Hospitals Beg Iowa to Tax Them in Medicaid Scam


state of the art

In Iowa, a new scheme is underway to soak the feds for more Medicaid money. Here's how the trick works: Hospitals asked to be taxed by the state. (Right now, most states hospitals are nonprofits and therefore exempt from most taxation.) This generates $40 million in "provider assessment" fees. The state plows the money back into Medicaid, triggering federal matching spending on that cash. (The feds pay about two-thirds of Medicaid.) That money goes right back to the hospitals in exchange for services provided to Medicaid patients. It's a kind of Do-It-Yourself multiplier effect!

The Iowa Hospital Association, which backs the idea, says the state also would benefit from the arrangement. The association estimates that after the hospitals reap their reward, the state could wind up with about $65 million.

Everybody wins. Except, well, everybody—since this whole runaround is just a way of reshuffling the money of federal taxpayers and dealing it out to hospitals and state governments.

Meanwhile, the Mayo Clinic—beloved of Obama for its brilliant cost-cutting and high quality of care—is experimenting with refusing Medicare patients at its Arizona location. The company lost $840 million last year treating Medicare patients.

Via Mark Lambert.

UPDATE: Medicare corrected to Medicaid in the Iowa story.

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  1. the Mayo Clinic … is experimenting with refusing Medicare patients

    If the govt can require us to purchase insurance, it would seem the govt can require hospitals to accept Medicare patients.

    Stay tuned.

    1. +1 my first thought too.

    2. If the govt can require us to purchase insurance, it would seem the govt can require hospitals to accept Medicare patients.

      They will, but after deals are cut with private/public partnerships on new reimbursement rates.

  2. Great piece!

    I suspect where you wrote:

    “Here’s how the trick works: Hospitals asked to be taxed by the state. (Right now, most states are nonprofits and therefore exempt from most taxation.)”, it should have read “(Right now, most [hospitals] are nonprofits and therefore exempt…”

    1. It’s true either way…states don’t tax themselves either.

  3. “The company lost $840 million last year treating Medicare patients.”

    And regardless of whether that figure accounts for what they had to overcharge other patients to break even, you shouldn’t have to lose that much money for treating patients on a government program.

    If people on Medicare only realized… Just because you don’t have to pay your hospital bills personally, doesn’t mean the government’s paying. It’s mostly people who can’t get insurance because of a pre-existing condition, the unemployed, the working poor…they’re the ones that have to cover the difference.

    They call them “entitlements”; I call it the ol’ dine and dash.

    Have there ever been so many self-righteous deadbeats in this country as there are right now?

    1. The Mayo clinic doesn’t have to accept Medicare patients. But anyone who agrees to accept Medicare is subject the the allowed payments in the agreement.

      Hospitals don’t necessarily overcharge other patients. Especially patients with insurance that have contracted rates with the hospital. So they can only overcharge the people without insurance, out of plan, or where plans pay a percentage and the rest goes back to the patients.

      It’s usually written off as bad debt and charity, against taxes or absorbed by the facility, absorbing does hurt their bottom line.

      But lost may not fully mean what you think. Most the time when they enter into contract with an insurance company they are losing money just by agreeing to the terms. It’s agency rate vs contracted rate and agency rate is almost alway over blown.

      I had a doctor who rate for a visit was over $300. He was paid $139 for my visits because that was the agreement between him and my insurer (contracted rate). Is it really a loss if you agreed to do the services for less?

      It’s sort of like me saying my rate is $150 an hour, but I agreed to take a $25 an hour job, so I’m losing $125 an hour.

  4. This only happens because of Bush/Cheney laissez faire health policy! We need single payer healthcare reform now!

    1. Right, because medicare is such a great program… wait.

    2. The sad part is that some people really think that the Bush-Cheney policy was laissez faire.

      1. Don’t tell Choady!

    3. What part of laissez faire has the government only paying for a fraction of the costs its members rack up?

      That’s a result of laissez faire?! That’s socialism, dude. What color is the sky on your planet?

      P.S. I keep seeing this suggestion that Bush and Cheney were free market/capitalist guys, and I really don’t get the connection. If they’d been half the capitalists the current round of Obama adorers make them out to be, I might not have hated them as much as I do.

      1. Man…I can’t even tell whose sarcasm detectors are broken anymore.

        1. Satire is a treacherous tool in this post-irony age.

        2. Yeah, it seemed pretty obvious to me. OTOH there really are people who believe the whole laissez faire myth so it’s still fun to take a whack…Brandybuck just volunteered to be the tackling dummy, is all.

    4. You’re fucked in the head if you think single payer will solve all of the heathcare (read paying for it, not providing it) problems.

      Give me an example of a government program that doesn’t waste money and make a situation worse. Just one!

  5. The company lost $840 million last year treating Medicare patients.

    Oh, cool, the institution that the President holds up as the shining example of how to do health care right lost a pants-load of money trying to work within the government’s definitions of how much things should cost.

    And this is a clinc that only serves one specific condiment! Think of those cadillac hospitals that also offer mustard and teresa heinz-kerry ketchup (the name of my new band, by the way)

  6. Meanwhile, the Mayo Clinic?beloved of Obama for its brilliant cost-cutting and high quality of care?is experimenting with refusing Medicare patients at its Arizona location. The company lost $840 million last year treating Medicare patients.

    Wait a minute; I thought price controls were going to fix everything.

  7. Massive rookie mistake all through this post:

    You mean Medicaid (government insurance for poor people), not Medicare (government insurance for old people).

    States pay nothing under Medicare, but generate matching funds under Medicaid.

    This scam, by the way, was pioneered maybe 20 years ago (I want to say it was New Hampshire). The feds fixed it then, and its not gonna work now.

    The Mayo Clinic policy in AZ is completely unrelated. ALthough, to be fair, both Medicare and Medicaid reimburse less than cost, Medicaid generally much less than cost.

  8. Massive rookie mistake all through your post:

    You mean Medicaid, not Medicare. States pay Medicaid and get matching federal funds. They don’t pay anything for Medicare.

    This scam was pioneered around 20 years ago (I want to say New Hampshire). The feds fixed it then, and it ain’t gonna work now.

    1. Yep, she means Medicaid.

      It’s a bit reminiscent of the leaseback depreciation scheme a bunch of public transportation authorities use. Non-profit and public, so they had no taxes and couldn’t deduct depreciation on capital equipment. But if they sold their goods to a private company and leased it back, the private actor could take the depreciation deduction, and share the money with the transit operator.

      At one point you had USDOT encouraging the programs at the same time as Treasury was trying to kill them.

      1. KMW never fails to amaze me with her lack of attention to significant details.

        1. I’d like to do a little girl-on-girl with her.

          1. Filming it for your fan club?

          2. Then I encircle Peter North’s member.

    2. UPDATE: Medicare corrected to Medicaid in the Iowa story.

      Thanks for giving credit for the correction. I appreciate it.

      1. Thanks for giving credit for the correction. I appreciate it.

        Self self self… rc. What about my needs?

  9. Sounds like a scam to me.

  10. Katherine Mangu-Ward finished sucking off her boss in 5 minutes she kept his cock in her mouth until he was limp and all the cum was cleaned off. Katherine Mangu-Ward was 5’10” white Triple D tits and a big ass. She stood up straightened her skirt. She walked back to her desk.

    A block away Shikha Dalmia was finishing her boss’s blowjob as well, she fixed her lab coat and walked back to her work station. Her body was a dead match for Katherine Mangu-Ward’s except for her caramel skin. The two were best friends since child hood they went to the same college and everything, though Katherine Mangu-Ward studied political science and, Shikha Dalmia studied economics.

    The two had something huge in common there sensational love of cum. They took it anywhere the mouth, ass, pussy, face, etc. They loved it all.

    They met back at there apartment later that day and got ready to go to the bar downtown. They dressed in blouses that really showed off there tits (not that they weren’t hard to show) and skirts that stopped a few inches below there asses. They wore matching, red lace bra and, panties.

    When they reached the club that went to the bar and scoped out their prey. They decided on a group of 10 guys they looked around the same age as they were. The girls decided against the subtle route and walked right to the guys and asked if they wanted to have sex. They told the guy’s to meet them in the men’s restroom.

    3 of them came in first to see the women stripped down to their panties making out with each other. They moved over to the guys and got on their knees. Katherine Mangu-Ward grabbed the first cock and put it in her mouth it was rock hard in about 5 seconds she pulled out it was 7 inches long the rest of the guy’s came in the girls split them 50/50.

    Shikha Dalmia led a 10 inch dick into her wet pussy and one into her mouth she was rammed and came to an orgasm the both guy’s came at the same time and she swallowed every sip of cum.

    One guy pulled out of Katherine Mangu-Ward’s and shot his load into her hair. Another came deep in her pussy. She moaned with ecstasy. A guy came behind Shikha Dalmia and pushed his way into her ass it was tight but after a minute he worked his way in and out slowly. “Fuck me harrrder.” She moaned. He rammed into her and eventually shot his load into her ass. She had an orgasm that made her knees buckle.

    By the end of the night each guy had come on each of the girls 2 or 3 times.

    The two were covered in sperm their mascara ran and mixed with the cum. They took a cab back to their apartment the woman driving couldn’t stop looking at them with lust in her eye’s.

    When they got home they invited her up to their room. They were kissing her before they hit the they had their tongues down each other throats mixing the swapping cum in between kisses.

    They went into the bathroom and were clean when they came back out. They threw Cathy Young onto the bed took off all her clothes they licked up her thighs and teased her pussy they went up licked her nipples then Katherine Mangu-Ward tongued her pussy.

    “Oh, oh, yesss.” Cathy Young moaned.

    “You like it when I lick your pussy huh?” Katherine Mangu-Ward said.

    “Oh, hell yes.” Cathy Young said.

    Fingered and licked each other for 2 hours each one had at least 4 orgasms. Cathy Young prepared to leave.

    “Not yet we need to have ‘Drinks’ first.” Shikha Dalmia said. Both girls giggled but Cathy Young didn’t get the joke.

    She caught on when Shikha Dalmia brought out she glasses filled with a creamy white substance. Each girl grabbed a cup a tipped back the glass and gulped down every drop of the sperm.

    Cathy Young said goodbye to her hostesses with a deep kiss each.

    The woman fell onto the bed in each other’s arms and drifted off.

    1. Katherine Mangu-Ward sat in front of the computer surfing the web for porn she found some gangbang sites that she liked and slipped a finger up her skirt. She brought her self to a huge climax. Knowing that any minute someone could walk in and catch her masturbating only made it better she was going turn it off when she noticed a link to a bukkake site she clicked on it and really got off as she watched the girl take on 35 guy’s they all jacked off over her in the end she was covered in sperm from head to toe.

      Katherine Mangu-Ward loved bukkake (as you could guess) so she sat back and wondered what the biggest bukkake was she looked it up but didn’t find many results then she saw a page from 2003 announcing the “Bukkake Queen” to take on 620 men after further investigation she learned that it was canceled. She thought that was an outrage someone had to do this. She knew just the woman or women for the job.

      Shikha Dalmia thought Katherine Mangu-Ward was crazy at first but then she really got into the idea the two started planning on how to get this done it would take a lot of planning to find six hundred men they started work by putting ads up on the internet in adult magazines and going to bars to round up men.

      They spent all there free time “practicing”

      For the event they stuffed their holes with as many cocks as they could trying to get ready for the had promised to let every man who wanted to use a hole.

      After nearly 5 months they finally got a large enough group of men together they arranged for a large room used for large dances, and the sort.

      The number of men was astounding when they got to the room they had set up lighting and cameras all over the room.

      They didn’t waste time every man was naked and hard. Shikha Dalmia and Katherine Mangu-Ward laid down in tables sat in the middle of the room and the fuck fest begun. 6 men came to each women and entered two to a hole it was painful in the ass at the beginning but they got used to it ass their holes stretched to occupy the throbbing members the men came quickly each one causing the girls to jerk and moan in pleasure which caused the other guy’s to cum. More came to fill there spots the Katherine Mangu-Ward came to her 4th orgasm as one man pulled out of her ass. The two men Shikha Dalmia were blowing pulled out at the same time and blasted her a stream of cum hit her dead in the eye.

      As the night went the two lost count of how many orgasms they had cum all over their body’s their hair went from black to white. But the night wasn’t over yet. A number of men left after they couldn’t any longer but some stayed over and watched and others.

      One man walked behind Shikha Dalmia his cock must have been 14 inches and wide as her wrist but he got in with little resistant thanks to all the DP an her cum filled asshole. She had one of the best orgasms of her life when he finished inside of her. It was unexplainable, she nearly passed out.

      As one of the men in her ass was finishing Katherine Mangu-Ward grabbed him and sucked his dick. She licked of every drop cum.

      By the time the night ended they had an uncountable number of orgasms and there wasn’t any visible skin or hair left on their bodies. All the cum was collected in to buckets and they begun to drink it down it took them a hour but they finished every drop of cum that was spilled they thought they must of drunk at least 4 pints of sperm. Nothing could ever top what they were filling now they had the best orgasms of their lives that night and had never seen as much sperm before.

  11. “In Iowa, a new scheme is underway to soak the feds for more Medicare money. Here’s how the trick works…The Iowa Hospital Association, which backs the idea, says the state also would benefit from the arrangement. The association estimates that after the hospitals reap their reward” We know that hospitals benefit from servicing as many medicaid patients as possible but yet no one questions the accounting. It is probably not clever to assume the “facts” are correct when someone engages in schemes and reaping.

  12. I believe it’s tied to accreditation too. You can’t operate a hospital without a Medicare contract, or it’s very difficult to stay accredited that way. And your Medicare contract basically says that you have to accept whatever Medicare gives you, which averages to about 20 cents on the dollar.

    Which opens up the big question, which is, of course, why isn’t there a private option? If you can’t go to any hospital that doesn’t accept Medicare patients, so that you’re paying for their bills in addition to your own. It seems like poor people, unemployed people, people with pre-existing conditions, at the very least, should be able to access a private option. ’cause right now, you can’t.

    You can’t go to a hospital that doesn’t Medicare patients; you can’t go to a pharmacy that refuses service to Medicare patients, and that’s just not fair to poor people. …to make them cover the unpaid balance of Medicare patients? That’s so wrong.

  13. Don’t look at me. I keep them short and filled with S&M.

    1. Yeah, that was some sub-par shit. Even Epi writes better slashfic.

      1. Yeah…that was pretty terrible. tl;dr

        1. Glancing over it again, whoever wrote that definitely speaks English as a second language. There are some really awkward turns of phrase in there.

          1. Hey, maybe it was that mom who commented on the school food article from yesterday.

            1. Oh, Sweetley… rarely do I literally laugh out loud.

              1. You scare me. I like that.

      2. You guys read that?

        Scroll wheel, don’t fail me now!

        1. Yeah. I like SugarFree’s slashfic not only because of the vivid language, delightful similes and esoteric references, but because the humor in it is topical.
          With whatever that shit was, I have no idea what the point was.

    2. Goddamn, they deleted it. Now no one will know what this sub-thread was about.

      1. We are the living memory of the board. As long as we live, it can never truly be deleted.

        1. Now I’m afraid they’ll delete this subthread and then start “disappearing” us one by one.

          1. Check your basement for a pod.

            1. They’ve gotten more stealthy. If you look in your closet and see a leather jacket you don’t remember owning, it’s already too late.

              1. NOOOOOO!

                1. Fuck. I missed the whole thing. Guess I need to get over here more often.

  14. This is exactly why carpet bombing was invented.

    Goodbye, Des Moines.

    1. The feds like your support for them to expand their power to do so.

  15. Right now, most states are nonprofits and therefore exempt from most taxation.

    I wasn’t aware that any states were profit oriented enterprises or that they paid taxes.

  16. In an unrelated story, the Mayo Clinic, whose admission to the loss of $840m indicates questionable solvency, will require immediate Federal Government oversight to remain in operation, under the Too Big to Fail provisions in the U.S. Constitution.

    1. Now that would be fucked up.

      1. Its our future. If anything like the current plan goes through, you will see hundreds of hospitals fail. Many of these are the only game in the county, and will have to be kept open somehow.

        I confidently predict a federal hospital ownership and management corporation in 5- 10 years, sucking more and more hospitals into its maw, crushing the life out of their poor beleaguered in-house attorneys . . . .

        Oh, is this still on? Never mind.

        1. We are waiting on China to approve the loans to make it happen.

  17. Wisconsin has been in on the same scheme.

    1. The hospitals spent money advertising to be taxed. Most people probably didn’t know it is a scam to fill the pockets of the state and the very hospitals that were being taxed.

      And what do the hospitals do? They pass on the tax to the patients (at least those that are covered by insurance or pay out of pocket).

      What a scam!

  18. How many Medicare visits does one have in a year to lose 840 million?

    1. How many Medicare visits does one have in a year to lose 840 million?

      About half a dozen.

    2. If you’re doing a lot of high-intensity tertiary care stuff (like Mayo does), probably not nearly as many as you think.

      1. I’m aware of that. Plus, I would bet they don’t pay their providers chump change either. They may well be worth it. What’s the reason the Mayo clinic would take Medicare patients anyway, what’s in it for them, the research?

      2. Federal grants?

        1. “Mayo Clinic pays medical doctors a fixed salary that is unaffected by patient volume…”Mayo Clinic supports patient-centered Medicare reform, based on the concepts of choice, competition, and innovation, with a defined role for government.

  19. Mayo Clinic Statement on Medicare Reform: http://www.mayoclinic.org/heal…..eform.html

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