‘Scootering’ all of the way to the bank

Motorized wheelchairThe Medicare program has been a target for scammers since its inception in 1965. Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.

Doctors billed the program for exams that they did’t give. Millions of dollars were paid out to doctors and other medical professionals for counseling sessions. Then we had Russian diplomats scheming to get their healthcare costs covered by Medicaid.

Once of the most profitable scams was the motorized wheelchair. From 1999 Medicare has paid out $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people. Today, the government cannot even guess at how much of that money was paid out to scammers.

The scam was simple and extremely profitable for the crooks. They simply set up a medical-supply company and ginned up bogus bills. Saying that they’d provided expensive wheelchairs to Medicare patients, who, in reality, didn’t need wheelchairs at all, the scammers then pocketed the huge markup that the government paid on each chair.

And what a markup! “Let me put it to you this way: An $840 power wheelchair, Medicare pays close to $5,000 for. So there’s a huge profit margin there. Huge,” said one California man who participated in a recent fraud scheme involving wheelchairs.

But now the government is on to the scammers and this once-profitable scheme is slowly fading away. But scammers are truly inventive and they come up with new schemes everyday.

In Brooklyn, for instance, the next big thing is shoe inserts. Scammers bill Medicare for a $500 custom-made orthotic, according to investigators. They give the patient a $30 Dr. Scholl’s inserts.

While it lasted, the scooter scam illuminated a critical problem in the federal bureaucracy: Medicare’s weak defenses against fraud. The government knew how the wheelchair scheme worked in 1998. But it wasn’t until 15 years later that officials finally did enough to significantly curb the practice.

Fraud in Medicare has been a top concern in Washington for decades, in part because the program’s mistakes are so expensive. In fiscal 2013, for instance, Medicare paid out almost $50 billion in “improper payments.”

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Educating Undocumented Students

Tiny illegal immigrantThe latest immigration crisis, floods of children coming over the border, has American in a real quandary. On the one hand many Americans are in favor of sending these children back to the countries of origin.

At the same time, Americans are a compassionate people. They are loathe to deny these illegal immigrants a basic education. But educating children is an expensive proposition. Across the nation the average cost to educate a child is $10,500.

Of course, this doesn’t take into account the increased cost for English as a Second Language programs. As of 2009, about 70,000 children of illegal immigrants were enrolled in special English instruction classes, adding another $440 million for taxpayers, according to the Federation for American Immigration Reform.

The new school year will soon be in session, and according to USA Today, possibly overcrowded. Federal law mandates that all children enroll in public school this fall, including an estimated 50,000 undocumented immigrant children.

As the border crisis comes to the classroom, states are rushing to prepare by hiring more teachers and even opening new schools. Here’s a video report from USA Today.

In the state of Virginia well over 2,000 illegal immigrants have been placed in homes throughout the state. Most have gone to the homes of relatives. Starting this week they will be enrolled in public schools all over the state.

But helping enroll school-aged children who aren’t citizens, as federal law requires, is just a typical part of the school year for those such as Gladis Bourdouane, communications director for family engagement and public information for Arlington County Public Schools.

For us, we’ve been doing this forever. This is nothing new. Our practices continue to remain the same. We have very good processes in place. For us, this is business as usual.

This casual attitude by one education bureaucrat begs the question: who will pay the additional cost for all of these students? Why, the American taxpayers will pay as they usually do?

Not only will we have to pay for the education expenses but children without citizenship or visas are eligible for free or reduced lunch through the National School Lunch Program, a program that cost Americans $11.6 billion in 2012.

What does this all mean for the deportation of these minor children? The longer that they remain in this country the more difficult that it will be to send them back. By the time they have deportation hearings and endless appeals it will be almost impossible to send them back.

And who knows if this administration or future administrations will have the courage to deport children who have become woven into the fabric of America?

America is a nation of immigrants. Somewhere along the line we or our ancestors were immigrants. Many immigrants were told that the streets of America were paved with gold.

Of course, the streets weren’t literally paved with gold but for the immigrants and their descendants they made their futures in this land of opportunity.

I am reminded of a Sicilian bootmaker who came here in 1895. Within two years he sent for his wife and five children. His family prospered through four generations.

An earlier immigrant came here from Ireland with his brother because they had no future in the country of their birth. Both men defended this country on the battlefields of the Civil War, seeing the best and the worst of America.

Eventually the son of the bootmaker married the granddaughter of the Irishmen. I am just one of their 11 grandchildren.

You see what I mean about having a quandary about these children. George Will, the well-known conservative has said that we should welcome these children to the fabric of America. After all we’re talking about a mere drop in the melting pot of America.

You decide.

 

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Inspectors General Say Obama Administration Obstructing Justice

Lies Obama Told UsThis post from Hans von Spakovsky of the Heritage Foundation says it all about the Obama administration’s lack of transparency. When 73 Inspectors General say Obama administration is obstructing justice it’s time that we realize they are hiding something.

In an unprecedented letter, a majority of the federal government’s inspectors general (IGs) claim that the Obama administration is obstructing their investigations into government mismanagement and corruption. So much for President Obama’s claim that his would be the most transparent administration in history.

And it truly IS unprecedented. Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee, says “there has never been a letter even with a dozen IGs complaining” about such obstruction by an administration. The fact that the Justice Department’s IG, Michael Horowitz, also signed on is particularly revealing. After all, it is the duty of senior executive officers like Eric Holder to advise subordinate officials that they are obligated to cooperate with the IGs of their agencies.

On Aug. 5, 47 of the federal government’s 73 inspectors general, many of whom were appointed by President Obama, sent their letter to Issa, Sen. Thomas Carper (D-Del.), and the ranking members of the House Oversight and Government Reform and Senate Homeland Security and Governmental Affairs Committees — essentially pleading with Congress to help the IGs do their jobs uncovering waste, mismanagement, fraud, and corruption within their respective agencies.

In the letter, the IGs complain about the “serious limitations on access to records that have recently impeded the work” of IGs at the Peace Corps, the EPA, and the Department of Justice. Administration lawyers have construed laws related to privilege in “a manner that would override the express authorization contained in the IG Act” and seriously impede the “ability [of the IGs] to conduct our work thoroughly, independently, and in a timely manner.”

According to the letter, the Justice Department withheld “essential records” in three different reviews, despite the fact that such records had been produced for the DOJ IG “in many prior reviews without objection.” Michael Horowitz eventually got access to the files, it seems, but not because Department officials realized they were misinterpreting the IG law in withholding access. No, Horowitz got the records only after DOJ leadership decided that “the three reviews were of assistance to the Department of Justice’s leadership.”

In other words, Attorney General Eric Holder and his political subordinates only gave the IG access to these records because they decided there was nothing in them that would prove embarrassing.

This is in blatant disregard of the Inspector General Act passed by Congress in 1978. As the IGs point out, Section 6 of the IG Act gives IGs access to “to all records, reports, audits, reviews, documents, papers, recommendations, or other material available” to the agency involved. Neither Eric Holder nor the head of any other federal agency has the right to withhold documents or other records relevant to an investigation from the IG for any reason unless another federal law “expressly so states,” let alone because that official thinks such records might reveal wrongdoing, ethical improprieties, or other embarrassing information.

A Justice Department spokesmanstated that “because the documents at issue included grand jury material, credit reports, and other information whose dissemination is restricted by law, it was necessary to identify exceptions to the laws to accommodate the inspector general’s request.” However, that is a poor excuse to stonewall or slow-walk the Inspector General’s inquiry.

As Prof. Ronald Rotunda, one of the leading ethics experts in the country, says in his treatise on “Legal Ethics – The Lawyer’s Deskbook on Professional Responsibility,” while a government lawyer does have an attorney-client privilege with his client, that client is the government. Therefore, the government lawyer cannot assert the privilege to refuse to divulge information “when it is the government itself that is seeking the information.”

Thus, any privilege doctrine — whether it be attorney-client, grand jury secrecy, or premised on some other privacy interest — does not generally prevent lawyers within DOJ from providing confidential information to the lawyers working in the IG’s office, who are also DOJ employees.

Gerald Walpin, the former IG of Americorp who was fired after he filed a report accusing a political supporter of President Obama of misusing an Americorp grant for personal use, says that he is “not surprised that this administration employs any means to thwart IGs’ performance of their important job.” He calls the privilege claim “ludicrous,” adding: “IGs are as entitled to all documents in the possession of an agency as anyone else in the agency.”

As the IGs say, “effective and independent oversight by Inspectors General” saves taxpayers money and improves the operations of the federal government. The behavior of the responsible agency heads with respect to the internal watchdogs in those agencies leaves those federal agencies “insulated from scrutiny and unacceptably vulnerable to mismanagement and misconduct.”

Congress and the American people should be extremely concerned by the behavior of the administration and the serious charges made by almost four dozen IGs whose responsibilities range across the entire spectrum of the federal government, from the Justice Department to the Environmental Protection Agency to the National Security Agency. The only thing more dangerous than an administration that abuses its power is an administration that tries to hide what it is doing from taxpayers, voters, and our elected representatives in Congress.

This article was originally published on Town Hall.

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The Great Pyramid of California

High Speed RailIn 2540 BC the Great Pyramid of Giza was begun and approximately 20 years later it was completed. No one knows how much that it cost and how many died building it. What we do know is that the Pharaoh Khufu was buried there in 2566 BC.

The pyramid remained the tallest man-made structure in the world for over 3,800 years, unsurpassed until the 520 foot spire of Lincoln Cathedral was completed c. 1300.

Fast forward to modern-day California where Governor Jerry Brown is attempting to push through his High Speed Rail (HSR) project connecting San Francisco to Los Angeles.

As David Dayen explained in Politico Magazine a few months ago:

[T]here is one project Brown has decided not to save for the future, his Great Pyramid of Giza: building the nation’s first high-speed rail line, one of the largest infrastructure projects in US history, with an estimated price tag of $68 billion—if not higher. Shovels are poised to hit the ground this year on the first section of track, the latest advance in Brown’s 32-year quest to erect something he believes befits the image of California as a “land of dreams.”

A recent California Appeals Court ruling allows the project to proceed without knowing where all the money will come from as it continues construction. It should be noted that large infrastructure programs seldom have all of their money lined up in advance. And at an estimated $68 billion and climbing, this is a large project.

A recent budget deal included the creation of a dedicated funding stream for the rail project, paid for by fees on polluters.

But one of Mr Brown’s most devoted foes, Kevin McCarthy, just took over as the second-ranking Republican in the House of Representatives in Washington, all but ensuring that there will be no more federal funds for the project in the immediate future.

However, here’s a story Dan Richard, the head of the state’s high-speed rail authority, told The Atlantic’s James Fallows recently:

When we started [expanding] BART [San Francisco's subway system] to SFO [San Francisco International Airport], we were supposed to have $750 million in federal funding. We had virtually none for years and Senator Dianne Feinstein and I walked out of Senator Mark Hatfield’s office [Hatfield was a senior member and once-and-future chairman of the powerful appropriations committee] in 1994 with the first $25 million, which was a pittance. In the end, we received all $750 million and that was after Republicans took control of the Congress and 1994 and we were assured we wouldn’t get another dollar of federal monies.

Recently, a panel of outside experts told a state Senate committee that California’s bullet train will not meet the 2-hour-and-40-minute travel time between Los Angeles and San Francisco that voters were promised when they approved billions of dollars in funding for the program a few years back.

Opponents of high-speed rail are now trying to force a popular vote on whether to scrap the project. A similar effort failed to qualify for the ballot in 2012—mostly because its backers were not able to raise the money needed to gather enough signatures. They may have better luck if stories such as this continue to reduce public support.

 

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5 Facts About The Export-Import Bank

Here’s an infographic from Nicole Rusenko at http://dailysignal.com/ with 5 facts about one terrible government program, the Export-Import Bank.

When lawmakers return from their August recess, they’ll be facing pressure to reauthorize the Export-Import Bank, a government agency whose charter is set to expire on Sept. 30. Rep. Jeb Hensarling, chairman of the House Financial Services Committee, is among the bank’s biggest critics. Writing for The Daily Signal last month, Texas Republican outlined five facts that his colleagues—and their constituents—should remember.

2014_08_01_ExImInfographic_RB-01

 

 

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The Problem with Government Unions

Government unions are crushing taxpayersMost Americans that many unions benefit from preferential treatment that their workers work for. This is most egregious at the Federal level, especially with the current labor-union friendly Obama administration.

More than 80 unions represent federal employees, including the American Federation of Government Employees, the National Treasury Employees Union, and the National Federation of Federal Employees.

The National Treasury Employees Union has 150,000 members working at 30 agencies of the Federal government. The union represents workers at agencies that are currently in news including the Internal Revenue Service and U.S. Customs and Border Protection.

The president of the union Colleen Kelley is an Obama appointee to the Federal Salary Council, which advises the government on how much to pay federal employees. But that’s just the tip of the iceberg.

The Washington Times reported this week that the Internal Revenue Service provides government salaries, office space and equipment to NTEU operatives, who ostensibly represent 92,000 IRS employees.

The IRS’ deputy commissioner calculates these union workers spent 573,319 hours in 2012 on NTEU business. That’s the equivalent of 286 full-time employees doing nothing but union labor.

In an Orwellian turn-of-phrase these workers are on “Official Time”.  the Office of Personnel Management defines official time as “paid time off from assigned government duties to represent a union or its bargaining-unit employees.”

OPM’s Official Time Usage in the Federal Government reported that in 2011 Uncle Sam paid $156 million for official time for federal civil-service employees in practically all its agencies, up from $139 million in 2010.

Additionally, the union spent $687,400 on travel — also on the taxpayers’ tab. And who can forget the $4.1 million Star Trek-themed “training” session in Las Vegas four years ago? Ninety-four percent of NTEU campaign contributions go to Democrats.

Nathan Mehrens, president of Americans for Limited Government, said more than 200 IRS employees work on union business full-time.

They’re not working for taxpayers. Instead, they’re working against the agency by bringing grievances and trying to increase the cost to taxpayers through collective bargaining agreements.

Meanwhile, the VA paid 258 full-time employees to do no work at all for veterans in 2012. These government workers are on “official time,” and they work full time for their unions. 

A complete list of full-time VA employees in 2012 shows that salaries of the 258 workers ranged from $26,420 to $131,849, with an average of $61,121. Seventeen had six-figure salaries.

The VA had 998,483 hours of official time in 2011, up 23% from 2010, at a cost of $42.5 million. The hours-per-employee rate was 4.02, compared with a government-wide average of 2.82, according to OPM.

Similar practices take place at the state and local level under the phrase “release time.” When state and local official time is added to federal time, the total cost may be as high as $1 billion a year for the employees’ man-hours alone—not including the value of office space, computer, telephones, automobiles, etc.

The federal government is supposed to release a report each year around March documenting official time, but the Obama administration has dragged its heels, releasing reports eight months, even a year late.

That means that the report that includes the month before the 2012 election—when unions fueled the President’s get-out-the-vote effort—might not be released until sometime this year.

Mallory Factor, co-author of Shadowbosses and of the lead report in the November 2012 Labor Watch, wrote in a Wall Street Journal op-ed:

Official time is a ruse for getting taxpayers to support union activities in the government workplace, including the lobbying of legislators for ever-more benefits. This effectively subsidizes unions so they can spend more dues income on political organizing. And it’s all done without taxpayers’ knowledge. It’s a shadowy practice that must be stopped.

 

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Earmarks by another name: Pet Projects

Congress has money to burnJust when you thought earmarks had gone away, they returned under another name: pet projects. Members of Congress have inserted almost $20 billion in the already bloated Defense budget.

The Senate included nearly $250 million for cancer research. House lawmakers added $10 million in research funding specifically directed to historically black colleges. Senators also added $3 million for the Healthy Base Initiative. This program makes sure healthy snacks are available in vending machines and troops know about workout facilities on military bases.

Now, these all of these are laudable programs but while the military is ending the careers of thousands of highly trained officers are they needs or wants?

Lawmakers banned earmarks when Republicans took control of the House in 2011, so none of the projects qualifies under Congress’ official definition for pork projects.

An analysis by the Taxpayers Protection Alliance says Congress added nearly $20 billion in projects that the Pentagon didn’t request. Lawmakers included in their versions of the defense spending bills some 137 items worth $8.2 billion in the House’s version and 190 pet projects worth $11.7 billion in the Senate’s version.

It’s quite simple. Members of Congress believe that they are the font of all wisdom when it comes to spending. They believe that they know more than the Executive Branch and the voting public. In most cases, these pet projects primarily benefit only one group: the very members of Congress who propose them.

The public does benefit peripherally but we also have to pay for these feel-good wants. By adding the projects, David Williams, president of the Taxpayers Protection Alliance, said, lawmakers are “doing what’s best for themselves, not the country.”

The biggest-ticket items were extra money for aircraft, including more EA-18G Growlers for the Navy and additional F-35 fighters for several branches.

 

Also included is extra money for the Iron Dome program that Israel uses to defend against rockets launched from the Gaza Strip. Congress approved the funding last week in an emergency spending bill signed by the president.

 

Some of the spending seems to raise other questions, including $1 million that the Senate proposed to teach math to Defense Department employees.

 

Cancer research isn’t in the core job responsibilities of the Pentagon, but the Senate allocated $120 million for breast cancer research, $64 million to study prostate cancer and $10 million to investigate ovarian cancer, as well as $50 million to author research papers about cancer studies.

 

Celebrations and festivities also got a slice of the pie: House lawmakers managed to sneak into defense spending legislation $4.9 million to subsidize next year’s installment of “A Capitol Fourth,” the Independence Day concert and fireworks extravaganza on the National Mall.

Now, you may ask why these pet projects are being stuffed into the Defense budget. The answer is simple enough. The Defense budget is unvetoable by the President thus it’s an opportunity for members of Congress to use it as a vehicle for their largess to favored groups.

Hopefully, sanity will prevail after the election when the defense budget is finalized but don’t bet on it.

 

 

 

 

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Is the TSA out of control?

Tiny potential felonThe Transportation Security Administration is a child of 9/11. Created in November of 2001 it has grown exponentially ever since to almost 56,000 employees and a budget of $7.39 billion.

Once considered a replacement for the private security screening services at airports it has branched out to overseeing security for highways, railroads, buses, mass transit systems, pipelines and ports.

This agency has brought us shoe removal procedures after the Shoe Bomber, Richard Reid, attempted to detonate explosives packed into the shoes he was wearing, while on American Airlines Flight 63 from Paris to Miami.

They required all of our carry-on liquids to be in clear containers. Here’s TSA Rule 3-1-1 for carry-ons: Liquids, gels, aerosols, creams and pastes must be 3.4 ounces (100ml) or less per container; must be in 1 quart-sized, clear, plastic, zip-top bag; 1 bag per passenger placed in screening bin. The bag limits the total liquid volume each traveler can bring.

The TSA has spent hundreds of millions on screening equipment that they have never used. In 2012, Bloomberg News quoted a Congressional report that the TSA bought $184 million in screening equipment that they never have used.

They then tried to prevent Congress from learning how many machines were in the warehouse that they paid $3.5 million to lease and manage. The warehouse held 5,700 pieces of unused equipment.

Some of the equipment has sat so long, it’s now obsolete. The items include explosive detection equipment, liquid scanners and items used to screen passengers. “Some of it (has been) sitting there for over a year. And (it’s) very important for the security of the people of the United States,” Rep. John Mica, R-Fla.

The TSA established an overwhelming number of rules for air travelers. Let’s take electronics as an example. Laptops have to come out of their bags and lie flat in a plastic tub—but not tablets, phones, Kindles, cameras or portable game consoles. Why the distinction?

On close inspection the rules get arbitrary very quickly. For example, according to the TSA, the 11-inch model of the MacBook Air is fine to leave in your bag, but the 13-inch model must be removed.

Then there are the airport checkpoints, where the old metal detectors are being replaced by millimeter-wave and backscatter scanners. They are supposed to be able to find nonmetal weapons and other contraband—not just objects made of metal.

Many people consider these machines invasive (they can see through your clothes), overpriced (at least $160,000 apiece) and, in the case of the backscatter machines, a potential cancer risk.

They also require twice as many employees to operate and far more passenger preparation (you can’t have anything in your pockets, not even your wallet or boarding pass). And they are much slower, the TSA says screening takes “less than a minute.” That’s about 60 times longer than it takes to walk through a metal detector.

As a result, some airports now suggest checking in two hours before a domestic flight. How many millions of dollars in productivity are we losing as a result?

Finally, there’s the Federal Aviation Administration rule that all electronics, even headphones and e-book readers, have to be turned off during takeoff and landing, allegedly to prevent interference with the plane’s navigation systems.

But the scientific evidence for this worry is sketchy. Some devices emit signals that could theoretically affect an aircraft’s electronics. Yet “there have never been any reported accidents from these kinds of devices on planes,” FAA spokesperson Les Dorr told the New York Times last year. Once again, irrational fear, not solid science, is dictating policy for millions of travelers.

 

Then, we have the arbitrary rules for searching people. We know that the majority of airline attacks have been carried out by Arabs and South Asians. Now, that may sound like profiling but it’s a fact.

Yet, we have TSA employees patting down children and grandmas because of their arbitrary rules. There was one report of the pat-down of a four-year old at a Wichita area airport. The child was forced to undergo a pat-down after hugging her grandmother, with security agents yelling and calling the crying girl an uncooperative suspect.

The TSA is becoming one of those government agencies that has a perpetual life. Maybe it’s time to reevaluate its effectiveness and bring back private screeners paid for by airports and airlines rather than the American taxpayers.

 

 

 

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Nice work if you can get it

A bottomless pitThe Federal government is leaking waste, fraud and abuse like a sieve. Every day there are new revelations of money being wasted by our administrative state. A million here, a billion there and as Senator Everett Dirksen once said…and pretty soon you’re talking real money”.

Well, the real money that our government is wasting everyday includes such egregious waste like the latest report fro the Washington Free Beacon about paralegals who are being paid to do nothing. On top of this travesty, they’re getting bonuses for their non-work.

You simply can’t make this stuff up. According to the Commerce Department’s Office of the Inspector General paralegals at the U.S. Patent and Trademark Office were “paid to do nothing”.

The abuses occurred at the Patent Trial and Appeal Board (PTAB) and resulted in millions of dollars in pay and bonuses to paralegals who had no work to do.

The 19 paralegals in question were hired in 2009 to work for judges who did not exist. The managers at the office were aware of the problems but did not to correct the situation. So the paralegals continue to be employed doing no government work.

Instead they have been instructed to report their time spent as “Other Time”. A senior manager described billing as “Other Time” as the “I don’t have work but I’m going to get paid code.” This includes watching television, doing laundry, checking Facebook or walking their dog.

According to the Inspector General’s report:

Our investigation uncovered substantial, pervasive waste at the PTAB that endured for more than four years and resulted in the misuse of federal resources totaling at least $5.09 million.

Many were frequently paid to do nothing, despite the fact that PTAB’s backlog was growing rapidly at the same time.

The report noted that most paralegals spent their work days at home, getting paid to watch television, surf the internet, use Facebook, exercise, read books and magazines, shop online, or catch up on household chores such as laundry and cleaning dishes.

Then to add to this financial disaster the paralegals were paid performance bonuses for their non-work. The OIG report continued:

The evidence established that PTAB managers were completely aware of the volume of Other Time hours during the relevant time frame and took little action to prevent such waste. Worse, PTAB managers rewarded these paralegals—including those with extensive Other Time hours—with performance bonuses of thousands of dollars apiece.

Paralegals who logged more than 50 percent of their hours received between $2,000 and $3,500 in performance awards each year.

This senior manager further stated that management had not considered the argument that the Paralegal Specialists should not have received bonuses in light of the fact they were already getting full-time pay to essentially work part-time.

What is most egregious, however, is the conduct of numerous federal employees at the PTAB in connection with this waste. Although the Other Time problem was widely known throughout the PTAB organization, no one seemed to take ownership of the issue. In the worst cases, paralegals seemed content to have extensive idle time while collecting full salaries and benefits, and PTAB management seemed to sit on their hands, anticipating the arrival of judges at some unknown date in the future.

The report noted that managers continued doling out the bonuses because they “felt constrained by the paralegals’ labor union, believing that any steps to address the Other Time issue would create conflict with the Union.”

In all, they received $561,195.91 in bonuses between 2009 and 2013, an average of $2,922.90 per bonus. A Lead Paralegal Specialist at the Patent and Trademark Office earns roughly $74,872 to $97,333 a year.

The OIG found that the number of wasted work hours was “remarkably high and troubling” between 2009 and 2013, with some paralegals charging more than half of their hours as Other Time. A total of 27,000 hours were billed in 2011, followed by 26,000 in 2012.

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Fraud in the Medicaid Program?

You bet, there’s fraud in the Medicaid program. Here’s a report from the Chicago Tribune in 2012 that details some startling facts about the Medicaid program in the state of Illinois. The most startling fact is that Medicaid is reimbursing non-psychotherapists for psychotherapy services. What gives?

A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions. Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.  And then there was this: The sessions were often being performed by obstetricians and gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled.

So Medicaid began cracking down, and spending plummeted after new rules were implemented. …Illinois doctors are still billing the federal Medicare program for large numbers of the same services, a ProPublica analysis of federal data shows. Medicare paid Illinois providers for more than 290,000 group psychotherapy sessions in 2012 — more than twice as many sessions as were reimbursed to providers in New York, the state with the second-highest total. Among the highest billers for group psychotherapy in Illinois were three OB-GYNs and a thoracic surgeon. The four combined for 37,864 sessions that year, more than the total for all providers in the state of California. They were reimbursed more than $730,000 by Medicare in 2012 just for psychotherapy sessions, according to an analysis of a separate Medicare data set released in April.

Now keep in mind that there are 365 days in a year with about 261 workdays when you read the next group of statistics.

Of the Illinois OB-GYNs billing for group psychotherapy, Dr. Josephine Kamper had the highest number of sessions. She was paid for 10,399 sessions in 2012, at a cost to Medicare of $207,980. …Another OB-GYN, Lofton Kennedy Jr., billed for 9,154 group psychotherapy services. He declined to comment. The third-highest-billing OB-GYN, Philip Okwuje, charged Medicare for 8,584 group therapy sessions.  

But the biggest bilker (excuse me, biller) in the country was from New York.

A Queens, N.Y., primary care doctor, Mark Burke, was paid for more sessions than anyone else in the country — 20,841. He accounted for nearly one in every six sessions delivered in the entire state of New York in Medicare, separate data show. He did not return messages left at his office. Another large biller was Makeba Gordon, a social worker in Detroit. She was reimbursed for nearly 5,000 group therapy sessions for her 26 Medicare patients, an average of 190 each. She also billed for 2,820 individual psychotherapy visits for the same 26 patients, who allegedly would have received an average of 298 therapy sessions apiece in 2012. Gordon could not be reached for comment.

Meanwhile, the auditors at Medicaid seem to be asleep at their computers. Their incredible response to the Tribune’s story illustrates why our country is over $17 trillion in debt.

Aaron Albright, a spokesman for the U.S. Centers for Medicare & Medicaid Services, said in an email that Medicare has no policy regarding which physicians may perform group psychotherapy. During such sessions, “personal and group dynamics are discussed and explored in a therapeutic setting allowing emotional catharsis, instruction, insight, and support,” according to rules set out by one of Medicare’s contractors.

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