earlier posts

I was talking to my mother today, and I asked her to describe, as she sees them, the challenges facing child protection agencies in the U.S. She worked for many years, variously, as a guardian ad litem, a lawyer representing parents whose children had been taken into a custody, and as an attorney for the child welfare agency of my home state, which, during her tenure, was sued for the failures of its foster-care system specifically. The problems it faced (and continues to face) can be broadly grouped into funding, political dysfunction, and bureaucratic dysfunction, as perhaps they can for most government agencies.

In the 90s, Home State’s child welfare system was drastically reorganized, putting child protective services for the first time under the aegis of a single agency. That agency was underfunded and ineffectually led, and the dysfunction of its foster-care system specifically led to a lawsuit engineered with the cooperation of interested parties in Home State’s government, since it was widely acknowledged by those with firsthand experience that that was the only way to get the state legislature to adequately fund the necessary changes. This lawsuit resulted in federal oversight of Home State’s child welfare system, until 2015 when the system began to meet the targets determined by the settlement in the original case, although only as a result of the current leadership (over the protests of the legal arm of the child welfare service) doing their best to lie about the relevant statistics for a number of years. CPS in that state is still underfunded; the usual anti-pattern, especially in cases of child removal, is that a child is removed from the home on a short-term bases (for which the burden of evidence is quite low), nominally contingent on the parent or parents being provided certain social services to improve the condition of the home, but these services never appear because of bureaucratic or funding failures on the part of CPS, and the case drags on much longer than it should.

Political dysfunction is also extreme, especially in rural areas of Home State; corruption of the form of kickbacks by privately-owned institutions to juvenile court judges is one form of corruption. The general understanding I have of politics in Home State is that, especially but not only in rural regions, networks of patronage and nepotism are endemic in a way they are not in better-run regions of the U.S. or foreign countries. Sometimes this corruption reaches farcical levels, like one child welfare lawyer’s life being threatened by a juvenile court judge with friends in the local police department. (Said judge is now a lawyer in private practice, and as far as I know has never been charged criminally.) There is also a much closer interface between the area of juvenile justice and child welfare than most people probably think: in the case of Home State, since the federal lawsuit governing the behavior of CPS affected only the foster-care system, there was some incentive to essentially neglect minors (especially boys--boys in general and adolescent African American boys in particular face severe challenges other children in the foster care system seem not to face) to the point where their behavior became a criminal matter, meaning they went directly into the juvenile justice system rather than becoming part of the foster care system.

The legislature of Home State was and is mostly uninterested in the issue of child welfare. The normal situation is critical underfunding, resulting in overworked social workers and lawyers, who therefore lack resources even if their intentions are the best (which they usually are) and their training and leadership is good (much more hit and miss), especially because at the highest levels CPS in Home State is run by political appointees, and therefore political considerations and concerns over external appearance dominate. Part of this is the incentive toward defensive social work: if a child who CPS has had contact with dies in the custody of their parents, there is a strong CYA incentive for social workers to be much more likely to remove children from the home if the risks to that child seem at all to warrant it. This kind of attitude makes it much more likely a  child might be removed from the home due to circumstances, like poverty, that are not the fault of the parent.

Many of these factors generalize to other parts of the U.S. The two factors my mother named which seemed in our discussion to be most deleterious to a well-run CPS organization in any state, though, are 1) the privatization of any component of the system, since that provides strong incentives for the people who are receiving state funds to care for children to keep the children in the system as long as possible (costs go down the longer a child is in the system; Home State essentially had to destroy the profit motive of private providers by reviewing the status of every child in their care every 30 days), and 2) the state of the healthcare system in general. Much of what CPS agencies provide or should provide is essentially highly-targeted mental health services. As a general rule, of course the provision of these services is woefully inadequate across the United States; one of the crucial differences, as she understands it, between the ability of the U.S. to have a decent child welfare system versus other developed countries is the poor provision of these services.

Despite improvements made for a time in Home State’s CPS agency as a result of the federal lawsuit, the system is currently not much better than it was in the late 90s. The last change in state administration provided a strong incentive to exit the settlement agreement by meeting the targets it set, and therefore to lie about whether those targets were being reached. Although Home State was once a national leader in some respects w/r/t its child welfare system, it is currently middle of the pack at best, which is to say doing abysmally by any objective standard.

[healthviewx]

2021 CPT Codes by the CMS for Medicare Extension Care Management Programs

Chronic Care Management:

The chronic care management program was virtually untouched by the 2021 Final Rule from CMS. There are three main CPT codes and two add-on CPT codes in 2021 that may be billed by primary care providers for CCM services.

Requirements for CCM:

Non-Complex CCM:

Two or more chronic conditions expected to last at least 12 months (or until the death of the patient)

Patient consent (verbal or signed)

Personalized care plan in a certified EHR and a copy provided to the patient

24/7 patient access to a member of the care team for urgent needs

Enhanced non-face-to-face communication between patient and care team

Management of care transitions

At least 20 minutes of clinical staff time per calendar month spent on non-face-to-face CCM services directed by a physician or other qualified healthcare professional

CCM services provided by a physician or other qualified healthcare professional are reported using CPT code 99491 and require at least 30 minutes of personal time spent in care management activities

Complex CCM:

Shares common required service elements with CCM but has different requirements for:

Amount of clinical staff service time provided (at least 60 minutes)

The complexity of medical decision-making involved (moderate to high complexity)

CPT Reimbursement Codes for CCM Service:

Non-complex CCM:

CPT Code 99490– This code requires that patients must have two or more chronic conditions, as well as documented consent to enroll in the program AND receive at least 20 minutes of CCM services from clinical staff within a given month. A personalized care plan, which shows an assessment of all patient factors and identifies gaps and barriers to be addressed, is also required. Reimbursement Rates – CPT Code 99490 – $42/patient/month.

CPT Code 99439 (formerly  G2058) -This code allows providers to bill for each additional 20 minutes spent for Basic CCM services in a given month, up to 2 times. For example, if CCM services were provided for at least 40 minutes with a patient in a given month that was not Complex, 99490 ($42) and 99439 ($38) would be billed together for that month. Reimbursement Rates – CPT Code 99439 (formerly  G2058) – $38/patient/month.

Complex CCM:

CPT code 99487– This code has a higher rate of reimbursement than the Basic CCM CPT code. To bill using this code requires moderate or high complexity in medical decision making AND acknowledgment by both patient & provider of an acute exacerbation (generally defined as a sudden worsening of a patient’s condition that necessitates additional time and resources). The patient must receive at least 60 minutes of services from clinical staff within a given month to bill for this code. Reimbursement Rates – CPT Code 99487 – $93/patient/month.

CPT code 99489 – The same as with the Basic Chronic Care Management code, the Complex Chronic Care Management code also has an add-on CPT code to cover time spent beyond 60 minutes. It allows for billing for each additional 30 minutes spent for Complex CCM services within a given month. Reimbursement Rates – CPT Code 99489 – $45/patient/month.

Transitional Care Management:

Transitional Care Management (TCM) services address the hand-off period between the inpatient and community settings. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy. Family physicians often manage their patients’ transitional care.

Requirements for TCM:

Contact the beneficiary or caregiver within two business days following a discharge. The contact may be via the telephone, email, or a face-to-face visit. Attempts to communicate should continue after the first two attempts in the required business days until successful.

Conduct a follow-up visit within 7 or 14 days of discharge, depending on the complexity of medical decision-making involved. The face-to-face visit is part of the TCM service and should not be reported separately.

Medicine reconciliation and management must be furnished no later than the date of the face-to-face visit.

Obtain and review discharge information.

Review the need for diagnostic tests/treatments and/or follow up on pending diagnostic tests/treatments.

Educate the beneficiary, family member, caregiver, and/or guardian.

Establish or reestablish referrals with community providers and services, if necessary.

Assist in scheduling follow-up visits with providers and services, if necessary.

CPT Reimbursement Codes for TCM Service:

CPT code 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge. Reimbursement  rate – $175.76/patient/month.

CPT code 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge. Reimbursement  rate – $237.11/patient/month.

Allowed reported services alongside TCM services include,

Prolonged services without direct patient contact (99358-99359);

Home and outpatient international normalized ratio (INR) monitoring (93792-93793);

End-stage renal disease (ESRD) services for patients ages 20 years and older (90960-90962, 90966, or 90970);

Interpretation of physiological data (99091); and

Care plan oversight (G0181-G0182).

Remote Patient Monitoring:

RPM involves the collection and analysis of patient physiologic data that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition.

Requirements for RPM:

To qualify for CMS reimbursements for utilizing the RPM services efficiently, the service providers and hospitals need to ensure the following:

Medicare part B patients are imposed 20% of copayment (renouncing the copayments regularly can trigger penalties under the Federal Civil Monetary Penalties Law and also the Anti-Kickback Statute)

Patients must take the remote monitoring services and are required to monitor for a minimum of 16 days to be applicable for a billing period.

The RPM services must be ordered by skilled physicians or other qualified healthcare experts.

Data must be wirelessly synced for proper evaluation, analysis, and treatment.

CPT Reimbursement Codes for RPM Service:

CPT code 99453 – It is a one-time practice expense reimbursing for the setup and patient education on RPM equipment. This code covers the initial setup of devices, training and education on the use of monitoring equipment, and any services needed to enroll the patient on-site. Reimbursement  rate – $18.77/patient/month.

CPT code 99454 – This code covers the supply and provisioning of devices used for RPM programs, and the code is billable only once in a 30-day billing period. Reimbursement  rate – $64.44/patient/month.

CPT code 99457 – This code covers the direct monthly expense for the remote monitoring of physiologic data as part of the patient’s treatment management services. To receive reimbursement, the physician, QHP or other clinical staff must provide RPM treatment management services for at least 20 minutes per month. Reimbursement  rate – $51.61 (non-facility); $32.84 (facility) /patient/month.

CPT code 99458 – This code is an add-on code for CPT Code 99457 and cannot be billed as a standalone code. This code can be utilized for each additional 20 minutes of remote monitoring and treatment management services provided. Reimbursement  rate – $42.22 (non-facility); $32.84 (facility) /patient/month.

Principal Care Management:

PCM codes are intended to cover services for patients with only one complex chronic condition that requires management by a specialist. Like other chronic care management (CCM) codes (chronic care management, transitional care management), the PCM codes are intended to reimburse physicians for the additional work they do to take care of high-risk, complex patients. This includes the extra time and work required for medication adjustments, creating a care plan, patient follow-up, and more.

Requirements for PCM:

One complex chronic condition lasting at least 3 months, which is the focus of the care plan,

The condition is of sufficient severity to place the patient at risk of hospitalization or has been the cause of recent hospitalization,

The condition requires development or revision of a disease-specific care plan,

The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities

CPT Reimbursement Codes for PCM Service:

CPT Code G2064 – requires 30 minutes of provider (allergist, NP, PA) time each calendar month to care for the patient. This code can be billed monthly (in addition to appropriate E/M codes) and approximate reimbursement is $52/patient/month.

CPT Code G2065 –  requires 30 minutes of clinical staff time directed by a provider each calendar month for patient care. Provider supervision does not require the provider to be onsite while clinical staff performs PCM services. This code can be billed monthly (in addition to appropriate E/M codes) and approximate reimbursement is $22/patient/month.

Annual Wellness Visit:

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical.

Requirements for AWV:

For G0438 (initial visit),

Billable for the first AWV only.

The patient must not have received an IPPE within the past 12 months.

Administer a Health Risk Assessment (HRA) that includes, at a minimum: demographic data, self-assessment of health status, psychosocial and behavioral risks, and activities of daily living (ADLs), instrumental ADLs including but not limited to shopping, housekeeping, managing own medications, and handling finances.

Establish the patient’s medical and family history.

Establish a list of current physicians and providers that are regularly involved in the medical care of the patient.

Obtain blood pressure, height, weight, body mass index or waist circumference, and other measurements, as deemed appropriate.

Assess a patient’s cognitive function.

Review risk factors for depression, including current or past experiences with depression or mood disorders.

Review patient’s functional ability and safety based on direct observation, or the use of appropriate screening questions.

Establish a written screening schedule for the individual, such as a checklist for the next 5 to 10 years based on appropriate recommendations.

Establish a list of risk factors and conditions for primary, secondary, or tertiary intervention.

Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.

At the patient’s discretion, furnish advance care planning services.

Patients are eligible after the first 12 months of Medicare coverage.

For services within the first 12 months, conduct the Initial Preventive Physical Exam (IPPE), also referred to as the Welcome to Medicare Visit (G0402).

For G0439 (subsequent visit),

Billable for subsequent AWV.

The patient cannot have had a prior AWV in the past 12 months.

Update the HRA.

Update the patient’s medical and family history.

Update the current physicians and providers that are regularly involved in providing the medical care to the patient, as developed during the initial AWV.

Obtain blood pressure, weight (or waist circumference, if appropriate), and other measurements, as deemed appropriate.

Assess a patient’s cognitive function.

Update the written screening schedule checklist established in the initial AWV.

Update the list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended or underway.

Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.

At the patient’s discretion, the subsequent AWV may also include advance care planning services.

CPT Reimbursement Codes for AWV Service:

The four CPT codes used to report AWV services are,

G0402 Initial Preventive Physical Exam – This code is used for patients visiting within 12 months after enrolling in Medicare.

G0438 Initial Visit – This visit is eligible within 11 calendar months from the date of IPPE.

G0439 Subsequent Visit – This code is used for every subsequent visit. Patients are eligible for this benefit every year after their Initial AWV.

CPT 99497/99498 – Patients are eligible for an Advance Care Planning (ACP) at any time. But if performed during an AWV, the patient has no copay.

Behavioral Health Integration:

Integrating behavioral health care with primary care (“behavioral health integration” or “BHI”) is an effective strategy for improving outcomes for millions of Americans with behavioral health conditions. Medicare makes separate payments to physicians and non-physician practitioners for BHI services they furnish to beneficiaries over a calendar month service period.

Requirements for BHI:

Any mental or behavioral health condition being treated by the billing practitioner, including substance use disorders, that, in the clinical judgment of the billing practitioner, warrants BHI services.

The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time.

CPT Reimbursement Codes for BHI Service:

The CPT code used to report BHI services is,

CPT Code 99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional.

References:

https://signallamphealth.com/2021-medicare-cms-chronic-care-management-ccm-cpt-code-updates/

https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1

https://college.acaai.org/new-principal-care-management-cpt-codes/#:~:text=G2064%20requires%2030%20minutes%20of,is%20%2452%2Fpatient%2Fmonth

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/transitional-care-management.htm

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf

[phgq]

Anti-corruption task force to evaluate all complaints next week

#PHnews: Anti-corruption task force to evaluate all complaints next week

MANILA – The Department of Justice (DOJ) on Friday said it would start sorting complaints received by the task force on corruption next week.

"All complaints so far received by the task force against corruption secretariat are now being screened and evaluated. I will call a meeting of the main task force next week to identify which of these complaints will be the subject of special investigating teams," Justice Secretary Menardo Guevarra told reporters when asked on the status of the complaints including those involving government officials and employees who are not part of the executive department.

The DOJ chief said a "general" update on the cases will be released next week on the cases.

"I do not wish to give special attention to any particular class of potential respondents," Guevarra said.

On Wednesday, Guevarra said he received instructions on going after public officials, who do not belong to the executive department, in the course of the investigations into corruption allegations.

"The President (Rodrigo Duterte) stated that if the involvement of a member of Congress, for instance, is germane to the anomalous transaction, then the latter’s inclusion in criminal charges will have to be endorsed to the Office of the Ombudsman through the Secretary of Justice," Guevarra said in a message to reporters.

Guevarra added that "when it comes to criminal investigation and prosecution, no one is exempt, except those enjoying immunity from suit during their tenure".

"The rule is different in administrative cases. the President has neither supervision nor control over other branches of the government and therefore may not investigate them for misconduct, dishonesty, and the like, as he (Duterte) correctly pointed out," he added.

In a public address on Monday night, President Rodrigo Duterte said he would refer to the Office of the Ombudsman information he received about some members of the House of Representatives who allegedly received kickbacks from project contractors.

Duterte bared that he received a list of lawmakers who were allegedly involved in corruption in projects in the Department of Public Works and Highways (DPWH).

He said the list was given to him by Presidential Anti-Corruption Commission (PACC) Commissioner Greco Belgica.

However, he refused to investigate and name these lawmakers saying he has no jurisdiction over members of a co-equal branch of government. (PNA)

***

References:

* Philippine News Agency. "Anti-corruption task force to evaluate all complaints next week." Philippine News Agency. https://www.pna.gov.ph/articles/1123207 (accessed November 28, 2020 at 01:51AM UTC+14).

* Philippine News Agency. "Anti-corruption task force to evaluate all complaints next week." Archive Today. https://archive.ph/?run=1&url=https://www.pna.gov.ph/articles/1123207 (archived).

[nox-lathiaen]

Attorney - Senior Counsel - Healthcare Law - Woodbridge, NJ

Apply legal expertise in healthcare law, including FDA regulatory proficiency and commercial contract experience to advise clients of a North East USA Multi-Office Regional Law Firm. Serve as legal counsel to various clients, advising on structuring and negotiating agreements, dispute resolution, and legal strategy impacting business decisions. Advise clients to promote compliance with industry standards of conduct and ethics, including fraud and abuse, anti-bribery, ant-kickback, and Foreign Corrupt Practices Act (FCPA). Provide advice to clients on legal risks of key business decisions that support strategic initiatives. Negotiate and draft complex commercial contracts and other commercial agreements. Manage prosecution and defense of legal claims, including managing the process and working with clients to ensure efficient and effective outcomes. Receive competitive starting compensation with full medical, dental and vision benefits along with matched 401(k) and performance bonus. Paid time off for personal days, vacations and holidays. Tuition reimbursement for continued education and paid training provided. For complete details contact Greg Foss at: (609) 584-9000 ext 270 Or submit resume online at: dmc9.com/gbf/app.asp Or email to: 1000043988_10006796 AT najbcareers302.com Please reference #39406112 when responding. Education Requirements: Doctorate degree Minimum Experience Requirements: 5-10 years Job City Location: Woodbridge Job State Location: NJ Job Country Location: USA Salary Range: $250,000to $350,000 Diedre Moire Corporation, Inc. Diedremoire_dot_com WE ARE AN EQUAL OPPORTUNITY EMPLOYER and our employment decisions are made without regard to race, color, religion, age, sex, national origin, handicap, disability or marital status. We reasonably accommodate individuals with handicaps, disabilities and bona fide religious beliefs. Jobs Career Position Hiring. CONSIDERED EXPERIENCE INCLUDES: Attorney Counsel Lawyer Healthcare Compliance Regulatory Compliance Healthcare Law #DiedreMoire #AttorneyJobs #JobSearch #JobHunt #JobOpening #Hiring #Job #Jobs #Careers #Employment #jobposting DISCLAIMER: We will make every effort to consider applications for all available positions and shall use one or more of the contact methods and addresses indicated in resume or online application. Indicated location may be proximate or may be desirable point of embarkation for paid or unpaid relocation to another venue. Job descriptions may fit single or multiple presently available or anticipated positions and are NOT an offer of employment or contract implied or otherwise. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers. Linguistics used herein may use First Person Singular and First Person Plural grammatical person construction for and with the meaning of Third Person Singular and Third Person Plural references. We reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Response to a specific posting or advertisement may result in consideration for other opportunities and not necessarily the incentive or basis of the response. Nothing herein is or may be considered a promise, guarantee, offer, pledge, agreement, contract, or oath. If you submit an application or resume which contains your email address, we will use that email address to communicate with you about this and other positions. We use an email quality control service to maintain security and a remove and dead address filter. To cancel receiving email communications, simply send an email from your address with the word "remove" in the subject line to pleaseremove_AT_candseek4.com Or, visit the website at jobbankremove_dot_com. If you have further concern regarding email received from us, call (609) 584-5499. Reference : Attorney - Senior Counsel - Healthcare Law - Woodbridge, NJ jobs Source: http://jobrealtime.com/jobs/technology/attorney-senior-counsel-healthcare-law-woodbridge-nj_i9568

[jobsaggregation2]

Attorney - Senior Counsel - Healthcare Law - Woodbridge, NJ

Apply legal expertise in healthcare law, including FDA regulatory proficiency and commercial contract experience to advise clients of a North East USA Multi-Office Regional Law Firm. Serve as legal counsel to various clients, advising on structuring and negotiating agreements, dispute resolution, and legal strategy impacting business decisions. Advise clients to promote compliance with industry standards of conduct and ethics, including fraud and abuse, anti-bribery, ant-kickback, and Foreign Corrupt Practices Act (FCPA). Provide advice to clients on legal risks of key business decisions that support strategic initiatives. Negotiate and draft complex commercial contracts and other commercial agreements. Manage prosecution and defense of legal claims, including managing the process and working with clients to ensure efficient and effective outcomes. Receive competitive starting compensation with full medical, dental and vision benefits along with matched 401(k) and performance bonus. Paid time off for personal days, vacations and holidays. Tuition reimbursement for continued education and paid training provided. For complete details contact Greg Foss at: (609) 584-9000 ext 270 Or submit resume online at: dmc9.com/gbf/app.asp Or email to: 1000043988_10006796 AT najbcareers302.com Please reference #39406112 when responding. Education Requirements: Doctorate degree Minimum Experience Requirements: 5-10 years Job City Location: Woodbridge Job State Location: NJ Job Country Location: USA Salary Range: $250,000to $350,000 Diedre Moire Corporation, Inc. Diedremoire_dot_com WE ARE AN EQUAL OPPORTUNITY EMPLOYER and our employment decisions are made without regard to race, color, religion, age, sex, national origin, handicap, disability or marital status. We reasonably accommodate individuals with handicaps, disabilities and bona fide religious beliefs. Jobs Career Position Hiring. CONSIDERED EXPERIENCE INCLUDES: Attorney Counsel Lawyer Healthcare Compliance Regulatory Compliance Healthcare Law #DiedreMoire #AttorneyJobs #JobSearch #JobHunt #JobOpening #Hiring #Job #Jobs #Careers #Employment #jobposting DISCLAIMER: We will make every effort to consider applications for all available positions and shall use one or more of the contact methods and addresses indicated in resume or online application. Indicated location may be proximate or may be desirable point of embarkation for paid or unpaid relocation to another venue. Job descriptions may fit single or multiple presently available or anticipated positions and are NOT an offer of employment or contract implied or otherwise. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers. Linguistics used herein may use First Person Singular and First Person Plural grammatical person construction for and with the meaning of Third Person Singular and Third Person Plural references. We reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Response to a specific posting or advertisement may result in consideration for other opportunities and not necessarily the incentive or basis of the response. Nothing herein is or may be considered a promise, guarantee, offer, pledge, agreement, contract, or oath. If you submit an application or resume which contains your email address, we will use that email address to communicate with you about this and other positions. We use an email quality control service to maintain security and a remove and dead address filter. To cancel receiving email communications, simply send an email from your address with the word "remove" in the subject line to pleaseremove_AT_candseek4.com Or, visit the website at jobbankremove_dot_com. If you have further concern regarding email received from us, call (609) 584-5499. Reference : Attorney - Senior Counsel - Healthcare Law - Woodbridge, NJ jobs from Latest listings added - JobsAggregation http://jobsaggregation.com/jobs/technology/attorney-senior-counsel-healthcare-law-woodbridge-nj_i8896

[chirpingtiger]

Bruce Wayne not only donates his own money to charities in very large amounts on a regular basis, but he does it unprompted.

Tony only donates when he needs a PR boost to get himself back into the public favor. And he does so with mass media coverage and his name plastered across all of it.

It's not philanthropy, it's marketing.

Bruce Wayne is usually very subtle about all his donations, with one very notable exception: his charity balls.

These are big and fancy and expensive, with tons of news coverage and a lot of wealthy and famous people in attendance.

It is, in short, your typical Tony Stark party.

But unlike Tony's parties, which are about making himself more weapons deals and getting himself more fame, Bruce uses his parties to collect massive amounts of monetary donations from all of the wealthiest people in the city - people who would not otherwise be donating to charity.

Bruce Wayne or the Wayne foundation run practically every charity and nonprofit organization in the entire city of Gotham.

Tony only makes one-off donations to get himself back in the public's favor.

There's also the matter of where their money is coming from.

Bruce gets his money from infrastructure, running companies in Gotham, and legitimate business.

Tony's billions are all blood money.

Whenever Bruce makes a new discovery, he immediately tries to implement it to help the whole city.

Tony is shown in canon discovering a way to make infinite energy with his father's reactor formula, and what does he do?

Uses it to power his own building so he doesn't have to pay for electricity anymore, and doesn't do anything else with it.

The anti crowd isn't arguing whether or not Tony has donated money. We're questioning his motives for doing so, the self-serving kickback he gets from his very public "donating," and his mentality when it comes to how he sees other people as expendable and beneath him - as pawns whose misfortune can be used for his gain.

Because Bruce will always put others before himself, and respects their dignity as people before their social or economic status.

Tony would throw just about anyone under the bus if it saved his ego.

(Example: Infinity War)

Honestly, Tony stans are just attacking Bruce Wayne because they know he'd be 110% team cap if something like the accords ever cropped up in his universe.

tony stark is just such a stupid character. hes like if batman sucked. literally every one of the avengers has powers that make them basically unstoppable but tonys like “i have enough money to solve poverty but im going to help the american imperial machine instead”

[marymillera6]

What are rebates and why should we care?

A common refrain is that drug prices are too high. The question is, which price? List prices–i.e., the sticker price–almost no one pays. Patient copayments are set by health plan generosity and often are loosely correlated with the price a health plan pays. Any what does the health plan pay?

To simplify, health plans pay the list price, but then negotiate rebates from manufacturers in exchange for volume (i.e., sales) or generous formulary placement. A white paper by ICER provides a nice historical overview:

Prior to 1996, manufacturers offered discounts to health plans for their drugs, while charging an undiscounted list price to wholesalers and pharmacies. Wholesalers would then bill the manufacturer for the difference between the amount they purchased the drug for from the drug manufacturer, and the amount they were reimbursed for the drug, as determined by the discounted rate negotiated by the health plan. This was known as a chargeback. Pharmacies, however, had no direct relationship with drug manufacturers and could not negotiate similar discounts, or chargebacks.

After a class action law was brought by the pharmacies, manufacturers could no longer discriminate against pharmacies. However, a 1996 law gave safe harbor to drug manufacturers to the Anti-Kickback Statue to allow them to pay rebates to health plans.

And boy have rebates grown over time. The ICER report uses data from CVS and shows that rebates as a percentage of list price have grown from 13% in 2011 to 30% in 2017. Large list prices may mean higher out-of-pocket costs for consumers, particularly those with large deductibles or cost sharing mechanisms.

From the Institute of Clinical and Economic Review

How rebates work does vary across payers in the U.S. Medicaid, for instance, receives either the lower of either a minimum 23.1% rebate off the average manufacturer price (AMP) for branded drugs or the “best price” offered to any other payer–public or private. State Medicaid Agencies can negotiate even steeper rebates in additional to the federal minimums. Why would manufacturers accept such steep rebates? Well, manufacturers who do not sell drugs to Medicaid are excluded from selling the same drug to Medicare by law. In Medicare Part D, the government and beneficiaries pay premiums for drugs, but the drug coverage is actually administered by private insurers. These private plans negotiate rebates with manufacturers without government involvement, but rebates accrued must be reported and paid to the government. Rebates in Medicare Part D are typically higher than individuals with commercial insurance. For private health plans, pharmacy benefit managers (PBMs) often negotiate rebates for private payers, and PBM reimbursement typically comes as a percentage of these rebates. Thus, PBMs prefer that drug list prices stay high so they can negotiate large rebates. However, some payers are requiring PBMs to pass through all rebates and instead PBMs would be paid directly by the health plans.

A survey report from the Pharmacy Benefit Management Institute (PBMI) reported that just under half of employer respondents said they received 100% of rebates (either with a minimum rebate guarantee [27%] or without [22%]), a significantly higher percentage than similar estimates from 2014.

Interestingly, based on an ICER survey, pharmaceutical firms were more likely to support transparency (only 14% preferred confidential pricing) whereas most PBMs prefer confidentiality (66%)