Wednesday, September 29, 2021

Randi has done it again - maddening playing all sides of the field with people who were OK with teachers giving up their lives to save the economy

They will debate this and hold multiple positions, but never a forum on something like union democracy or class size solutions... A NYC teacher

She and Leo Casey said the same thing about Bill Gates – saying it’s always good to discuss and bring people to the table.  I agree with that. But not give them a public forum to transmit their toxic ideas!  That’s completely different.... Parent activist

Randi working with the Open Schools Movement people - and a guy who said teachers dying was the acceptable cost of opening schools. The message to him should be FUCK OFF! But she is saying FUCK OFF to teachers risking their health in overcrowded schools.

She wants dialogue with our enemies but ignores the progressive voices in her own union. 90% vaxed but she and Mulgrew cater to the resisters. There's an entire resistance movement in the UFT but too progressive for Randi and crew --- she may be the Kyrsten Sinema of our union. I put her closer to Joe Manchin than Bernie Sanders.


See https://twitter.com/rweingarten/status/1443237326172442625?s=20 See thread and responses

She invited Dr. Jay Bhattacharya co-author of the Great Barrington Declaration, to speak at her Town Hall tomorrow. 

Bu

https://gbdeclaration.org/

Yet she just tweeted that the Great Barington Declaration was “reprehensible”.  Reminds me of when she invited Gates to speak at the AFT convention.

 

Rallies, Lawsuit Updates - Retirees go to court - NY Post, AETNA LAWSUIT Calls for halt to Medicare change - Wants piece of $38 Billion up for grabs

...on Friday, some 100 retirees had a die-in press conference at City Hall where they dressed as the Grim Reaper and mimicked choking to death in protest of the plan. Sarah Shapiro, a retired teacher with the Cross Union Retirees Organizing Committee, said they are being thrown “under the bus after decades of service to this city. We are in the midst of a pandemic. We have frail and sickly retirees who are in the middle of cancer treatments,” she said..... NY Post

Question of the day - or year - or decade: 

Why does the UFT leadership oppose Single payer, medicare for all plans and promote privatized MedAdv plans with its profits, high salaries and lower level of service?

Norm's commentary: 

There is a bunch of news around the joint union/city attempt to move 225k retirees out of Medicare and into a privatized version known as Medicare Advantage. A law suit by retirees and a law suit by the losing bidder, Aetna - both reported on below my commentary.



There is an option to opt out and remain in traditional Medicare, which an increasing number of people are taking but at a cost -- it will cost me and my wife around $4500 a year for the same thing we've been getting for free. An extortion plot hatched by our union leaders. The more you know about Medicare Advantage, the more you want to vomit.

Read these for a deeper dive --  

The Retiree Advocate/UFT caucus has been leading the battle since April with press conferences, rallies and marches.

Our vote total went up to 30% in the retiree chapter election in April when many retirees had not yet heard of the change. With a general UFT election coming this March-May and the retiree vote crucial for Unity Caucus control of the UFT, another 10 point slippage might put the election in play for the first time. (Already retirees are asking to be added to the oppositon slate.) Add this to the general unhappiness with the UFT by working members over school safety and their support for the minority of unvaxed teachers, this election can be interesting.

I reported on recent events, some organized by a cross union group that included Retiree Advocates --- We had a great Die-in on Friday near City Hall with hundreds of people --- people in hospital gowns were "examined" by doctors - some of them real docs - and rejected, upon which they "died" on a mat while the grim reaper stood over them. (There were also concurrent Taxi and Climate protests in the same area- a perfect day for protests.)

 [ see - “Die-In” is to publicize the inadequacies of the NYC Medicare Advantage switch-over by Mayor de Blasio and Unions]

We were out in force at the  Sept. 22 UFT chapter leader meeting, which ironically was limited to 200 people in Shanker Hall which seats 850 -- ironically because the UFT seems OK with sending its members into crowded schools with little social distancing. Monday night there was an Ex bd meeting in person where everyone had to show proof of vax. I'm wondering if the UFT has a must vax order for its own employees.

The Aetna lawsuit has a better chance of halting things before Jan. 1 than the members vote -- I didn't join as a plaintive but wish them luck. Aetna is pissed because they lost out and are claiming the people who won out are incompetent at managing these type of plans. I join Retiree Advocate in opposing all private insurance and wanting a medicare for all, single payer system. Yes, it's socialized medicine -- but Medicare has basically proved that it works. Below the break are details of the lawsuits:

Sunday, September 26, 2021

School Staff Complains About Undisclosed COVID Cases at Clara Barton HS -- Guess Who the UFT is Busy Defending?

We don't feel safe in our community anymore. We love our school and know it can be better. We want a safer school and we do not want additional COVID outbreaks. 
 .. Clara Barton HS staff members
UFT claims not allowing unvaxed into schools makes them unsafe while seemingly OK with letting them in and threatening COVID spread? WTF

Staffs are going to war with each other over masking and vaccines. Talk about a threat to the union. Where is the UFT? I have an idea -- threaten to stop paying dues and watch how fast you get a meeting and a response. 
 
The UFT leadership is so focused on the minority unvaxxed, they are losing sight of the real threat to the union, with the overwhelming majority vaxed and masked and getting more and more pissed off. Religious exemptions? Don't dare try using Jewish as an excuse. The other real threat is future refusals to get vaxxed for anything and wild measles and other outbreaks to come. We are going back to the dark ages and the UFT is paving the way.


I'm hearing this from other schools -- There is a Zoom on Wednesday at 7PM for people to tell their stories, anonymously if they want.

Such stories are rolling in and ignored by the UFT leaders which is focusing its attention on due process for the unvaxed. Do the vaxed get due process for their health conditions?

district36@council.nyc.gov,
askjb@council.nyc.gov,
District45@council.nyc.gov,
drose@council.nyc.gov,
borelli@council.nyc.gov,
district41@council.nyc.gov,
District31@council.nyc.gov,
District30@council.nyc.gov,
KPowers@council.nyc.gov,
district7@council.nyc.gov,
gethelp@pubadvocate.nyc.gov,
action@comptroller.nyc.gov,
da@brooklynda.org,
askeric@brooklynbp.nyc.gov,
bk09@cb.nyc.gov,
LCOLONB@schools.nyc.gov,
Office of Superintendent Michael Prayor <admin@supmprayor.com>,
kwatts@schools.nyc.gov,
osi-inquiries@schools.nyc.gov,
sci@schools.nyc.gov,
pep@schools.nyc.gov,
cec17@schools.nyc.gov
bcc:normsco@gmail.com
date:Sep 25, 2021, 7:37 PM

 

To Whom It May Concern:

We are a group of constituents from the Clara Barton HS community in Brooklyn. We have sent the following to our principal but we have not seen any substantial change in our community. We have staff calling out and rumors are flying it's for undisclosed COVID cases. Students are in quarantine. There was a nasty fight this past week and nothing is being done to control students from unmasking in the halls. We do not feel safe at all. Please help us! We have contacted the press. 

Anonymous 

Dear Dr. Forman:

We are a group of staff from the CBHS community who are really concerned. We have brought concerns to the UFT reps to take to consultation. But we feel that nobody is doing anything. 

While you hide in your office we have observed the following in Barton:
1. Teachers and paras not wearing masks around children during class time.
2. Deans and aides not masking in the Deans' Office.
3. Students smoking weed communally during class time in Stairwell E And F.
4. Large groups of faculty in the auditorium meeting without social distancing on Sept 9
5. Classrooms with no open windows or purifiers. 
6. Staff and students who have said: "COVID is a lie produced by the  media and masking/vaccines don't work."
7. No social distancing or ventilation in the cafeteria 
8. Faculty unmasking in meetings

We don't feel safe in our community anymore. We love our school and know it can be better. We want a safer school and we do not want additional COVID outbreaks. 

If our needs are not addressed promptly the media and the City will be notified. We do not want negative attention to our community. We just want a safer work environment and a safer learning environment for the kids. 

Thank you.

Anonymous

 

Friday, September 24, 2021

Today 4PM -“Die-In” is to publicize the inadequacies of the NYC Medicare Advantage switch-over by Mayor de Blasio and Unions - Broadway side

Who: We are the Cross-Union Retiree Organizing Committee (CROC) composed of retirees from NYC's municipal labor unions. We oppose the City's move to save money by endangering the healthcare coverage of vulnerable seniors.

I'm heading back into the city for this well-thought out event that includes reps from many municipal unions.  I'm not the grim reaper and I'm not laying down because I won't get up so I am handing out leaflets. COME ON DOWN!!!

BTW - here is opt out link: https://nyc-ma-plus.empireblue.com/optout/

FOR IMMEDIATE RELEASE

 

Media Advisory: Municipal Worker Retirees Plan Protest To Halt Healthcare Changes

What:  NYC municipal union retirees will stage a "Die-In" at City Hall Park to protest the life-threatening danger faced by 250,000 retirees as the City prepares to switch their traditional Medicare coverage to a  privately managed Medicare Advantage plan beginning Jan. 1, 2022.  At a mock "Medicare DisAdvantage Clinic" overseen by the Grim Reaper, participants will enact the potentially fatal consequences of restricting healthcare for seniors.

The protest comes on the heels of a lawsuit filed by Aetna charging the City and its Office of Labor Relations of bid-rigging in awarding the health coverage contract.

When: Friday, September 24, 2021, rain or shine

Time: 4:00 p.m. to 5:00 p. m.

Where: The Broadway side of City Hall Park (between Murray & Park Sts.)

image.png


Who: We are the Cross-Union Retiree Organizing Committee (CROC) composed of retirees from NYC's municipal labor unions. We oppose the City's move to save money by endangering the healthcare coverage of vulnerable seniors.

Press Contacts:

Sarah Shapiro, spokesperson for CROC (sarahmorah@gmail.com)

Len Rodberg, expert on Medicare issues (lrodberg@gmail.com

 

“Die-In” Action

 

When: Friday, September 24, 2021 

Time: Participants arrive at 3:15pm for a rehearsal. The action takes place from 4:00pm-5:00pm.

Where: on Broadway next to City Hall Park between Murray Street and Park Place

 

The point of the “Die-In” is to publicize the inadequacies of the NYC Medicare Advantage switch-over by Mayor de Blasio and to pressure the new mayor to scrap the plan .

 

There will be a Medicare Dis-Advantage health clinic on the Broadway side of City Hall between Murray Street and Park Place. Some participants will play sick patients waiting in two patient feeder lines to be examined by other participants dressed up as doctors and nurses. These mock doctors and nurses will theatrically examine three or four patients for 30 seconds. Then the patients will be determined ineligible for treatment. To communicate this, the doctors and nurse will hold up “No Authorization” signs. Patients will then walk over to the death mat and die in whatever way they like for 30 seconds while a drum rolls and the Grim Reaper approaches. Patients can get back in line to be examined and die multiple times. Protesters with signs will stand on the sidelines. We cannot block the sidewalk! A picket march down Broadway and through City Hall Park will take place once there is a large enough crowd of protesters. We are hopeful that a few politicians will attend, and if they do, we will pause the action for a few minutes in order for them to speak. We expect some press to be there too.

 



 

Tuesday, September 21, 2021

Retirees to Rally at UFT Chapter Leader Meeting Wednesday to inform Working UFT Members of dangers of healthcare changes -- Plus a Die-in Friday

 



Chapter Leader Meeting on Wednesday Sept 22 at 3:30pm

We'll be outside the first CL Meeting at the UFT at 52 Broadway starting at 3:30 to let our working educator brothers and sisters know what happened to our health care and to warn them that negative  changes are also in store for them. Help us greet them with smiles and informational fliers.


Street Theatre Die-In on Friday Sept 24 at 4 pm

NYC municipal retirees present A Street Theatre “Die-In”  on Broadway in front of City Hall Park between Murray & Park Sts. to publicize the life-threatening danger faced by 250,000 retirees as the City prepares to switch their traditional Medicare coverage to a privately managed Medicare Advantage plan on Jan 1, 2022.

Produced by: CROC (Cross-Union Retiree Organizing Committee

We still need "actors" for this event. No experience necessary.        Please send an email to : retireequestions@gmail.com     if you are interested



1F2DBBF7-83D7-4917-845A-51D24256B8FE.png

 

Sunday, September 19, 2021

Wowsa -- Aetna sues NYC, union leaders over ‘tainted’ Medicare contract - NY Post

“There’s definitely some fishiness going on. This contract doesn’t make any sense,” said Marianne Pizzitola, president of the FDNY’s EMS Retirees Association and a rep for the New York City Organization of Public Service Retirees, whose groups are affected by the contract.

Pizzitola said retirees were “kept in the dark” on the deliberations and raised the appearance of a conflict with Teamsters’ head Floyd sitting on the board of the winning bidder.

“How is that not fishy?” she said.

 This may be a biggie -- let's be clear -- we don't want Aetna either. No Med-Disadvantage plans -- but if this screws the pooch -- go at it.

https://nypost.com/2021/09/19/aetna-sues-nyc-unions-over-tainted-medicare-contract

By

September 19, 2021 

New York’s largest private Medicare administrator is suing the Big Apple and its local union leaders for allegedly awarding a $34 billion “tainted” contract to an unqualified rival bidder.

Insurance giant Aetna’s bombshell lawsuit against New York City and the Municipal Labor Committee alleges that the bidding process was fixed to favor Alliance, a consortium that includes Emblem Health and Anthem/Blue Cross Blue Shield, to operate the Medicare Advantage Plus program, which administers health benefits to 250,000 retired city workers.

“OLR [the city’s Office of Labor Relations] has selected an inexperienced and unqualified bidder through a procurement process that violated New York Procurement law, lacked transparency, and violated principles of public trust and fairness for a procurement that could last up to a minimum of five or as many as eleven years and generate $34 billion dollars in claims revenue,” Aetna alleges in its suit filed in Manhattan Supreme Court earlier this month.

Aetna and Alliance were the two finalists that city officials and union leaders considered for the whopping contract, which is anticipated to save the Big Apple about $3 billion over five years, or roughly $600 million a year.

Aetna is asking the court to nix the contract, which takes effect Jan. 1.

Retired city workers are eligible for Medicare, the federally run program that provides health insurance for people who reach 65 — but their union contract also calls for the Big Apple to pick up the cost of their monthly premiums for Medicare Part B, which covers outpatient care as well as other supplemental services not covered by Medicare.

Gregory Floyd president of Teamsters Local 237
Gregory Floyd, president of Teamsters Local 237, is associated with Alliance partner Emblem Health, who was awarded the city’s Medicare program contract over Aetna.

Aetna is arguing that it has more experience than Alliance in handling such matters. And even city officials have acknowledged that Aetna, the nation’s third largest health-insurance provider, was clearly the more experienced bidder in running Medicare Advantage programs across the country.

One of the criteria in the proposal was that bidders had to have provided service to a client with at least 50,000 subscribers.

Aetna currently runs New Jersey’s Medicare Advantage program for 196,577 retirees, the United Auto Workers Retiree Medical Benefits Trust with 140,305 members, the Ohio State Teachers Retirement System with 96,106), the Pennsylvania Employees Benefit Trust Fund with 75,369 members) and Verizon with 73,176 members, according to the lawsuit.

Aetna alleges that Alliance failed to meet even this “low bar.”

Alliance has noted that one of its partners, Indiana-based Anthem, ran the Medicare Advantage program for the Colorado Public Employees Retirement system with 50,000 members. But Aetna claims that Anthem’s contract only covered 43,000 retirees, which should disqualify the Alliance bid for the city work.

Other concerns raised in the lawsuit involved:

  • Costs: Aetna claimed its prescription-drug plan was at least $30 less expensive per worker monthly than Alliance’s plan and offered free prescriptions for certain generic medications. It also said its plan premium was $366 lower per year for every worker than the advertised Alliance rate.
  • Breach of confidentiality: The insurer said a city evaluator wrongly disclosed some of its cost proposals at a meeting with union members, which “tainted” the selection process by alerting rival Alliance to its figures.
  • Arbitrator/familiarity: The city and labor unions turned to a state arbitrator to help resolve an impasse over the selection of a winning bidder — a decision that was not mentioned as part of the procurement process.

During the early evaluation process, city officials favored Aetna because of its experience running Medicare Advantage programs, the suit says. But union leaders preferred the Alliance because partners GHI/Emblem Health and Blue Cross had more of a history providing medical benefits to city workers, according to the papers.

The parties asked arbitrator Martin Scheinman — who recently ruled that religious exemptions can be granted from COVID vaccine requirements for public-school teachers — to be brought in to issue a recommendation on which final bidder the city and the unions should choose. At the time, Scheinman chaired a city panel to find health-care savings.

Scheinman chose Alliance, arguing that its “familiarity” with providing benefits to the city workforce trumped Aetna’s superior experience in running Medicare programs, the documents say.

Sanitation Department workers collect garbage near 675 Central Avenue in Brooklyn on March 10, 2021.
Sanitation Department workers collect garbage near 675 Central Avenue in Brooklyn on March 10, 2021.
James Keivom

His voice helped tip the award to the Alliance, the suit says.

But Aetna argues in the court documents that “the Solicitation and applicable procurement law did not provide for this action … and Arbitrator Scheinman’s recommendation was based on a new criterion mentioned nowhere in the procurement documents.”

Aetna also claims that Alliance reps were afforded the opportunity to discuss matters with Scheinman, while its people weren’t.

Aetna received the highest scores during the early phases of the evaluation process, the suit says.

Other sources familiar with the negotiations said it appeared that Alliance had an inside track because of its connections to labor leaders. Teamsters Local 237 President Gregory Floyd, for example, sits on the board of Alliance partner Emblem Health.

Some advocates for retirees joined Aetna in questioning the granting of the contract.

First responders arrive at a construction site in Hudson Street to Vandam Street in Manhattan after a man fell 20 feet into a shaft on September 14, 2021.
First responders arrive at a construction site in Hudson Street to Vandam Street in Manhattan after a man fell 20 feet into a shaft on September 14, 2021.
William Farrington

“There’s definitely some fishiness going on. This contract doesn’t make any sense,” said Marianne Pizzitola, president of the FDNY’s EMS Retirees Association and a rep for the New York City Organization of Public Service Retirees, whose groups are affected by the contract.

Pizzitola said retirees were “kept in the dark” on the deliberations and raised the appearance of a conflict with Teamsters’ head Floyd sitting on the board of the winning bidder.

“How is that not fishy?” she said.

Nicholas Paolucci, a rep with the city Law Department, told The Post in an e-mail, “The City is committed to selecting providers that are in the best interest of the City and it’s retirees. We’ll review the case.”

Meanwhile, union leaders in the Municipal Labor Council dismissed Aetna’s lawsuit as the desperate gambit of a sore loser.

“We got it done. It was fair and right to the point. I haven’t heard anything wrong with that particular contract, the way it was done. Everything was done to the T,” said Harry Nespoli, chairman of the Municipal Labor Council and president of the Sanitation workers’ union.

“To me it sounds like sour grapes. Aetna had their shot at it. It does save money for the city of New York. What’s wrong with that? I thought it was a spectacular deal. I still think it is,” he said.

Teamsters Local 237 President Floyd said his role sitting on the governing board of bidder Emblem Health didn’t pose a conflict. He voted to award to Emblem/Anthem-Blue Cross.

“It’s only a conflict if I was the only union leader voting or if I had the most influential vote. It wasn’t the case. I had one vote — that was it,” Floyd said.

“This a stupid lawsuit. Aenta put in a bid, and they lost the bid. They’re a sore loser.”

Harry Nespoli, president of the Sanitation workers' union.
Harry Nespoli, president of the Sanitation workers’ union, argues insurance company Aetna is acting “like sour grapes,” with their city lawsuit.
William Farrington

Noting that Aetna is one of the country’s largest private health-insurance companies, Floyd said, “How greedy can you get?”

Floyd said contracts expire and that there will be opportunities for future business — but he added that Aetna is burning its bridges.

“I have a long memory,” Floyd said.

He said Aetna currently administers prescription-drug benefits to his members, who work as security officers in schools, homeless shelters and NYCHA complexes.

In that case, Aetna replaced HIP/Emblem Health because the union didn’t like the latter’s performance, and Aetna is doing a “good job,” the Teamsters boss said.

 

Friday, September 17, 2021

Medicare Advantage Scams Fed Medicare System by Fabricating Medical Diagnoses - NPR

Medicare Payment Advisory Commission:

There is no question that Medicare Advantage is unsustainable in the long term. It’s driving up Part B premiums, eroding the Medicare trust fund, and costing taxpayers tens of billions a year more than traditional Medicare. The plans are also taking a toll on federal coffers, due to overpayments and disenrollments in the final year of life, among other factors. “The current state of quality reporting in [Medicare Advantage] is such that the Commission can no longer provide an accurate description of the quality of care......

UFT Plays 3 card monte with our health

Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging

Our union leaders are leading us into the Med Adv Mob. Some might take the attitude that they don't care if the medicare system is ravished into oblivion. I don't. We need a fraud proof Medicare for all system and Med Adv profit makers are the opposite direction. Mulgrew can tell us till the cows come home how Med Adv is as good as traditional medicare --- except for the scams profit making companies are willing to pull. It's not just about them making money over cutting services but also about scamming Medicare and ultimately making it untenable for anyone.

The DOJ Says A Data Mining Company Fabricated Medical Diagnoses To Make Money

https://www.npr.org/sections/health-shots/2021/09/14/1036776812/medicare-advantage-fraud-data-mining?sc=18&f=1001

The Justice Department has accused an upstate New York health insurance plan for seniors, along with a medical analytics company the insurer is affiliated with, of cheating the government out of tens of millions of dollars.

The civil complaint of fraud, filed this week, is the first by the federal government to target a data mining company for allegedly helping a Medicare Advantage program to game federal billing regulations in a way that enables the plan to overcharge for patient treatment.

The lawsuit names as defendants the medical records review company DxID and Independent Health Association, of Buffalo, which operates two Medicare Advantage plans. Betsy Gaffney, DxID's founder and CEO, is also named in the suit. DxID, which shut down in August, is owned by Independent Health through another subsidiary.

Medicare Advantage plans are paid more for sicker patients

The Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage plans using a complex formula called a "risk score," which is intended to render higher rates for sicker patients and less for those in good health. The data mining company combed electronic medical records to identify missed diagnoses — pocketing up to 20% of new revenue it generated for the health plan.

But the Department of Justice alleges that DxID's reviews triggered "tens of millions" of dollars in overcharges when those missing diagnoses were filled in with exaggerations of how sick patients were or with charges for medical conditions the patients did not have.

In an email, Frank Sava, a spokesperson for Independent Health, stated: "We are aware of the DOJ complaint filed late [Monday] and will continue to defend ourselves vigorously against the allegations. Because this is an open case I cannot comment further."

Gaffney's lawyer did not respond to requests for comment.

The DOJ complaint expands on a 2012 whistleblower suit filed by Teresa Ross, a former medical-coding official at Group Health Cooperative in Seattle, one of the nation's oldest and most prestigious health plans. Among the entities Ross sued were Group Health, DxID and Independent Health.

 

Ross alleged in that suit that Group Health hired DxID in 2011 to boost revenues. The company submitted more than $30 million in new disease claims — many of which were not valid, according to Ross — to Medicare on behalf of Group Health for 2010 and 2011.

A patient with an "amazingly sunny disposition" gets a label of "major depression"

For instance, Ross alleged that the plan billed for "major depression" in a patient described by his doctor as having an "amazingly sunny disposition." Group Health, now known as the Kaiser Foundation Health Plan of Washington (a company unrelated to Kaiser Health News or the Kaiser Family Foundation), denied wrongdoing. But in November 2020, the insurer settled the case by paying $6.3 million.

Now the Justice Department is taking over the case and targeting DxID for its work on behalf of both Group Health and Independent Health. The department alleges that DxID submitted thousands of "unsupported" medical condition codes on behalf of Independent Health from 2010 to 2017.

"Hopefully the case sends a message that coding companies that exist only to enrich themselves by violating many, many CMS rules will face consequences," said Max Voldman, an attorney who represents Ross.

Timothy Layton, an associate professor of health care policy at Harvard Medical School who has studied Medicare Advantage payment policy, said he has not seen the government take legal actions against data analytics companies before.

"They are often the ones doing a lot of the scraping for [billing] codes, so I wouldn't be surprised if they came under more scrutiny," Layton said.

" 'Trolling' patient medical records to gin up ... 'new' diagnoses"

In the legal complaint filed Monday, the Justice Department alleges that Gaffney pitched DxID's revenue-generating tools as "too attractive to pass up."

"There is no upfront fee, we don't get paid until you get paid and we work on a percentage of the actual proven recoveries," she wrote, according to the complaint.

The 102-page suit describes DxID's chart review process as "fraudulent" and says it "relied on 'trolling' patient medical records to gin up, in many cases, 'new' diagnoses exclusively from information derived from impermissible sources."

The complaint cites medical conditions that it says either were exaggerated or weren't supported by the medical records, such as billing for treating chronic depression that had been resolved. It also cites allegedly unsupported claims for renal failure, the most severe form of chronic kidney disease. The suit alleges that Gaffney said these cases were "worth a ton of money to IH [Independent Health] and the majority of people (over) 70 have it at some level."

The complaint says that CMS would have tried to recover money paid to the health plan improperly had it known about DxID's tactics and "has now done so via this suit."

The Justice Department is seeking treble damages in the False Claims Act suit, plus an unspecified civil penalty for each violation of the law.

Medicare Advantage, a fast-growing private alternative to original Medicare, has enrolled more than 26 million people, according to AHIP, an industry trade group.

While popular with seniors, Medicare Advantage has been the target of multiple government investigations, Justice Department and whistleblower lawsuits and Medicare audits. One 2020 report estimated improper payments to the plans topped $16 billion the previous year.

At least two dozen whistleblower cases, some dating to 2009, have alleged fraud by Medicare Advantage plans related to manipulating patient risk scores to boost revenues.

In July, the Justice Department consolidated six such cases against Kaiser Permanente health plans. In August, California-based Sutter Health agreed to pay $90 million to settle a similar fraud case. Previous settlements have totaled more than $300 million.

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

Thursday, September 16, 2021

Advice on third booster shots: Hold off and take anti-body tests - Revised - I got the booster

UPDATE NOV. 30 - After a packed Bat Mitzvah a few weeks ago in a tent at 38 degrees with over a hundred unmasked people - I got the Moderna booster two days later with no side affects at all - in fact I was juiced up for weeks -- give me one every month.

Happy Yom Kippur -- Sept. 16, 2021 - I'm fasting - my wife hid all the bags of chips and that's all I want to eat. Tonight will be hog heaven without the hogs. Many Jews only use daity to break the fast and I've got my eyes on the herring in cream sauce.

[Added Sept 17 - See the anon comment for more advice with an good link to a discussion on boosters --- https://www.youtube.com/watch?v=cKJkC3MLcDg.]

From a colleague from 50 years ago:

Norm

My son is a biologist doing cutting edge genetics research. He advises us to hold off on a booster until they develop one for the upcoming variants that will avoid the mRNA protection. 
Breakthrough for Delta means you can catch it if you have the mRNA in your body, but it will not harm you.
This protection will not wane after 8 months
The current push for boosters vs Delta is a sales pitch.

Pete Farruggio, PhD
Associate Professor, Bilingual Education (retired)
University of Texas RGV

Pete also sent this discouraging news from this link: https://tinyurl.com/2csx29at

Covid cases rise to winter levels

History repeats. As with the 1918-20 flu epidemic, the waning of the first wave of viral spread  induced a premature relaxing of caution (e.g. reopening unsafe schools), which caused a second larger wave. This pattern caused a third wave through 1920. Instead  of vaccines, what ended the epidemic was the killing off of the more susceptible, as in previous plagues (herd immunity).

I don't want to be one of the susceptibles and was ready to take the booster in 3 weeks. But what if there is a new vax that provides more protection from variables in a few months. Do you get a 4th shot? My doc says hold off.

So I'm rethinking getting the third booster shot. Pete's advice correlates to that of my primary doc. Friends have been to him in the past few days and here is what he told them:

Our doctor does not believe in over vaccinating. He is testing for my antibody levels. When or if they are low then he recommends the booster. If they reconfigure the vaccine to deal with the variants then we can have a further discussion about boosters  ... from a friend

We use the same doctor - for the past 20 years and have gotten many of our friends to go to him too, so there is a lot of trust. Last spring he told us to not get the shingles shot yet because he felt we might need a booster in the fall. My friends did the antibody test and found they had sufficient immunity at this point. Doc says retest in 3 months. 

[ MORE info from patient with same doctor - Sept 17 --- Our doctor told us that each lab determines the antibody count in their own way so you can`t compare numbers from lab to lab. The lab where MY results will come from has 200 as the magic number of normal. Anything OVER 250 will just come back as over 250 but no further number will be given. I asked him about the benefit of having a LOT of antibodies--way higer than normal--from getting the booster now.  He said that a lot of learning is going on now about all of these things but one thing that MAY be true is that too many antibodies could interfere with the T cells and keep them from being effective at what they need to do. He said that it MAY be the case that LESS is more in this situation! He also said that if the booster was comprised with more ability to fight the Delta variant than it might be wise to get the booster sooner, but since it is NOT comprised any differently than what we already have in our systems you are not getting more of an ability to fight Delta (as long as your antibody count is normal). We will wait another 3 months and retest. When our number goes below normal is when we will take the booster. ]

Interesting. One of the right wing criticisms of Biden and vax mandates is that those who had COVID have antibodies too --- and they argue that they should not be forced to be vaxed. There is a point and I wonder if you present an anti-body test result, that counts as vaxed.

There are outbreaks in Israel which is highly vaxed with third shots. Covid seems like a raging fire which no matter what we do will find places to burn until it burns itself out --- herd immunity. 

Look at the south as cases begin to come down after their wave and now we in the northeast escaped, we will be facing a surge, based on back to work and open schools. 

You know the case they make for those who are vaxed as being safe from hospitalization or getting real sick even if you get it -- it will be mild. But I don't even want a mild case due to stories of long covid which hits 30% in some cases. I know people who are still very affected even a year and a half later. I don't need to spend the rest of my life battling issues I didn't need to battle.

Tuesday, September 14, 2021

Vax Mania: Are we required to stop people from committing suicide? Why stop at red lights?

If people want to risk death, must we stop them? What if their risks affects the rest of us? Do people have the personal right to drive recklessly? Why is risking the health of others and over taxing the hospital systems any more dangerous than reckless driving? 


I might also ask -- are the economics driving De Blasio to open schools a risk that touches on the same risky behavior of the unvaxed?

[Ed NotesOsterholm escalates on schools - Learning loss vs life, Minimizes masks, weekly testing, maximizes filter, airflow and more frequent testing]

By the way, I was walking past a testing truck in Manhattan on Friday and got tested  for the first time - not rapid but the nose swab - and had the results the next evening. Others standing there with me needed a test for travel before they could fly. Oh my, those damn governament regulations. I'm outraged every time I have to show my drivers license when I have to fly - and why can't I carry a box cutter onto planes?

You are 11 times more likely to die without shots -- NYT
So you might take the position of fuck em - if they want to risk death. 

Now imagine someone ready to jump off a building. Do you say fuck em? Or do you try your best to talk them out of it? Or do you get together with others and hold a blanket to try to catch them? Do you care about their pain? Or is it that you don't give a shit about them but are worried they might fall on you and kill you?

Well, there are versions of all these arguments in the vax vs anti-vax angst.

Biden's new toughness is resonating with most people who are fed up with the anti-vax personal freedom bullshit from people who have given up so much personal freedom in so many ways. Chris Wallace questioned the gov of Nebraska yesterday, who is outraged at Biden, about the loss of freedom to choose over about 10 Nebraska vax mandates in order to go back to school. The response was those vax's are tested. No more tested than the current vaccines.

So let's talk about the freedoms Biden is taking away and the over the top Republicans politicizing this. I heard George Will on NBC and Chris Christie talking about how Biden is violating the constitution - and stopping him is a higher priority than stopping people from dying. That's like telling people to jump and pulling away the blanket to catch them like Lucy does with the football. 

Like we are not in an emergency that is not only killing people but the economy. Would they worry about the constitution if it were Ebola? Didn't they suspend all airline flights for weeks after 9/11? Like a 1000 times more people have died from COVID than on 9/11. This is not an emergency?

I was frustrated that Stefanoplis and Chuck Todd didn't bring up how Lincoln threw out the constitution during the Civil War emergency. Or how FDR pushed the boundaries during the depression. 

I understand the fear of some people about vaccinations. I don't love them. I avoided the flu shot for years until my wife and my doctor scared me into them. I still don't have the shingle shot and want to get it but my doc told us to not pump too many vaccines into us in a short period of time. He told us that in May when we asked about shingles and he said we would probably need a booster in the fall. The other day he told someone to hold off on the booster as long as possible. He is wary of over vaxing. This is at least rational advice. I do want to take the booster at 8 months which for me is Oct. 10. What about the flu shot and when?

Meanwhile, watch out for the freedom from government control people when crossing the street. Stop lights are too much government control.

Monday, September 13, 2021

Osterholm escalates on schools - Learning loss vs life, Minimizes masks, weekly testing, maximizes filter, airflow and more frequent testing

Is de Blasio and his partner Mulgrew risking lives in opening schools fully (the former) and supporting people who don't want to be vaxed (the latter)? 


If you are a fan of the Osterholm weekly podcast, he just stopped short of putting De Blasio in that frame as he mocked the 3 feet distance rulings -- and said the CDC people would one day have an accounting over that issue. He also put the learning loss argument on trial. And masking too - the least effective barrier to the disease. If he had a choice between ventilation and Hepa Filters or masks, he would choose the latter. Oh, and testing once a week is a joke. He also raised the issue of economic pressure leading to bad decisions - and we can pretty much say that is the situation here in NYC ---

He said that NYC with back to school would be a bellweather for the nation. 

Oy! Good luck DeB and Mulgrew. Anyway - a must listen.

Episode 68: Recalculating Risk - https://www.cidrap.umn.edu/covid-19/podcasts-webinars/episode-68

September 9, 2021

This week, Dr. Osterholm provides insight on the state of the pandemic in the US and internationally, the importance of keeping children safer as schools go back in session, and the risk of outdoor events for fully vaccinated individuals.

Email us your questions: OsterholmUpdate@umn.edu (link sends e-mail)

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Sunday, September 12, 2021

UFT Elections: Boycott?- Why Run at all if Unity stacks the deck? - The Sunday Special

You know that bogus Einstein quote about the definition of insanity: doing the same thing over and over and expecting different outcomes.

One thing never tried it a total boycott of UFT elections.

Sunday, Sept. 12 -- I keep asking myself this question every single election cycle. What's the point of running if you are bound to lose? Over 30 years the best the opposition could do was once win 13 Ex Bd seats (1991) and win the 7 high school seats most of the rest of the time. History counts -- the vote totals on all the elections are pretty consistent. 

Why is this year different/ (I know, it's Yom Kippur coming up, not Passover.) 

Well, there is the always eternal hope that there will be a head to head confrontation between a united opposition and Unity -- which we had (sort of) in 2016. Then there is the unpopularity of Mulgrew. Then there is the mishandling of the pandemic by the UFT on so many fronts. Then there is the union's turning off so many retirees, the lifeblood of Unity, by taking away their medicare. Then there was the OT/PT functional chapter revolt where MORE swept the chapter leader and delegate positions, a sigificant event. Then there is word from other functional chapters. Then there were the school chapter elections last year where anti-Unity voices made some headway. Then there is Educators of NYC run by Daniel Alicea who actually voted for Unity in 2019 but has become a strong critical independent voice. I bet there are a bunch of people out there like Daniel.

Then there is  ...... PLEASE STOP TRYING TO CONVINCE MYSELF TO PUT ANY TIME OR EFFORT INTO ANOTHER UFT ELECTION.

There is the history of elections where no matter how I get my hopes up the outcome is pretty much the same.

I was deeply involved in UFT elections in 2004, 07, 10 (ICE), 13, 16 (MORE). I was out of the 2019 elections as I was in the process of being purged from MORE for publicly disagreeing with the faction in control of MORE that engineered the decision not only to not run with other groups but to purposely run in a way to not contend for any winnable positions - A minimalist campaign for what purpose I still can't figure out. Ed Notes covered the contradiction in their position in March, 2019.

My final words to the MOREs was to either run with everyone in a serious manner to maximize the anti-Unity vote with the aim of winning the high schools and taking a serious shot at the middle schools or not run at all but use the election (which occupies a great deal of time) time saved as an organizing tool for the caucus. I told the MOREs that an election is like a high stakes test for a caucus. At the very least it must hold its own in vote totals but most people other than hard core organizers (like I was) get discouraged if these numbers don't grow. I can't tell you how many people I saw pass through the groups I was in over these 50 years.

I have been urging boycotts of UFT elections in every election since 2010 to emphasize the undemocratic nature of the UFT itself where winning an election is almost impossible. Why run of the outcome is pre-decided? John Lawhead from ICE and now Solidarity Caucus came up with the idea of uncaucusing for the elections and focusing on issues of concern to the members without engaging in the cumbersome and often distracting election process. Behind my idea was to leave the membership with no options on the ballot other than Unity as a wake-up call. I know that prospect actually scares the Unity people because it exposes them. If there were no opposition running Unity would make one up.

I was overruled every time and ended up throwing myself deep into the elections. I ran the petitioning campaigns for MORE in 2013, 2016 along with Ellen Fox. The MORE decision in 2019 relieved me of all that work and sitting out the election was a relief.

Now we are upon yet another UFT election cycle for 2022 and we are in the same position  - will the opposition come together this time with a united front challenge to Unity? So far most of the various caucus and uncaucus groups have spoken as Retiree Advocate, ICE, Solidarity, New Action, Educators of NYC - and even this lonely spot - Ed Notes - have endorsed that idea with rumors that MORE was taking a membership vote that ended Friday on a positive note.

The hard part would be to put everyone together in a room and lock the doors. The best thing about this election is that I will be outside that room blocking the exits.

Previous Ed Notes

Everything you wanted to know about UFT Elections ...

Thursday, September 9, 2021

Good luck to all On the first day of school, It's as much about testing as vaccines -


Brace yourself, everyone. The city has decided, with almost everyone in attendance, that it only needs a fraction of the testing it did when it only had a fraction of the students. If you can't see what that spells, you may just be hard of reading.  ... NYC Educator. 

Scary story: Last night we hear about a healthy late-30, early 40-ish vaxed teacher who had some mild symptoms and got tested and came up pos for covid. Important point-- he went and got tested on his own, NOT BY DOE. If he went in today he would have subjected 60 colleagues. His wife, also DOE, is getting tested but still must go into work today. They are keeping their middle school kid home and actually intended to keep the kid home all along. Both of them have been very careful with masking etc.

Today I am going into the city for the first time in 6 weeks, taking the ferry. Why am I as nervous as I was a year ago before I was even vaxed? Tell me how it is not likely I'd get real sick. That's not enough for me. I don't want to get anywhere near this virus due to possibly long-term effects. You don't end up with reduced kidney function with a cold.

Another Hidden Covid Risk: Lingering Kidney Problems

https://www.nytimes.com › health › covid-kidney-damage
Sep 1, 2021 — Doctors are unsure why Covid can cause kidney damage. Kidneys might be especially sensitive to surges of inflammation or immune system ...
I'm 76 and in one month it will be 8 months since last vaxed and I will be first in line to get the booster.

It's now about testing, especially since there will be loads of unvaxed working in the same space.

Thursday, September 9, 2021

Good morning everyone on back to school day, the most nervous day of the year for me for 35 years, but joyful for the past 19. After two months of total freedom, I was bummed but also ready to see colleagues and students and parents. Butterflies but excited butterflies.

Every single year began with some chaos in my various schools. But today I feel butterflies for all the people who have to go back in the midst of as much fear and chaos as I've every seen. Teachers in LA and Chicago, due to strong progressive unions, may feel safer than NYC school employees - due to the political ambitions of de Blasio, whose political ambitions will crash even further than they have when things fall apart.

And de Blasio will be aided by the UFT's Michael Mulgrew who, other than Unity loyalists, may be the most unpopular UFT leader in history. [Unsafe Schools at any speed --call on UFT and DOE to issue 10 foot poles to vaxed school employees].
 
Mulgrew and Randi actually met with the leader of the unvaxed group while ignoring the calls of the majority of UFT members calling for some remote options, not for them but for parents, whose fears that lead to them not sending their kids to school may be met by DOE investigations instead of support. Mulgrew is silent.
 
As Arthur points out, the reduced testing is a head scratcher.

[Sign a petition for more testing. (see below break for text.)]

If you don't follow Dr. Michael Osterholm's weekly podcasts, they are a must listen.

The Osterholm Update: COVID-19

He mocks the 3 foot distance rule and even the learning loss argument for forcing kids back to school. It's being driven by the it's the economy, stupid. Osterholm should be on TV more than Fauci -- and actually is appearing as the absolute realists. He also feels we are not doing enough testing.

Here is another must listen -- Michael Mina on Brian Lehrer advocates rapid testing as being as important as vaccines -- he even says we won't vax ourselves out of this pandemic but we can test our way out.

Brian Lehrer - Sept. 1

Michael Mina, MD, PhD, assistant professor of epidemiology at Harvard T. H. Chan School of Public Health, talks about how schools are preparing to test students, the science on boosters and who gets them, and more of the latest COVID-19 news.

https://www.wnyc.org/story/defense-home-rapid-test

Dr. Mina: Absolutely. COVID and quarantining is really an information problem. We quarantine a child and we say, "You can't go to school for 10 days because you've been exposed," because we don't know whether or not they've been infected, so we say, "Go home and quarantine." We actually have the tools now to know if they are infected and infectious and [unintelligible 00:03:35] a simple rapid test that a lot of people have now been finally hearing about.

Instead of quarantining the child or a whole classroom of children because somebody else turns up positive in the class, we can do what I call test to [unintelligible 00:03:53]. That's instead of having everyone quarantine, you just have them use a simple rapid test at home before school and you do that each day that they would otherwise be quarantining. You say, "You've been exposed potentially. We don't know if you're infected," so on Monday, use a rapid test in the morning, and if negative, go to school. Tuesday, use rapid test in the morning, and do that for the week. Most people don't actually turn positive who ended up being quarantine.

This is in a critical tool that we haven't really utilized very well at all in this pandemic to keep society running. This works for businesses, for schools. It's an information problem and we know how to solve that problem.

Brian: We always hear that the rapid tests aren't as accurate as the so-called PCR tests, the full nose swab. Are the rapid tests accurate enough for use like that and still protect the other kids in the class?

Dr. Mina: Absolutely. The rapid tests that have been authorized thus far in the United States are very accurate to answer the question, am I infectious? This is a very different question than have I been infected in the last few weeks? The question is, and why we quarantine people is we are worried about whether or not they are spreading the virus today. These rapid tests do exactly that, they detect infectiousness. I actually like to call them-- These are public health tools that I think should actually be called contagiousness indicators or something along those lines, because that's really what they excel at. They are very, very good to answer that question.

Brian: I see you have this Twitter thread going that's partly aimed at the Los Angeles public schools in particular. Is LA and outlier for some reason or typical of this issue?

Dr. Mina: This is happening all over the place. That was just one of the first big news reports to break. That was that day one, day two of school there were a huge number of quarantines and now we're seeing people and the teachers unions and such pushing for more extreme quarantines, that when one child becomes positive in a class, to quarantine the whole classroom. This is not the way to go. It wasn't last year and it still is not.

Kids have been out of school enough. The last thing we want to do in a pandemic is to have the societal ramifications be worse than the virus itself. We need to figure out and utilize the tools that we have available to us to ensure that children remain in school, to ensure that businesses keep running and we don't just keep using these brute force methods of closing things down and make major quarantines to solve a public health problem. Those solutions should be considered public health failures, and we have ways not to have to utilize those.

Petition text:

Petition for More COVID Testing in Schools
Dear Mayor de Blasio and Chancellor Porter,

Everyone who works for NYCDOE must protect students’ safety. To keep our communities safer, we demand more COVID testing in New York City’s public schools.

Children aged thirteen to seventeen have the highest positivity rates in New York City. For children aged five to twelve, the positivity rate increased tenfold over the summer. In the second half of August, about one in twenty school-aged children has been testing positive. That rate translates to at least one COVID-positive student in every K-12 class in New York City.

Just when schools need more COVID testing, NYCDOE plans less. Last year, once every week, NYCDOE tested 20% of the students. This year, every OTHER week, NYCDOE will test 10%. Testing half as many kids, half as often, reduces safety. Breakthrough cases are common, but NYCDOE will not test vaccinated staff or students. NYCDOE now allows families to refuse in-school testing. We still do not have testing for 3K, pre-K, or kindergarten; citywide, that leaves about 14% of our students in classes that never get tested.

The following measures will keep our city safer:


Test 40% or more every week. Larger sample sizes detect spreading cases. More frequent testing detects cases while there’s still time to act.

Test the vaccinated. When the Delta variant breaks through, vaccinated people spread COVID. Everyone stays safer if vaccinated students participate.

Require participation. This year should be like last year: families should acknowledge that their children will be tested, but testing should not be optional.

Test early childhood. Random testing cannot monitor untested classrooms. Include 3K, 4K, and kindergarten.

Restore staff testing. Every day, principals and assistant principals enter nearly every classroom. Educational administrators travel school to school. None of us wants to pass COVID to the students we love. If administrators, teachers, paraprofessionals, school aides, custodial staff and kitchen workers all test alongside our students, we know our kids are safer.


You charged us with opening schools and keeping them open. More testing leads to more early quarantining, but less testing eventually results in more cases than our city can ignore. Another systemwide shutdown would undo everyone's goals for mental health, physical wellbeing, and academic learning.

We need early detection to maintain student health and public trust. Give us more testing, more often, for much more safety.