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    Crossroads GPS, a conservative nonprofit outside spending group, began a $2.3 million ad campaign Wednesday, including the Crossroads network’s first reported foray into congressional races and ads in four hotly contested Senate races. With its entry into the House race, Crossroads is now active at all levels of the national election.

    This campaign is part of a larger $10 million-plus offensive from Republican strategist Karl Rove’s Crossroads network that began this week. Super PAC American Crossroads just announced an $8.8 million campaign targeting President Barack Obama.

    Crossroads GPS’ ads target Senate races in Montana, Nevada, North Dakota and Wisconsin as well as New York’s 1st Congressional District, where Republicans have become adamant about ousting Democratic Rep. Tim Bishop:

    • Number One” opposes Sen. Jon Tester, D-Mont., who faces a challenge from Republican Rep. Denny Rehberg. A report with the Federal Election Commission shows the initial buy cost $615,000.
    • Shameful” opposes Rep. Shelley Berkley, D-Nev., who is challenging Republican Sen. Dean Heller. The ad focuses on her support of the Affordable Care Act and her ethics investigation.
    • Your Vote” opposes former North Dakota Attorney General Heidi Heitkamp, the Democrat running for U.S. Senate against Rep. Rick Berg, a Republican. The ad focuses on Heitkamp’s support of the Affordable Care Act. FEC reports show the initial buy at $139,000.
    • Dang Right” opposes Rep. Tammy Baldwin, D-Wis., who is running against former Wisconsin Gov. Tommy Thompson, a Republican. The ad shows Baldwin yelling, “You’re damn right we’re making a difference,” followed by the narrator asking, “Tired of all the shouting? Tammy Baldwin is just out of touch with Wisconsin.”
    • Judgment” opposes Rep. Tim Bishop, the Democrat representing New York’s 1st District. Bishop is being challenged by Republican businessman Randy Altschuler. The ad focuses on an incident in which Bishop allegedly helped a constituent in exchange for a campaign contribution.

    The anti-Bishop expenditure by Crossroads is its first in this election, but Bishop is no stranger to the group.

    In 2010, just after Bishop barely beat Altschuler for the first time, Crossroads launched radio ads urging Bishop to support extending tax cuts. Because the ad did not explicitly urge a yes-or-no vote for Bishop — the election had just concluded, after all — it did not need to be reported to the FEC.

    The new Crossroads ads come a week after ads by Prosperity First, a super PAC that appears to be solely dedicated to ousting Bishop. Prosperity First is bankrolled by wealthy hedge fund executive Robert Mercer, as the Center for Public Integrity reported last week.

    As a 501(c)(4) nonprofit, Crossroads GPS is not required to publicly disclose its donors.

    The super PAC and nonprofit have primarily focused their spending on the presidential race. American Crossroads’ newest ad, “Next,” features business owners who say Obama’s economic policies have hurt them, including one man who says Obama treats them like “the enemy.” The presidential ads will run in Colorado, Florida, Iowa, North Carolina, New Hampshire, Nevada, Ohio and Virginia, according to Politico.

    Crossroads is also paying more attention to the Senate. Just last week, Crossroads GPS released a $2.5 million wave of ads hitting Democrats Berkley in Nevada, Tim Kaine in Virginia and Sen. Sherrod Brown in Ohio, as the Daily Disclosure reported.

    American Crossroads’ biggest donors include Harold Simmons and his chemical company Contran Corp., homebuilder Bob Perry, former Univision owner Jerry Perenchio, and Crow Holdings, which is owned by real estate mogul Harlan Crow.

    In other outside spending news:

    • Pro-Obama super PAC Priorities USA Action released “Doors,” an ad capitalizing on the secret fundraising video recently released of GOP presidential nominee Mitt Romney.
    • The NEA Fund for Children and Public Education, the PAC of the National Education Association, reported spending $1.1 million opposing Ohio Treasurer Josh Mandel, the Republican challenging Brown for U.S. Senate, and opposing Rep. Steve King, R-Iowa, who faces a challenge from Democrat and former teacher, Christie Vilsack.
    • The U.S. Chamber of Commerce released “A Vote Against American Energy Security,” which opposes Brown’s re-election in Ohio. The Chamber has endorsed his opponent Mandel for U.S. Senate.
    • The Democratic Congressional Campaign Committee released “Gutting Medicare,” which opposes Rep. Sean Duffy, R-Wis. Duffy is challenged by former Wisconsin state Sen. Pat Kreitlow, a Democrat. It also ran an ad opposing former Arizona state Sen. Jonathan Paton, who is running for U.S. House in Arizona’s 1st District and an ad opposing Republican Rep. Allen West’s re-election. The DCCC reported spending $2.4 million on these and other ads.
    • The Democratic Senatorial Campaign Committee released an ad opposing Indiana State Treasurer Richard Mourdock for Senate.
    • Waste” from Majority PAC, a super PAC supporting Democrats running for Senate, opposes former Sen. George Allen, a Republican who faces Kaine, Virginia’s former governor.
    • The Now or Never PAC, a conservative super PAC, reported spending $810,000 in support of Rep. Joe Walsh, R-Ill., who is challenged by Democrat Tammy Duckworth, an Iraq veteran and former Assistant Secretary of Veterans Affairs.
    • Conservative super PAC FreedomWorks for America, which the Daily Disclosure reported released a spate of online ads this week, reported spending $2.3 million on online advertising supporting Republicans and opposing Democrats.
    • Center Forward, formerly the Blue Dog Democrats, spent $552,000 on ads opposing three Republicans: “Struggle,” opposes Georgia state Rep. Lee Anderson in the state’s 12th District race; “Problem” opposes Saratoga Springs, Utah, Mayor Mia Love in the state’s 4th District race; and “Refuse” opposes Mourdock in Indiana's U.S. Senate race. 

    Who paid for that political ad? You might be surprised by the answer. Email us and we will try to find out. Describe the advertisement — was it mean or nice? Will it affect your vote? When and where did it run and what were the names of the candidates? And PLEASE tell us what the disclaimer at the end says, and we will check it out.

    With this ad targeting Rep. Tim Bishop, D-N.Y., Crossroads GPS is now active at all levels of the national election. Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/19/10940/daily-disclosure-crossroads-gps-charges-congressional-race

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    AUGUSTA, Maine  — Two of the state’s top political leaders are vowing a bipartisan effort to make government ethics, accountability and transparency key issues in the upcoming legislative session.

    Republican Gov. Paul LePage and House Democratic leader Emily Cain are responding to a national report that gave Maine government an “F” for its potential for corruption.

    Maine ranked 46th in the “State Integrity Investigation” by three nonpartisan groups that was released in mid-March.

    Cain, the Democratic House leader who is running for a Senate seat from Orono, has proposed two linked initiatives that she hopes will lead to government ethics reform.

    Cain said Tuesday she will ask her fellow lawmakers to form a bipartisan, joint select committee to consider ethics reform and report out a bill in the legislative session that begins in January, 2013.

    “While the report didn’t reveal that Maine is corrupt, we have a lot of things to look at to do better,” Cain said, adding that she believes key areas of concern include nepotism, cronyism, legislative financial disclosure, government transparency and citizen access to information.

    Cain on Tuesday submitted a “concept draft” bill, “An Act to Strengthen Maine's Ethics Laws and Improve Public Access to Information,” that she hopes will provide a vehicle for bipartisan reform proposals.

    Cain said her reform effort could succeed where others have failed in the past in part because the public is more aware now of the potential for corruption.

    “I think the fact that Maine had a public blemish in that report changes a mindset for the public and for legislators,” Cain said.

    “And we can say to ourselves: why did we get scored that way and can we take a look at ourselves in the mirror and say what do we want to be known for?”

    Both Cain and Gov. Paul LePage vowed after the integrity report’s release last spring to spearhead comprehensive government ethics reform proposals.

    The report was based on research into 330 indicators in 14 categories, from procurement to campaign disclosure to lobbying. No state got an A, leading the report’s sponsors to conclude, “statehouses remain ripe for self dealing and corruption.”

    Global Integrity collaborated with the Center for Public Integrity and Public Radio International on the investigation. In Maine, the research was done by the Maine Center for Public Interest Reporting, based in Augusta. The Center’s research was then analyzed by the three sponsoring groups, which came up with the scores.

    Maine got an F in nine of the 14 categories, including executive accountability, public access to information, civil service management, pension fund management, the insurance commission, legislative accountability, lobbying disclosure, ethics enforcement and redistricting.

    The state got a D+ in judicial accountability and political financing and a C- in the budget process and procurement. It got one A: in internal auditing.

    This week, LePage’s acting chief legal counsel, Michael Cianchette, said that the governor’s office is working with a University of Maine student to research and write omnibus ethics reform legislation.

    That student, Shelbe Lane of Patten, will make the legislation the subject of her Honors College thesis. That, in turn, said Cianchette, will be turned into a bill from the governor’s office.

    “Rewriting ethics laws and finding best practices is a big objective,” Cianchette said. And he said that while it may be unusual to hand the job over to a college student, Lane is up to the challenge.

    “She’s an intelligent young Mainer who wants to undertake this public service and it will of course go through process in the governor’s office and the legislature to find the best way forward,” Cianchette said.

    While the goal is to address a range of problems identified in the report, Cianchette said he believes the legislation will ultimately “focus in on a few red flag areas.”

    Lane, 20, worked as an intern in LePage’s office in the fall of 2011. She said the work she’s undertaking now is daunting.

    “I would say that at times, yes, it makes me a little nervous to think about what I will be doing,” Lane said. “But I am getting ready to go to law school next year, so I’m also looking at it as a good step to working on my skills to help me through my career.”

    And Lane said her interest in ethics reform went beyond the personal. Pride in her state motivates her.

    “I am a student and I am always going after straight A’s,” she said. “This report card is not my own, but what I hope to accomplish is a better report card and ranking for the State of Maine in the form of straight A’s!”

    Both Cain and Cianchette said the reform efforts will not be politicized.

    “Anything I’m doing I want to do in collaboration with the governor’s office, Republicans in the legislature, everyone,” Cain said.

    “What I’d like to see happen is not only an end result that increases trust in state government, but a process that reflects and leads to an increased trust as well.”

    “It’s not a Republican or Democrat issue,” said Cianchette. “It’s a transparency issue.”

    The bipartisan theme extends to Lane: Her thesis advisor is Cianchette, a Republican, while Democrat Cain sits on her thesis review committee.

    The Maine Center for Public Interest Reporting is a nonpartisan, non-profit news service based in Hallowell. Email: mainecenter@gmail.com. Web: pinetreewatchdog.org.

    Maine Gov. Paul LePage. Naomi Schalit http://www.publicintegrity.org/authors/naomi-schalit John Christie http://www.publicintegrity.org/authors/john-christie http://www.publicintegrity.org/2012/09/19/10945/impact-new-ethics-effort-maine

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    Judging by their bills, it would appear that elderly patients treated in the emergency room at Baylor Medical Center in Irving, Texas, are among the sickest in the country — far sicker than patients at most other hospitals.

    In 2008, the hospital billed Medicare for the two most expensive levels of care for eight of every 10 patients it treated and released from its emergency room — almost twice the national average, according to a Center for Public Integrity analysis. Among those claims, 64 percent of the total were for the most expensive level of care.

    But the charges may have more to do with billing practices than sicker patients. A Baylor representative conceded hospital billing for emergency room care “did not align with industry trends,” but said that the hospital since 2009 has reined in its charges.

    The Texas hospital’s billing pattern is far from unique. Between 2001 and 2008, hospitals across the country dramatically increased their Medicare billing for emergency room care, adding more than $1 billion to the cost of the program to taxpayers, a Center investigation has found. The fees are based on a system of billing codes — so-called evaluation and management codes — that makes higher payments for treatments that require more time and resources.

    Use of the top two most expensive codes for emergency room care nationwide nearly doubled, from 25 percent to 45 percent of all claims, during the time period examined. In many cases, these claims were not for treating patients with life-threatening injuries. Instead, the claims the Center analyzed included only patients who were sent home from the emergency room without being admitted to the hospital. Often, they were treated for seemingly minor injuries and complaints.

    While taxpayers footed most of the bill, the charges also hit elderly patients in the pocketbook, increasing the amount of their 20-percent co-payments for emergency room care.

    Hospitals and federal officials say the rise has likely been caused by an increase in sicker patients seeking care in emergency rooms, more accurate billing on the part of hospitals, and an increasing number of options for patients who aren’t as sick — options that include retail-based clinics and urgent care facilities. But the Center’s investigation found that the surge in billing also reflects lax government oversight, confusion about proper billing standards, and widespread payment errors that have plagued Medicare for more than a decade. And the data suggest that some hospitals are working the billing system — and its flaws — to maximize payments.

    Dr. Donald Berwick, the immediate past administrator of the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, said a small portion of the billing increase is likely caused by outright fraud, but in the majority of cases hospitals are legally boosting profits by targeting the vulnerabilities of Medicare’s payment system. “They are learning how to play the game,” Berwick said about the hospitals.

    Hospital industry insiders say it’s no secret that hospitals are pushing the limits to bill higher-priced Medicare codes, a practice known as upcoding. “There is such financial pressure to upcode,” said Barbara Vandegrift, a health care consultant at Tennessee-based Quorum Health Resources. “It’s ‘wait until we get caught and we’ll fight it at that point.’ ”

    Few hospitals, however, are being scrutinized. Medicare officials are aware of the rising expense of emergency room billing for evaluation and management services, but the agency has downplayed the problem and done little to verify the accuracy of hospital emergency room charges. Instead, it has given hospitals a free hand to set their own billing policies, with little agency guidance and even less auditing.

    Medicare lacks rules for hospital ER billing

    Since 2000, hospitals have chosen among five codes to bill Medicare and other insurers for evaluating emergency room patients and coordinating their treatment. This hospital “facility fee,” which can add millions of dollars to the hospital’s bottom line in the course of a year, ranges from $50 to $324, depending on which code is chosen for any given case. It comes on top of physician charges.

    The system dates back to a change in federal law requiring hospitals be paid a set fee for services, rather than a blanket payment based on the cost of providing care, which was meant to save the program money. Yet instead of developing specialized billing codes just for hospitals, CMS since 2000 has required hospitals to file claims using a set of codes developed and licensed for physician billing by the American Medical Association — so-called Current Procedural Terminology, or CPT, codes. The lack of specific hospital codes, or guidelines for how hospitals should use physician codes, has left the system open to broad interpretation by hospitals.

    “All the hospitals looked at each other and said, ‘OK, how are we going to do this?’ To make a long story very short, we still have no guidelines,” said Duane Abbey, a hospital billing consultant in California.

    Medicare administrators acknowledge as much. Since 2000, CMS has repeatedly announced plans to develop new hospital evaluation and management codes, or at least provide national guidelines for hospital billing. But the agency has failed to deliver. Instead, CMS requires hospitals to develop their own guidelines for billing those codes designed for doctors. Some follow strict internal policies, Abbey and other hospitals billing consultants said, while others wildly inflate charges, regularly change their billing criteria, and sometimes fail to follow even their own lax internal policies.

    “The whole issue of the E and M levels for the emergency department … is an absolute mess,” Abbey said.

    Chasing dollars

    Left to develop their own billing rules, hospitals have flocked to higher paying emergency room codes. Leatrice Ford, an independent consultant in Louisville, Ky., who uses Medicare claims data to advise hospitals on their emergency room billing, said it’s well known in the industry that many hospitals inflate their charges. But Ford said it’s a tough sell for a consultant to convince hospitals their billing is too high. “In my experience hospitals are reluctant to give up their overpayments,” Ford said.  The reason, she said, is that Medicare and the contractors it employs to administer payments are not checking.

    “I have never once seen or heard of anyone being audited or called on the carpet for their distribution of E and M codes,” Ford said. “That’s a standard audit for physician practices, but I’ve never seen a hospital get in trouble for it.”

    In 2008, more than 500 hospitals of the more than 2,400 in the database billed the two most expensive codes for more than 60 percent of patients. More than 100 billed the two most expensive codes for at least 70 percent of patients.

    Some — like Baylor Medical Center in Irving — were even higher. In 2007, Yuma Regional Medical Center, a 369-bed nonprofit hospital in southwestern Arizona, billed the top two most expensive codes for eight of every 10 Medicare emergency room patients. Billing at the hospital made Yuma, Arizona, the nation’s regional leader for the percentage of billing of the top two levels of E and M codes, far higher than metropolitan areas like New York City and Chicago.

    Yuma’s CEO Pat Walz, however, said the charges are accurate. When the Center first asked about the claims, Walz said elderly winter visitors have driven up the hospital’s number of serious emergency room cases. Yuma claims data reviewed by the Center for Public Integrity, however, suggest the average age of the hospital’s emergency room patients remained steady from 2001 to 2008 at around 77 years old.

    Walz also conceded that the installation of Medhost, an electronic emergency department information system, was likely one of the most significant drivers of the hospital’s push toward more expensive codes. Before Medhost, nurses and doctors wrote patient notes by hand, Walz said. Computerized charting captured much more of the work they actually performed, which he said resulted in higher E and M levels.

    But Walz said the electronic system is not overcharging Medicare. Rather, it is simply helping the hospital make money from care that once fell through the cracks. “If you look at any industry — as it goes from human to electronic input, the same thing is going to happen,” Walz said.

    Walz said Medhost has paid for itself through increased billing, but he said the decision to install it was not financial. “We did it to improve the quality of patient care,” he said. Medhost did not respond to requests for comment.

    CMS: hospital billing increase “slight”

    The Centers for Medicare and Medicaid Services has so far downplayed the spike of hospital billing. In 2011 comments published in the Federal Register, CMS said it noticed a “slight shift” toward hospital billing of more expensive evaluation and management codes. The agency said it also noticed that emergency room charges for the higher-level visits “seem to be trending upward year over year.”

    Presented with the Center’s analysis, which shows a far more dramatic shift toward expensive codes, CMS declined interview requests. But in written responses to questions, the agency’s press office said the trend is only “notable” over several years. Considered year to year, as the agency said it examined the data, the higher level codes increase at no more than 2 percent.

    Further, the agency wrote that the trend may reflect more accurate coding by hospitals and physicians rather than upcoding. Indeed, the agency said its advisory panel, which is made up of physicians, hospital administrators and other hospital financial staff, told CMS that the rise in billing is a result of hospitals getting better at capturing their costs.

    “They would argue that the costs were inadequately reflected in our data several years ago,” the agency wrote, “so the increases we are seeing now are bringing the payment system to where it should have been all along.”

    Dr. Scott Manaker, a professor of medicine at the University of Pennsylvania Perelman School of Medicine, a member of the panel, said there are a number of possible causes for the rise in high-level billing, including more accurate hospital coding. Manaker said he doubts upcoding is the major cause, but said it’s impossible for the panel to determine without examining individual patient charts and hospital billing records, which it has not done.

    Another panel member said hospital emergency room billing has not been a critical issue during meetings. “In my four years in the panel there has not been a lot of discussion of E and M leveling on the facility side,” said Judith Kelly, director of health information management at Unity Health System in Rochester, N.Y. To address the issue, Kelly said CMS should issue hospital-specific billing codes or guidelines for emergency care. “When there is ambiguity, there are problems,” she said.

    In response to questions, CMS said some hospitals have been audited. But the agency said the process of auditing and seeking reimbursement of overpayment is “expensive and time consuming relative to the potential return that will be realized on individual claims for relatively low cost services.”

    But some question whether CMS contractors — who help administer Medicare payments — can effectively audit hospital billing. Without national billing guidelines, said Abbey, the hospital auditor, it would be difficult for CMS contractors to determine who is cheating the system. Indeed, he said they would need first to ask each hospital for a copy of its internal billing guidelines. “They should have one of their famous committees developing guidelines right now,” Abbey said. “My sense is they aren’t, but they should be.”

    A never-ending quest for billing guidelines

    During the 12 years that CMS has allowed hospitals to set their own billing policies for E and M codes, a host of organizations have proposed national guidelines. So far, none of them have made the cut.

    In 2002, the American Hospital Association (AHA) and the American Health Information Management Association, an association representing health information management professionals, formed an expert panel to develop guidelines for hospital emergency room billing at the urging of CMS. In 2003, the groups submitted detailed recommendations for a billing system that measured hospital emergency room care. The recommendations went nowhere. “It just died a slow death,” said William Briggs, a nurse who represented the Emergency Nurses Association on the expert panel.

    CMS has called the AHA proposal the “most appropriate and well-developed guidelines” available. Yet the agency has not required hospitals to follow them. Not long after the AHA proposed the guidelines, a CMS-funded outside study found a number of problems with the guidelines.

    A separate small-scale study, however, suggested the guidelines save money. In 2009, the Ohio-based company Permedion, which reviews medical claims for state and federal agencies, found that 37 percent of a sample of Ohio Medicaid emergency room claims should have been coded at lower levels, based on the AHA guidelines. The remainder were in agreement with the guidelines.

    The AHA remains one of the loudest voices pushing for guidelines, but it is discouraged over the long delay. “We keep asking them to issue national guidelines,” said Nelly Leon-Chisen, the association’s director of coding and classification. “We do it every year and they don’t do anything about it.”

    By 2007, though, it appears CMS had effectively given up on releasing new guidelines. The effort “was proving more challenging than we initially thought,” the agency wrote in the Federal Register.

    Industry insiders say there are a number of reasons why the agency never established guidelines. Some suggested a working set of rules that accurately reflects costs for all hospitals may be impossible to develop. Others say CMS is reticent to sign off on an outside group’s system, as it has with the American Medical Association, which licenses the use of the CPT codes it owns and administers.

    In written responses to questions submitted by the Center, CMS said “it seems unlikely that one set of straightforward national guidelines could apply to the reporting of visits in all hospitals and specialty clinics.” It also said the agency believes that “as a whole, hospitals have worked diligently and carefully to develop and implement their own internal guidelines that reflect the scope and type of services they provide.”

    Asked about the hospital shift toward billing more expensive codes, Roslyne Schulman, the hospital association’s director of policy development, said she was unaware billing had risen at the rate revealed by the Center’s data analysis, and could only speculate on the reasons without comparing billing to patient charts. Asked if hospitals were simply billing for levels of care they did not provide, Schulman said, “I would hope that would not be an issue.”

    Hospitals say patients are “sicker and older”

    In 2008, Sentara Virginia Beach General Hospital, a 276-bed hospital a few miles from the Atlantic Ocean, billed the top two emergency room codes for 80 percent of all patients, up from about 29 percent in 2001. Hospital spokeswoman Amy Sandoval said the hospital since 2001 has used the electronic charge system Optum Lynx to determine evaluation and management billing levels.

    In a written response to questions about the hospital’s billing, Sandoval said Optum reviewed the hospital’s billing and found it within acceptable limits. Sandoval said “possible” reasons for the high level of billing include an older and sicker patient population, the intensive resources required to treat psychiatric patients before transfer, and a trend of less sick patients seeking care outside of emergency rooms to avoid long waits and high co-pays. The hospital, she added, is a level III trauma center, located within a mile of seven assisted-living centers and nursing homes.

    Representatives from small-town hospitals and major urban trauma centers generally offered the same justification for their rising charges. These explanations could be accurate for individual hospitals, but they are not borne out in the national Medicare billing data analyzed by the Center. The average age of emergency room patients in data examined by the Center was 77 and remained constant from 2001 to 2008. The total number of emergency room claims rose 31 percent during that time, however, as compared to a less than 10 percent increase in Medicare beneficiaries, which suggests urgent care clinics have not sapped overall business levels.

    Some of the rise could be accounted for by emergency room care advances. In the eight years from 2001 to 2008, advances in medical care allowed emergency rooms to treat patients without later admitting them to the hospital. Since the Medicare data the Center for Public Integrity examined includes only treat-and-release patients, these sicker patients would be included in the data more often in 2008 than in 2001. But some experts strongly doubt this accounts for the extent of the rapid rise.

    Moreover, the ten most common “primary diagnoses” — the chief complaints for why patients seek care in emergency rooms — remained unchanged during the time period of the data reviewed by the Center. Although those top diagnoses including dangerous symptoms like chest pain and loss of consciousness, the list also included seemingly minor complaints like lower-back discomfort, urinary tract infections and limb pain.

    But while the most common diagnoses remained constant, billing of the most expensive codes surged. Take the case of emergency room headaches. From 2001 to 2008, hospital billing of the top two evaluation and management codes for headache patients more than doubled to 43 percent. The number of tests and procedures doctors performed on headache patients also rose. In 2001, hospital emergency rooms billed an average of six revenue codes (which represent areas of the hospital where costs occur, including imaging, labs, and supplies) for headache patients, according to Medicare billing data. In 2008, they billed an average of nine.

    In addition to changes in standards of care over those eight years, hospitals say they simply are seeing sicker Medicare patients than in the past. But some disagree.

    Berwick, the former CMS head, said patients haven’t changed. What’s changed is the aggressiveness of how hospitals bill. “They are smart,” Berwick said. “If you create a payment system in which there is a premium for increasing the number of things you do or the recording of what you do, well, that’s what you’ll get.”

    Dr. Stephen Pitts, an emergency physician and associate professor in the Emory University School of Medicine, examined data from the Centers for Disease Control and Prevention’s National Hospital Ambulatory Medical Care Survey, a well-established nationally representative survey of emergency department visits. Pitts found that between 2001 and 2008 emergency patients did not appear to be getting sicker.

    “It’s total nonsense,” Pitts said of hospital claims that sicker patients have led to higher charges.

    Emergency physician billing also rises

    A more likely cause, Pitts said, is the pressure hospitals put on emergency room physicians to bill every patient at the highest rates possible. Emergency room salaries at many hospitals are tied in part to how much profit doctors generate per patient, Pitts said. From the business side, this makes sense. “If you don’t bill maximally, your ER is going to die,” Pitts said. But from a patient perspective, it means doctors perform more tests and procedures than they did in the past, which increases the costs of care.

    Although hospital facility charges are separate from physician charges, billing and coding experts say the two are linked. And like hospital charges, emergency room physician charges for evaluation and management services are soaring. In 2008, emergency room physicians billed the most expensive code for 44 percent of patients, up from 27 percent in 2001, according to Center analysis of Medicare claims data.

    The cost associated with this rise is substantial. In 2010, the top level physical evaluation and management code for emergency care cost the program nearly $1.6 billion, up 21 percent form 2008.

    Unlike hospital billing, CMS requires that physicians follow American Medical Association criteria for billing emergency room evaluation and management services. The top level code 99285, for example, requires doctors to perform a comprehensive medical history, a comprehensive exam and engage in highly complex medical decision making.

    Yet a number of probes have found physicians are over-billing the top-level code. A 2012 probe of physician billing of 99285 in Iowa, Kansas, Missouri, and Nebraska found an error rate of almost 50 percent. The probe, performed by Medicare contractor Wisconsin Physicians Service Insurance Corporation, found that physician documentation did not support the 99285 level.

    David McKenzie, the reimbursement director of the American College of Emergency Physicians, said upcoding is not to blame for the rise in physician charges. Emergency room doctors are simply getting better at documenting their work, and Medicare patients in general are getting sicker, McKenzie said. In addition, nurse practitioners and physician assistants are treating less sick patients who in the past would have been treated by doctors, which is skewing their numbers.

    Evaluation and management of health care in seniors takes time, McKenzie said. “A broken leg in a 17-year-old football player is not the same as a broken leg in an 88-year-old diabetic.”

    CMS says rise unlikely caused by upcoding

    In written comments, CMS said upcoding is unlikely to account for the rapid rise in hospital emergency room billing since the trend appears “to be consistent across hospitals and physicians.” But billing at some hospitals is rising much faster than at others. Asked if the agency is monitoring hospitals, like Baylor Medical Center in Irving, Texas, with rates that were nearly twice the national average, CMS said it is inappropriate for the agency to discuss audits involving specific hospitals.

    But Baylor Irving’s president, Cindy Schamp, said CMS never questioned the hospital’s 2008 evaluation and management code billing. In 2009, Schamp said, the hospital instituted new billing rules that led to fewer claims for the top two codes. She said the change was voluntary.

    Asked if the hospital returned Medicare overpayments, Schamp said it has not. “To date, we have not made any payments back to Medicare,” Schamp wrote in response to questions. “However, continuing to work to do the right thing, we feel it is appropriate to review."

    Four months later, a Baylor spokeswoman said the review was complete. “We looked at a sample set of (emergency room) charges made at Baylor Irving during that time period to see if they were accurate in the context of the billing guidelines at that time,” Nikki Mitchell wrote. “That is the appropriate way to review charges.  In the review, no overcharges were found.”

    Joe Eaton http://www.publicintegrity.org/authors/joe-eaton David Donald http://www.publicintegrity.org/authors/david-donald http://www.publicintegrity.org/2012/09/20/10811/hospitals-grab-least-1-billion-extra-fees-emergency-room-visits

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    Conservative nonprofit Let Freedom Ring attempts to link President Barack Obama to child soldiers in a new ad focusing on the United States’ military aid to certain countries in Africa and the Middle East.

    The ad opens with brief background on child soldiers and notes that Sen. Obama supported a bill that restricted American aid to countries that use child soldiers in militaries and state-backed militias.

    “This was the right thing to do. It’s what leaders do,” the narrator says. “But then, as president, Obama waived these restrictions, allowing millions of our taxpayer dollars to go to countries where children as young as 11 — 11! — are forced to fight.”

    “Why, Mr. President? Why?” the ad finishes.

    In 2011, Obama waived restrictions on military aid to countries that the U.S. has identified as using child soldiers, despite the 2008 Child Soldiers Protection Act that he, as senator, supported.

    The states that received waivers — Sudan, Chad, the Democratic Republic of the Congo and Yemen — were considered key to American national security interests. Burma and Somalia, the other two countries identified in a 2010 State Department report as using child soldiers, were not granted waivers, the Christian Science Monitor reported.

    The move sparked controversy not only because it appeared that the Obama administration was overlooking human rights abuses, but also because it sidestepped Congress’ authority and appeared to not adequately consult human rights activists, Foreign Policy reported.

    Let Freedom Ring is not required to publicly disclose its donors because of its status as a 501(c)(4) “social welfare” organization. However, Federal Election Commission reports in 2009 and 2010 show John Templeton Jr. was the primary backer.

    Templeton, a physician by trade, is the eldest son of wealthy investor and philanthropist John Templeton. The younger Templeton is the chairman and president of the John Templeton Foundation, whose CFO, Valerie Martin, serves on the board of Let Freedom Ring, according to tax filings.

    Super donor Foster Friess was also reported as a contributor in the past.

    The group's only reported independent expenditure this election cycle is $5,601 spent on a TV ad and website development. Let Freedom Ring has produced several ads this election season, such as the recent “Muslim Brotherhood” and “Uncle Sam Sheds a Tear.”

    Let Freedom Ring runs a variety of websites, including WhyMrPresidentWhy.org, which opposes Obama, GasolineIsTooDamnHigh.com, which advocates for more oil drilling, WheresYourPlan.com, which focuses on the debt ceiling and Medicare reform, BBAorBust.com, which supports a balanced budget amendment, TheirOwnWords.com, which promotes “jihadist awareness,” JobsThroughGrowth.com, which supports cutting corporate taxes and rolling back regulations, and WeNeedaFence.com, which supports tighter immigration laws, including a fence at the Mexican border.

    In other outside spending news:

    • Pro-Mitt Romney super PAC Restore Our Future released “Disappearing,” which refers to the Americans who have dropped out of the work force because they could not find jobs.
       
    • The Lunch Pail Republicans Independent Expenditure Only PAC, a super PAC, reported spending $253,000 total in support of Republicans in eight districts, including five in Illinois. The organization, based in Indiana and also active in Indiana state legislative races, supports limited government and unions.
       
    • The U.S. Chamber of Commerce spent a total $2 million opposing three candidates for U.S. Senate: $439,000 on “It’s Good,” which opposes former Maine Gov. Angus King, an independent; $445,000 on “Failed,” which opposes Sen. Jon Tester, D-Mont.; and $1.1 million on “American Energy,” which opposes Sen. Sherrod Brown, D-Ohio.
       
    • Crossroads GPS, a conservative nonprofit that began a major ad campaign yesterday, reported spending a total $2.4 million opposing Obama, Rep. Tim Bishop, D-N.Y., Rep. Shelley Berkley, D-Nev., and Rep. Tammy Baldwin, D-Wis. Bishop is running for re-election in New York’s 1st District, and Berkley and Baldwin are running for U.S. Senate. American Crossroads, the sister super PAC of Crossroads GPS, reported $10.1 million in total spending against Obama and for Romney.
       
    • The National Federation of Independent Businesses/Save America’s Free Enterprise Trust, the PAC of the NFIB, reported spending $638,000 opposing former Iowa first lady Christie Vilsack, a Democrat running for U.S. House in the state’s 4th District, and supporting former county executive Maggie Brooks, a Republican running for U.S. house in New York’s 25th District.
       
    • SEIU COPE, the PAC of the Service Employees International Union, reported spending $590,000 opposing Romney and five Republican candidates for U.S. House as well as supporting Democrat Cheri Bustos in Illinois’ 17th District. SEIU PEA Federal, the union’s super PAC, reported spending a total $1.9 million on the presidential race and in support of Democrats in numerous Senate and House races.
       
    • AFSCME PEOPLE, the PAC of the American Federation of State, County and Municipal Employees union, released “17 Days” on Wednesday, which opposes former Hawaii Gov. Linda Lingle for handing down school furloughs. Lingle, a Republican, is running against Rep. Mazie Hirono for U.S. Senate in Hawaii.
       
    • The NRA Political Victory Fund, the PAC of the National Rifle Association, reported spending $440,000 on online advertising opposing Sen. Bill Nelson, D-Fla., Sen. Sherrod Brown, D-Ohio, and former Gov. Tim Kaine, the Democratic candidate for U.S. Senate in Virginia.
       
    • Changed,” from conservative nonprofit American Future Fund, opposes Democrat Kyrsten Sinema, who is running for U.S. House in Arizona’s new 9th District. Sinema, a former Arizona state senator, faces Republican Vernon Parker, a former Paradise Valley city councilman.
       
    • In “Ending Medicare, Outsourcing Jobs,” the Democratic Congressional Campaign Committee opposes the election of North Carolina state Sen. David Rouzer, a Republican, to U.S. House in the state’s 7th District. Rouzer is challenging Democratic incumbent Rep. Mike McIntyre.

    Who paid for that political ad? You might be surprised by the answer. Email us and we will try to find out. Describe the advertisement — was it mean or nice? Will it affect your vote? When and where did it run and what were the names of the candidates? And PLEASE tell us what the disclaimer at the end says, and we will check it out.

    The conservative nonprofit Let Freedom Ring attacks Obama for allowing countries that use child soldiers to receive American military aid. Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/20/10947/daily-disclosure-ad-hits-obama-child-soldiers

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    When Minerva Dickson first saw her high school she thought it looked like a prison. After her first week, she says, she realized how right her initial impressions were.

    Every day when she arrived at the Thomas Jefferson Campus in Brownsville, Brooklyn, she waited in a line that snaked out onto Pennsylvania Avenue. She would shuffle up two steps passing beneath words from Abraham Lincoln inscribed on the neo-classical pediment: “Let Reverence for the Laws Become the Political Religion of the Nation.”

    Next, she reached into her pocket for her identification card and slid it through a machine. When it recognized her, it blurted an approving beep and a green light would flash. When it didn’t, the machine made an abrasive buzzing noise and lit up red.

    Clear of the reader, she headed to the metal detectors. There, at least a half dozen school safety agents waited. School safety agents, who answer to the New York City Police Department, wear a police uniform and a shield. A pair of handcuffs dangles from their belts.

    Under their gaze, Dickson would remove her jewelry, hairpins, and shoes. She would place her purse and her backpack on the conveyor belt and wait for an agent to nod her through. Another would run a security wand around her diminutive frame while she stood arms out, legs spread.

    She’d collect her belongings, slip on her shoes and hurry to first period.

    “They never said anything to us,” she said, standing outside her school one recent evening. “There was no relationship at all. They just stared at the monitors. They treated us like criminals. It made me hate school. When you cage up students like that it doesn’t make us safe, it makes things worse.”

    More than the arrests, the summonses, and the substitution of detention halls with jail cells, critics of the burgeoning police presence in public schools point to the corrosive daily experiences of students like Dickson to explain why the system needs to change. Students have grown to see school as a joyless place where they are treated like perps instead of pupils, critics say. 

    Police officials says it's a matter of safety, and cite statistics showing a substantial drop in crime in the schools. But a growing number of parents and educators disagree. With the growth of the police presence in New York City in the last decade, students say their confidence has eroded not only in school, but in other civic institutions as well. Critics worry that poor and minority students more and more see education as extension of a burgeoning police state, one that seems to disproportionately target them. Whether with stop-and-frisks in the streets or in “the Riker’s Island treatment” on their way to class, students say they feel like the government’s push to make them secure in school has left them feeling like inmates instead. And with authority for school safety lodged in the most powerful police department in the world, educators feel like they are helpless to change it.

    On its own, the 5200 school safety agents in the NYPD’s School Safety Division, and the additional 190 armed officers -- stationed in the halls of some of the city’s 1700 schools make up a force bigger than the police departments of Boston, Las Vegas, Detroit or Washington, D.C. If removed from the NYPD, the division would be the fifth biggest police force in the country. And like members in the NYPD, the agents have full arresting power on and off school grounds, both in the city and the state.

    Prospective agents are trained for 14 weeks in the police academy, only a fraction of the six months of training police officers receive. They leave as peace officers, who have the power to use handcuffs and, when necessary, deadly force.

    The New York Civil Liberties Union has a federal lawsuit against the city alleging the agents make wrongful arrests, use excessive force, and detain and handcuff students in violation of their Fourth Amendment rights. Johanna Miller, the Assistant Advocacy Director, hopes the courts will limit the School Safety Division’s authority and give educators control over discipline.

    She said recent data reveals a system that targets poor and minority students. There were 2,548 students arrested or cited for a summons for the 216 high school and 209 middle school days from July 1, 2011 to June 30, 2012 -- 11 students a day. Of those, 95 percent were either black or Latino.

    She said agents often arrest a child instead of trying to de-escalate a tense situation, contributing to what she calls a school-to-prison pipeline. Poor, minority students often get arrested for behavior that would be treated as a school matter in a wealthier school.

    “The students that are more likely to get in trouble with the police at younger ages are more likely to drop out,” she said. “And the dropouts are much more likely to end up in jail once they leave school.”

    Miller concedes there needs to be security at schools. But it needs to be supervised by the schools, not the police. Now, she notes, there are more cops in the schools than guidance counselors and social workers combined.

    “It shouldn’t be a permanent occupation,” she said. "What’s the point of putting kids through this nightmare?"

    In December 2010, after languishing in various committees, the City Council unanimously passed the School Safety Act. The act mandates that the NYPD release reports on police activity in the schools. For the first time in the country, disciplinary activity of students would be made public as a matter of law. Advocates hope the act serves as a model for reform.

    But people in the system say even the most transparent reporting system misses the point. Dickson said there is no way to quantify what she went through attending a high school outfitted like a fortress. She said you can’t put a number on four years of being searched, and scanned, of turning a hallway corner to see a cop staring back.

    Although it did not comment on this story, the NYPD’s position on school safety has been clear. In mid-August, in response to the first public release of school arrest data, the NYPD’s chief spokesman, Paul Browne, said in interviews with numerous publications that the NYCLU "persists in smearing school safety agents and police officers who do good work professionally and in an unbiased manner."

    He said critics like the NYCLU and others dismiss the incidents that lead to arrests as typical horseplay among children, but he said that assumption is wrong.

    “It can involve serious assaults, with weapons, and including sexual assaults and including serious crimes,” he said at the time.

    He also said again and again that the high number of arrests of blacks and Latinos was not driven by bias but instead it was a result of the descriptions of suspects provided by victims.

    He said school crime has plummeted under the current administration. In 2001 before the current administration took office, that there were 1,577 felonies compared to 801 felonies during the last school year under Mayor Michael Bloomberg and NYPD Commissioner Raymond Kelly.

    The student

    One morning in her senior year Dickson was working on a school project. She snapped a picture with a digital camera of agents in the hallway. None of the agents’ faces were in the picture, just their backs. According to Dickson here’s what happened.

    An agent shouted at Dickson: “Young lady, come here.” The flash, Dickson suspects, must have caught their attention.

    Dickson complied.

    The agent said: “Give me the camera.”

    Dickson: “Why?”

    Agent: “You can’t take pictures of agents that’s why.”

    Dickson: "But there's no faces in it."

    Agent: "Get out of my face young lady."

    A dean snatched the camera away and escorted Dickson to the school's assistant principal of security. The dean, the agent and the principal proceeded to go through the pictures erasing any that included agents. They were going to confiscate the camera. It was the first time she had ever been in trouble.

    "I started crying," she said. "Tears were pouring down my face. My eyes were all red."

    It wasn't until a teacher saw her that anyone in the school tried to comfort her, she said. She later learned that the pictures were legal, but that they were not sanctioned. She was told she could use pictures approved by the Board of Education -- generic pictures of metal detectors and security stations pulled from a Google search-- but no pictures of agents.

    The incident was never reported but it made an impression.

    “It was the worst day of my life,” Dickson said. “It made me feel like a criminal for taking pictures. She made me feel like an inmate.”

    In 1998 then Mayor Rudolph Giuliani signed off on a 15-page memorandum of understanding between the city’s Board of Education and police department transferring control of school safety from educators to officers.

    With bland wording, the mayor revolutionized policing in the schools: “...it is therefore appropriate that the parties take all necessary steps to transfer the school security and ancillary functions performed by the Division of School Safety of the Board to the NYPD.”

    At the time it was approved there were 3000 School Safety Agents. Now, there are 5200 agents (but 70,000 fewer students), up more than 60 percent from the 1998 staffing levels.

    The mayor was responding in part to a notorious shooting that occurred at Dickson’s high school in Feburary, 1992 when Khalil Sumpter, 15, shot Ian Moore, 17, in the chest and Tyrone Sinkler, 16 in the head in second-floor hallway, killing them both. Although the shooting took place under Mayor David Dinkins watch, it cast a shadow into Giuliani’s administration.

    The NYC Board of Education has not responded to requests for comment. The teachers' union declined to comment.

    As years went by the Sumpter shootings became shorthand for safer schools. At the time, no one put up much of a fight. Even political opponents of Giuliani recognized that his consolidation of the housing and traffic cops in the NYPD was a smart and efficient move. When he did the same with school safety, Eugene O’Donnell, Professor of Police Studies at John Jay College, believed that nobody thought it would lead to this.

    “It’s shocking that education got shunted aside in a large degree by scare-mongering,” O’Donnell said. “ You had the Thomas Jefferson shootings and other high profile incidents and they pounded on those incidents to expand the policing in the schools.”

    O’Donnell said he is concerned that the “encampment approach” institutionalizes low expectations. It sets the bar at “no stabbings or shootings”, but does nothing to help children.

    “The problem is that there’s a populist logic to a punitive approach,” he said. “Don’t give anyone a break, zero tolerance, don’t let anything slip by. After a while you lose your way.”

    Critics can point to a list of high profile anecdotes over the years illustrating the agent overreach.

    Chelsea Fraser, the 13-year old arrested and handcuffed in front of her classmates in April, 2007 at Dyker Heights Intermediate School for writing “okay” in her desk. Dennis Rivera, 5, a kindergartener, who had his tiny hands cuffed behind his back in January 2008 by an agent for throwing a temper tantrum at P.S. 81. Principal Mark Federman, a decorated educator and veteran of the city’s public school system, who was arrested for trying to stop one of his students from getting arrested.

    The problem with emphasizing the extreme cases, critics say, is that it fails to show the toll a massive police presence has on students, educators and the learning environment.

    The teacher

    One teacher, who spoke on a condition of anonymity because she was worried about ramifications from her superiors, said in her school, there is no question of who is in charge.

    “The educators defer to the police,” she said. “Absolutely. If the schools were in charge the agents would get to know the students and the techniques and the theories and the new ideas behind education and positive re-enforcement -- right now the agents are not part of any of that.”

    It’s not just the gruff demeanor or the arguments they instigate with parents. She said the agents play into destructive stereotypes.

    She said she has a number of students enrolled in her school who are poor and Latino and live in nearby city housing projects. She says the agents -- as many as 8 stationed in the halls at one time over the years -- constantly say behave or else. Agents say that dealing with them -- the police -- is a preparation for real life.

    “The agents are acting like, ‘this is how it is in the hood’ or ‘this what these kids need’ and ‘this is what these kids are used to’ is something I’ve heard a lot over the years,” she said. “But If we’re going to break this dreary cycle were going to need to give the student an opportunity to get out of that environment, that mentality. These agents are adding to the cycle; they’re not giving the kid a chance to get out.”

    She said her lowest moment as a teacher came when she didn’t stop an aggressive agent. When she first started as an elementary school teacher in Manhattan’s Lower East Side, she once saw an agent telling a poor Latina how if she kept misbehaving she would be taken to jail. The mother of the child had brought the student into school to orchestrate an intervention. She was pantomiming concern, the teacher said, pleading with the agent not to take her daughter. At the time she refused to participate. Now, with seven years experience, she would’ve stopped it.

    “You can’t arrest a child for misbehaving in school,” she said. “What kind of relationship does that tell the kid to form with authority at the age of eight? It just tells them all the rumors they hear in the street are true. You should hate the cops. They are out to get you. Not only is it ridiculous, but how is it helpful? ”

    The student’s behavior deteriorated, she said. Later in the school year the student was singled out for searches. She said agents made an “embarrassing show” of them.

    “It affected her,” said the teacher who watched the student become more withdrawn over the year. “It was part of her experience. That’s the standard she was held to as an 8-year old.”

    The teacher said the students’ exposure to an intrusive police presence undermines the school’s sense of community.

    “School should be a safe place for children,” she said. “Safe doesn’t mean there’s some big, bad ass cop at the door. It means that students can relax and express themselves freely and be open to learning. This is elementary school, this is where these ideas need to start changing.”

    The agent

    On a recent overcast afternoon at the Grand Street Campus, a sprawling complex home to several high schools in the heavily Latino neighborhood of Bushwick, hundreds of school safety agents gathered after saying goodbye to one of their own. The sidewalks surrounding Grand Campus, normally a staging area for agents, had been converted into an impromptu parking lot. The agents stowed their cars while they attended a colleague’s funeral. Among them was an agent who agreed to talk about the job, on condition that he do so anonymously, for fear that speaking would get him in trouble.

    "We’re out here busting our chops," he said. "Fatigue sets in. After awhile they come in for the money, the check. They don't come in for the heart."

    The agent, who is 42, was in his uniform but his shirt was unbuttoned and untucked since he was off duty. One problem is that agents don't get the same respect that cops do. He pointed to the haggard looking agents climbing into their economy cars as an example. If a cop died, he said, there would be bagpipes and helicopters flying overhead.

    "When you're a cop all you have to do is put your hand on your gun, you don't even have to pull it out, you just need to put your hand on it and all the sudden you get some attention," he said. “We're babysitting."

    Unlike babysitters, he said he has to deal with riots, assaults and gang initiations. The agent said he used to be assigned to the Belmont Academy —  a shuttered suspension center —where students knew how to counterfeit money, smuggle weapons and make bombs.

    “Unfortunately, we have students who don’t want to abide by the rules and regulations,” he said. “Take one of those civil liberties lawyers and put them in schools and see what we see and see why they get arrested it would change their minds. These kids these days, they’re off the chain.”

    In his more than seven years working as an agent, he said he has made numerous arrests. He works with the Brooklyn Patrol, one of the city's ten task forces that assist agents who need back up.  When he gets called, he said, someone is getting arrested.

    He suggested introducing a law course to the curriculum. If the children are taught the law, the logic goes, and they will understand their rights in the hybrid educational-criminal justice system.

    "Then maybe they think twice," he said. "They learn that if you F up, your freedom will be taken from you."

    But he said a bigger problem is a deep misunderstanding educators have of what his role is in the system. A common experience, he said, is when he goes on a call and subdues a student. When he begins cuffing him, a teacher will run up and start shouting.

    "’What's going on? What are you doing?,’ they shout," he said. "I tell them, ‘I'm doing my job!’"

    What people need to understand, he explains, is that school safety agents are not in the guidance counselor business. At the end of the day, he said, he and his fellow agents are there to enforce the law.

    "If the agent is on the job and he sees a student disobey the law then he'll throw you up against the wall and that's that," he said.

    The principal

    Henry Leonardatos remembers walking through the Wise Towers with his mother and how she’d shoo him away from the blank-faced men swaying on the benches. The next day he would see syringes scattered on the ground. He lived in a public housing project known at the time as “Needle Park” for its concentration of heroin addicts. Now he is a principal at Clarkstown High School North, 25 miles from Time’s Square and decades removed from the towers.

    “I lived in projects for seven years, we were one of the few white families there,” he said. “When I left I learned that that wasn’t the real world. What teachers and educators should be doing is getting these students to think outside of that world and prepare them to be productive instead of re-enforcing these patterns and norms out of them.”

    Putting students through the rigamarole of pat downs and metal detectors and beefed up security ends up teaching students to not think for themselves.

    “What do the kids do?” he said. “They play the role that is expected of them —  they will play the role of the criminal and victimizer because the cops will say, ‘don’t do this and don’t that.’ When you do that to a kid you’re telling the kid that this is how the world is supposed to be. You end putting the idea in the kid’s head that this is what he’s supposed to be doing.”

    He said agents can’t police everyone in school -- they need to work together with the teachers, the administrators and the students.

    “They can’t play out this version of policing that we see on the street where an agent sees someone do something and then shoves him against a wall, spreads him, searches then arrests him,” he said. “We can’t replicate that.”

    Leonardatos has been the principal of 1500 poor, middle class, and rich students at the Rockland County school for eight years. There is one officer who sits at the entrance. He greets the students when they come in the morning.

    “It’s two different worlds,” he said.

    He said the agents in the city don’t know the students.

    “They’re there to see who makes an infraction and make the arrest,” he said.

    Leonardatos did his training in the Bronx, the borough with the most school arrests. He said the students in poor, minority communities can’t escape. They’re stopped and frisked in their neighborhoods, then they have agents at school. They end up seeing their school as another “appendage to the police state.”

    As a principal he has overseen one arrest in his school in seven years. And that was done at the police station because of an “extreme situation.” If there’s a problem in his school the officer reports to him.

    “It’s a safe environment to work in not because of the one officer at the door,” he said. “It’s because of trust. Communication. If there were arrests and pat downs and metal detectors the community wouldn’t stand for it. There’d be a rebellion.”

    The yearbook 

    Dickson estimates she wasted hours waiting in lines at school. Once at a conference shemet a student from Staten Island who, “blew her mind.” He told her that his school he didn’t have a garrison of agents greeting him.

    “I thought all schools were like mine,” she said. “I couldn’t believe a student could just walk into their school without dealing with all that.”

    Eventually after weeks and months of security checks and the ubiquitous presence of uniformed agents prowling the halls she internalized the “encampment mentality,” she said.

    “We got used to it,” Dickson said. “We said to ourselves we can’t wait to grow up and get out of that school.”

    Dickson, now a 19-year-old freshman psychology major at Ithaca College, does not dispute that students need to be safe. The legacy of the fatal killings of Sumpter and Moore still haunt her school. She said she knows that means taking some precautions. But she wonders whether having cops at school is the answer.

    “I asked an agent once why she treated us like this,” she said. “She told me she didn’t have to answer me or any one of us. She told me she didn’t work for the school; she said she worked for the police department.”

    Despite having a trying time at school, Dickson was eager to get her yearbook. Due to a printing error, the yearbook was available after Dickson’s class had already graduated. Earlier in the summer she went back to pick it up. She was greeted by school safety agents. They told her if she wanted to get it she’d have to go through security.

    Dickson protested but the agents would not relent. She left without her yearbook, which housed a year’s worth of memories, but with a reminder, she said, of why she is so happy she never has to go back in that place.

    This story was produced in partnership with the Juvenile Justice Information Exchange

    Minerva Dickson Daryl Khan http://www.publicintegrity.org/authors/daryl-khan http://www.publicintegrity.org/2012/09/21/10950/perps-or-pupils-safety-policy-creates-friction-new-york-city-schools

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    A little over five weeks ago, the Pentagon’s F-35 program got a new deputy manager, and a few days ago, he gave a candid “outsider’s” appraisal of the most costly weapons program in history — one that was noteworthy for its appraisal of how poorly the troubled aircraft program was run during the past decade and its criticism of the chaotic way that the Pentagon has been buying such high-tech weapons.

    Maj. Gen. Christopher Bogdan, a seven-year Air Force acquisition veteran who last managed the KC-46 tanker program, warned an Air Force Association audience on Sept. 17 at National Harbor, Maryland, that “some of you may cringe at what I say.” Then he disclosed that the F-35’s buggy software “scares the heck out of me,” that its computer-driven logistics system is “frightening,” and that the relationship between the Air Force and the plane’s lead contractor Lockheed Martin is “the worst I’ve ever seen.”

    The Pentagon intends to spend over $1.5 trillion over the next thirty years on the F-35, which it considers critical to the country’s military future. It’s a “joint” program because the plane is to be used by the Air Force, Navy, and Marines, an approach initially conceived to save costs. But Bogdan said that describing these as variants reflects a fundamental misunderstanding of what the effort has become: “It’s three separate airplane programs that have common avionics and a common engine.”

    Not only that, the program has eight foreign partners and two foreign customers, a number the Pentagon hopes to grow. Partly as a result, its management has been a mess: Cost overruns so far have hit a billion dollars and production and flight testing are years behind schedule. In his 15-minute talk, Bogdan used the words “complex” or “complicated” 17 times, at one point asserting that “there is not a more complex program on the planet.”

    Even after sixteen years of development and six years of production, the plane’s design remains a moving target. Bogdan said that “one of the things in the first five weeks that really shook me a little bit about this program is the amount of change that we allow….Change in any acquisition program is destabilizing and unsettling.” Affirming years of criticism by the Government Accountability Office, he said that allowing planes to be manufactured (32 so far) while it is still being designed is “the greatest of all sins in the Joint Strike Fighter Program.”

    Simultaneously trying to design, produce and field the plane, while training new pilots and creating a parts-and-repair system has been a huge strain, Bogdan explained. “What program would you ever put on paper to do all those things at one time? You wouldn’t do it.” But he said the Pentagon is now stuck in its own mess, and called “concurrency” a “way of life for us” that’s “not going to go away.”

    Bogdan expressed optimism that some of the plane’s legendary troubles are diminishing, but warned that the Air Force and the contractor are not measuring its progress by useful yardsticks. Lately, they’ve been boasting about passing key “test points,” accumulating more “flight hours” and achieving more “test sorties,” These don’t matter so much, Bogdan said, because the right standards are “more capability based….I’m not sure we’re measuring the right progress, but the test program is starting to create some momentum and that’s a good thing.”

    He said a running dispute between the program’s management and the Pentagon’s director of test and evaluation over the scale and composition of the F-35 test program is no longer about substance, but about “where and when and who pays for it, quite frankly.” He also said that Lockheed, under heavy pressure from the Pentagon, had started to cut its production costs. “Are they coming down as fast as we want them to? No. But they’re coming down.”

    But then Bogdan spoke candidly about engineering troubles that he said keep him “up at night.”

    The largest of these is the software, now about three to four months behind schedule and still facing its steepest challenge: creating lines of code that fully integrate the fighter’s weapons systems with the plane’s operation. In anticipation, the software effort has been revamped, it’s gotten independent oversight, and the contractor has been barred from moving from one set of code to the next one without government approval.

    “Until we have some time to see that really play out…we’ll withhold judgment as to whether or not it’s a touchdown or not,” he said.

    Another major challenge is the jet’s complex helmet, a “Star Wars”-like device meant to project onto its visor how the plane is performing, where enemy targets are, and which weapons the pilot can use to handle them. As the Center reported in June, the display has been shaking so much it’s unreadable, and it also does not update swiftly enough. The helmet, Bogdan said, only works in “a very rudimentary way,” warning that uncertainties remain about whether it can be used at night, in bad weather, or in warfighting – the “basic” missions, as he put it.

    If the problems can’t be fixed, or if an alternative ($80 million) helmet from Lockheed competitor BAE systems does not meet their needs, “then we have a big problem,” he said. “You don’t fly this airplane without a helmet.”

    The new plane also cannot function without highly-sophisticated monitoring of its flight and repair history and the requisite programming of its missions. These are to be performed for each jet by something called the Autonomic Logistics Information System (ALIS). Bogdan said it answers these questions: “What parts do you need? What pilots are qualified? What maintainers are qualified? What mission plan is going?” In short, ALIS is meant to hold a trove of critical, militarily-sensitive data.

    There’s just one major problem: The stream of data was found to contain security flaws. So the coding was rewritten, and is still undergoing testing.  If ALIS doesn’t work, “this airplane doesn’t work,” Bogdan said. While a version might be functioning by November, the Pentagon has refused to accept some planes Lockheed built because they don’t have the fully functioning ALIS software.

    Bogdan warned that both the Pentagon and Lockheed need to be told from now on that the F-35 managers will meet “your needs and not your wants.” He said the program can no longer expect unlimited injections of cash, noting the “great gift” that DOD gave his superior, Navy Vice Admiral Dave Venlet, in February, when it agreed to restructure the F-35 contract and add billions of dollars to its budget.

    “There’s no more money and there’s no more time” coming for the program, “so… we’re going to have to do this in a disciplined way,” Bogdan said, adding that if changes can be made and long-term strategies worked out, “we’ve got a shot at getting this done,” he said. “We’ve got a shot.  It will not be easy.”

    Lockheed spokesman Michael Rein responded gamely to reporters that “it’s always good to have someone with a fresh set of eyes” looking at the program. “We remain committed to continuing our work to solve program challenges and build on the momentum and success we’ve achieved during the past couple of years,” he said in a Monday statement.

    But he declined to discuss the sour relationship his company has with the Pentagon, something that Bogdan described as a “cultural thing” afflicting both sides.

    Cheryl Irwin, a spokeswoman for the Office of the Secretary of Defense, told the Center that “there is broad agreement…with Major General Bogdan's comments that the F-35 program will not succeed without strengthening the trust relationship between industry, stakeholders, and the government -- across all aspects of the program."

    Newly-installed Air Force Chief of Staff Mark Welsh told reporters in a separate session at the AFA conference that the F-35 is one of three key programs for the Air Force. But he acknowledged that the price of the plane is still an issue. “We need the airplane, but the program's got to perform,” said Welsh.

    The Lockheed Martin F-35B is shown during an unveiling ceremony in Fort Worth, Texas in this 2007 photo. R. Jeffrey Smith http://www.publicintegrity.org/authors/r-jeffrey-smith Aaron Mehta http://www.publicintegrity.org/authors/aaron-mehta http://www.publicintegrity.org/2012/09/21/10953/f-35-deputy-sees-challenges-ahead

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    Medical professionals who cheat Medicare by billing for more complex and costly services than they deliver threaten to drain the elderly health-care program’s already shaky finances, Sen. Charles Grassley said Thursday.

    The Iowa Republican’s comments came in reaction to The Center for Public Integrity’s “Cracking the Codes”  series published this week. The investigation found that thousands of medical professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees.

    Grassley called the findings “disturbing,” though “not surprising” because any time Medicare creates a new payment structure, “a cottage industry develops to teach providers how to maximize revenue in the system.” 

    The Center’s year-long examination  uncovered a variety of costly billing errors and abuses that have plagued Medicare for years—from confusion over how to pick proper payment codes to outright overcharges. The findings also suggest the problems are worsening as doctors and hospitals switch to electronic health records.

     Medicare pays doctors for office visits using five escalating payment codes, which range from a minimal visit of about five minutes time for about $20 to about $140 paid for more complex treatments that generally take 40 minutes or more of face-to-face time with the doctor. Federal officials expect a medical practice to report a range of the five codes because some patients require more time and effort to treat than others. Medicare uses the scales to pay for more than 200 million office visits each year and other doctor services that cost taxpayers more than $33 billion.

    But Medicare billing data analyzed by the Center show that doctors over the past decade increasingly abandoned lower-level codes for better paying ones—even though there’s little hard evidence that they spent more time with patients or that patients were sicker and required more complicated  and time-consuming care.  Hospitals also use the billing codes, and the Center found similar problems with billing for emergency room services

    More than 7,500 physicians billed the two top paying codes for three out of four office visits in 2008, a sharp rise from the numbers of doctors who did so at the start of the decade, the Center’s data analysis found. Officials said such changes in billing can signal that some doctors are billing for more complex services than they delivered, a practice known as “upcoding.”

    “Providers should be compensated appropriately for their time and skills.  If there are concerns that payment rates are inadequate, we need to have an open and frank discussion about that,” Grassley said in a statement. 

    “However, anyone who’s systematically upcoding to make up for what are seen as inadequate payment rates is cheating the system. That kind of gaming is self-defeating because it makes Medicare’s financial condition worse, with less money available for services,” Grassley said.

    In 2010 alone, Medicare paid for more than six million more visits at the second highest level code, 99214, than the year before. That upsurge cost Medicare more than $1 billion, government records show.

    Medicare’s finances have emerged as a presidential campaign issue, with both Barack Obama and Mitt Romney vowing to tame its spending growth while protecting seniors. But there’s been little talk about the impact of billing and coding practices in driving up costs, and what to do about them.

    However, the American Academy of Family Physicians said it expects an upcoming  surge in Medicare audits of doctor billings for the two highest codes—99214 and 99215— in 15 states, including Florida and Texas.

    The 99214 code requires two of three components: a detailed history or examination and medical decision making of “moderate complexity.” It typically requires 25 minutes of face-to-face contact with the patient.

    To bill for the top code, 99215, doctors must do two of three things: a comprehensive examination, a detailed history of the patient’s health status, or make a medical decision of “high complexity.” That typically requires 40 minutes.

    A spokesperson for the Centers for Medicare and Medicaid Services, which runs Medicare,  said the proposal to step up audits “was not a final decision” and the pilot project would review only the top code.

    “This is not a widespread audit. Rather it is a test to determine if a widespread audit should be approved to proceed,” the statement said.

    These “Evaluation and Management” codes were developed in 1992 by the American Medical Association, which controls their use.

    Physician groups argue that coding guidelines are vague and subjective and that just as many doctors undervalue their work by picking lower codes as bill too much. Medical organizations also argue that more elderly patients over the past decade have been diagnosed with multiple health problems that require additional time and effort to treat. But  the Medicare billing data analyzed by the Center do not show that patients are getting more infirm; their reasons for visiting the doctor’s office and hospital emergency rooms were essentially unchanged over the decade. And the average age of patients remained the same as well. It is clear that Medicare auditors have uncovered a high rate of billing mistakes — many of them overcharges—in several states.

    A Medicare contractor called Trailblazer audited patient office visits in early 2010 in Virginia and found mistakes in half the records it reviewed. A similar audit in Colorado, New Mexico, Oklahoma and Texas reported a 91% error rate for billing for office visits, for instance.

    CMS acting Administrator Marilyn Tavenner earlier this year confirmed that the agency planned to contact as many as 5,000 doctors it identified as billing outside norms, but said the effort was “not intended to be punitive or sent as an indication of fraud.”

    She said the agency would focus on the top ten high billers in each Medicare region as a first step, but that it might cost the agency more to investigate suspicious claims than it could collect.

    The agency, Tavenner  wrote in a letter published in a May Inspector General’s  report , “must take into account the respective return on investment of medical review activities.”

    At the same time, the agency is considering stepping up the audits by Recovery Audit Contractors, known as RACs, an oversight  program created by Congress to identify Medicare overpayments and recoup them.

    These reviews have come under fire from doctors, particularly because the companies are paid a percentage of any money they recover. The American Medical Association in a position paper said it is “deeply opposed” to the contingency fees “since it is a bounty-hunter like program that creates a financial incentive for RACs to identify overpayments.”

    In June, a bi-partisan group of lawmakers asked the Government Accountability Office to evaluate whether the program is working effectively and whether some doctors are being subjected to multiple audits at the same time.

    “What we’re pushing for is legislative oversight,” said Frank Cohen, a Florida consultant who assists doctors with coding and billing issues.  He said the companies have become “far too aggressive and zealous with regard to their audit tactics.”

    CMS in its statement said that the agency “monitors the contractors’ actions closely” and reviews a sample of their work regularly.

    The 15 states covered by the proposed RAC audit are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia.

    Sen. Charles Grassley, R-Iowa Fred Schulte http://www.publicintegrity.org/authors/fred-schulte http://www.publicintegrity.org/2012/09/21/10954/grassley-says-providers-who-overbill-medicare-are-draining-its-finances

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    Democratic super PACs have begun to make up ground in the political arms race, raising substantially more in August than they did during the previous month, new filings with the Federal Election Commission show.

    For much of the 2012 election cycle, Democratic super PACs have been outraised their GOP rivals. The groups, made possible in the aftermath of the U.S. Supreme Court’s 2010 Citizens United ruling, are allowed to collect contributions of unlimited size from individuals, unions and companies — so long as the funds are spent on advertisements that are not coordinated with any candidate.

    Priorities USA Action, the primary super PAC supporting the re-election of President Barack Obama, took in $10.1 million through the end of August. That’s up from just $4.8 million in July. While the group finished August with $4.8 million cash on hand, during the first three weeks of September, it reported spending more than $7.8 million — suggesting that the cash has continued to come in.

    Top donors to Priorities USA Action in August included James Simons, founder of the hedge fund giant Renaissance Technologies, who gave $2 million; Anne Cox Chambers, the owner of Cox Enterprises, who gave $1 million; and attorney Steve Mostyn, who also gave $1 million. The majority owner of the Baltimore Orioles, Peter Angelos, also gave big, contributing $500,000 in his first ever donation to the pro-Obama group.

    The pro-Mitt Romney super PAC, Restore Our Future, kept pace with its July contributions, but it did not fare as well in August as rival Priorities USA Action. The GOP super PAC received $7 million in contributions during August, down slightly from its July take of $7.5 million. It finished the month with $6.3 million cash on hand. So far during September, it has been keeping its powder dry.

    Robert Parsons, the founder of web hosting service Go Daddy, gave $1 million to Restore Our Future in August, as did Odyssey Re, a leading underwriter of reinsurance and specialty insurance that is a subsidiary of the Canadian firm Fairfax Financial.

    Other Democratic super PACs followed Priorities USA with big takes in August.

    Thanks to a half-million-dollar contribution from Orioles’ owner Angelos, the Senate-focused Majority PAC raised about $2.6 million through the end of August. The PACs of the Laborers International Union and the Operating Engineers also ranked among the top contributors to the super PAC in August, with each group giving $250,000. Notably, Sen. Jay Rockefeller, D-W.Va., also gave the super PAC $200,000.

    The Democratic super PAC finished the month with $1.3 million cash on hand, but since then, the group appears to have continued to see money flow into its coffers. During the first three weeks of September, it has reported spending more than $1.5 million on independent expenditures.

    House Majority PAC, the super PAC backing Democrats for U.S. House, raised nearly $5.6 million in August, including $1 million from Working for Working Americans, the super PAC of the United Brotherhood of Carpenters. Notably, an additional $700,000 came from the Blue Dog PAC, which supports moderate Democrats. House Majority PAC finished August with $8.3 million in the bank, up from July’s balance of $4.6 million.

    Contributions to conservative super PACs dipped during August, with the exception of American Crossroads, the super PAC co-founded by Republican strategists Karl Rove and Ed Gillespie. The GOP juggernaut collected $9.5 million in August — up from $7.1 million in July.

    American Crossroads finished August with a whopping $32 million cash on hand — nearly as much as Priorities USA Action has raised since it was launched last year.

    The group's top contributors in August include some familiar names, and some new ones. Super donor Bob Perry contributed $2 million. B. Wayne Hughes Sr., the founder of Public Storage, gave $1 million. So did Clayton Williams Energy Inc., a Texas oil and gas drilling company run by Clayton Williams.

    And three donors gave American Crossroads half-a-million dollars in August: super donor John W. Childs; Weaver Holdings, the Indiana company behind the popcorn brands Pop Weaver and Trail’s End that is sold by Boy Scouts across the country; and Richard Gaby, whose wife sits on the board of the conservative Heritage Foundation.

    Meanwhile, the conservative super PAC Club for Growth Action brought in $589,000 in August, down significantly from the $2.9 million it raised in July. It finished the month with $1.5 million cash on hand. The Club’s top donor in August was Marilyn Hayden, the wife of Club for Growth board member Jerry Hayden.

    And conservative super PAC FreedomWorks for America took in just over $1 million in contributions in August, finishing the month with $1.6 million in the bank. Conway Ivy, the owner of minerals and mining company Ivy Minerals Inc., was the group’s top donor last month at $100,000.

    TD Ameritrade founder Joe Ricketts’ right-leaning Ending Spending Action Fund received no direct contributions in August. Of the $27,500 it reported in receipts, most came in the form of in-kind contributions from its sister nonprofit, Ending Spending Inc.

    While the super PAC finished August with only $11,000 in the bank, Ricketts is expected to fill its coffers this fall as he uses the group to fund more than $12 million in ads against Obama and congressional Democrats.

    In other outside spending news:

    • Pro-Obama super PAC Priorities USA Action reported spending nearly $2.9 million on ads opposing Romney.
       
    • House Majority PAC released “What’s Worse,” attacking Florida Republican Rep. Allen West’s record on women’s health. The ad is part of a $1 million ad buy in the district, according to a press release. The super PAC also reported an additional $1.4 million in anti-Republican ads in a handful of other House races.
       
    • Majority PAC reported spending $1 million on ads opposing former Sen. George Allen in his quest to regain a U.S. Senate seat in Virginia. Allen, a Republican, faces former Democratic Gov. Tim Kaine.
       
    • Patriot Majority USA, a liberal nonprofit, released “Minimum Wage” opposing Rep. Rick Berg, R-N.D. Berg faces former Democratic Attorney General Heidi Heitkamp in the state’s U.S. Senate race. Records show the ad is backed by a buy of at least $462,000. The group also released “Fair Share,” which opposes tax cuts for millionaires.
       
    • The Democratic Congressional Campaign Committee launched “Time to Cut Our Losses,” an ad opposing Rep. Mary Bono Mack, the Republican candidate for U.S. House in California’s 36th District. The DCCC also released “Some Things,” which opposes Rep. Brian Bilbray, R-Calif., in the 52nd District. It further reported spending about $295,000 on ads against Rep. Allen West, R-Fla., and Rodney Davis, the Republican candidate for U.S. House in Illinois’ 13th District.
       
    • The Democratic Senatorial Campaign Committee reported spending more than $2 million opposing four Republican Senate candidates: Indiana State Treasurer Richard Mourdock, Sen. Dean Heller in Nevada, Rep. Denny Rehberg in Montana and Rep. Rick Berg in North Dakota.
       
    • The U.S. Chamber of Commerce reported spending $2.9 million on ads in U.S. Senate races: $1.4 million opposing former Democratic Gov. Tim Kaine of Virginia; $750,000 opposing Rep. Tammy Baldwin, D-Wis.; $455,000 opposing Rep. Martin Heinrich, D-N.M.; and $311,000 in support of former Hawaii Gov. Linda Lingle, a Republican.
       
    • The Center for Individual Freedom, a conservative nonprofit that has received at least $2.75 million from Crossroads GPS, reported spending nearly $1.9 million opposing Democratic candidates for U.S. House in six districts. This is the group’s first reported independent expenditure of the 2012 election cycle.
       
    • American Action Network, a conservative nonprofit, reported spending about $333,000 on TV ads and mailers in support of Richard Mourdock, the Republican candidate for U.S. Senate in Indiana. Mourdock, who defeated incumbent Sen. Dick Lugar in the GOP primary, now faces Democratic Rep. Joe Donnelly in a hotly contested race.
       
    • Another conservative nonprofit, American Future Fund, reported spending  $486,000 against Obama and former Arizona legislator Kyrsten Sinema, the Democratic candidate for U.S. House in Arizona’s  9th District.
       
    • The liberal super PAC End the Gridlock spent $241,000 on ads opposing Nebraska state Sen. Deb Fischer, a GOP candidate for U.S. Senate. Fischer is running against former Nebraska Gov. Bob Kerrey in an open seat race. End the Gridlock has received a large percentage of its own receipts from Democratic super PAC Majority PAC, which has given the group more than $267,000.
    President Barack Obama waves as he arrives to speak at a fundraiser at The House of Blues in New Orleans, Wednesday, July 25, 2012. (AP Photo/Gerald Herbert) Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/21/10956/daily-disclosure-democratic-super-pacs-gain-ground

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    After two bruising years for organized labor in the Midwest, the movement has managed to land two pro-union measures on the November ballot in Michigan.

    Michigan locals and their national leaders now face an ad campaign by the Michigan Chamber of Commerce and its friends, urging voters to resist “D.C. union bosses.” Unions, however, have far outraised their detractors, bringing in a quarter of the $30 million total raised for the state’s six ballot initiatives, according to the Michigan Campaign Finance Network.

    Labor wants to repeal Gov. Rick Snyder’s landmark emergency manager law, which has been a bane to public sector unions, and to enshrine collective bargaining rights in the state constitution to stave off future attacks.

    Efforts to curtail union rights “really did spike” since the GOP swept into power in 20 more state legislative houses in 2010, said Jeanne Mejeur, labor expert at the National Conference of State Legislatures. “Last year we saw about 950 [labor-related] bills nationwide, compared to about 100 a year over the last 10 years.”

    What happens in Michigan may be an even greater measure of the labor movement’s influence than its unsuccessful attempt to remove union-busting Wisconsin Gov. Scott Walker from office earlier this year.

    “The eyes of the nation will be on Michigan in November,” said Chris Fleming, a national spokesman for the American Federation of State, County and Municipal Employees in Washington, D.C. “If there’s a chance to enshrine collective bargaining in any state, we will be there to support it.”

    Unions in the region, a traditional stronghold, can use the help. In just two years, labor has been battered by the failed recall effort in Wisconsin and an anti-union right-to-work law in Indiana.

    Right-to-work laws have stifled union membership in 23 states, mostly in the South. They allow individual employees at organized workplaces to forego membership in, and dues to, the unions that represent them.

    Michigan unions have also fought Snyder’s emergency manager law, which has effectively ended collective bargaining rights for public employees in several cities. The Republican-majority Legislature, meanwhile, has passed a slew of anti-union laws chipping away at bargaining rights.

    “It’s been death by a thousand cuts,” said Dan Lijana, a spokesman for the Michigan-based union coalition Protect our Jobs.

    Ballot lines drawn

    The state’s Protect our Jobs initiative has raised at least $8 million, more than a quarter of it from out-of-state unions, to amend the state’s constitution and guarantee collective bargaining rights for all Michigan workers in the future. A victory would produce the first state constitutional amendment in the nation with such strong pro-labor provisions.

    “I hope it sets a nationwide model,” said Larry Roehrig, a leader of AFSCME’s Michigan affiliate.

    If voters approve the measure, it would effectively prohibit passage of a right-to-work law in the state and overturn other laws that limit collective bargaining, including a key provision in Snyder’s emergency manager law.

    In the past year alone, 16 new states have proposed bills similar to right-to-work laws, according to Mejeur.

    “We’re not just going to wait for them to cut our throat,” said Roehrig. “If they get their way, they’ll crush the middle class.”

    National unions have invested heavily in the effort: $1.25 million from the Washington, D.C.-based AFL-CIO State Unity Fund; $500,000 from AFSCME; $333,000 from the Teamsters; $125,000 from National Nurses United and $100,000 from New York-based hospitality union UNITE HERE.

    The D.C.-based United Food and Commercial Workers chipped in $50,000 and the International Association of Firefighters sent along $33,000 to the Michigan effort.

    While national unions have helped considerably, state-based unions including auto workers, teachers, carpenters, electrical workers, nurses and professors have all given big money. The United Auto Workers dropped $1 million into the campaign and the Michigan Education Association — the state’s largest union — gave $500,000.

    The giant fundraising effort has paid for three television ads blanketing the state. The group’s first ad, released in August, features a 5th-grade teacher from a school in suburban Detroit. Cutting against the critiques that collective bargaining serves a small fraction of the state’s residents at the expense of everyone else, teacher Karen Kuciel argues that collective bargaining rights allow teachers to bargain over things like class size.

    “Collective bargaining helps our kids,” she says in the ad.

    Stiff opposition

    The business community, free-market think tanks and the Snyder administration say the constitutional amendment will only benefit the unions.

    The primary opposition to the amendment has come from the state’s Chamber of Commerce — despite its lack of a formal stance on right-to-work law in the state.

    The governor’s office says it is in favor of collective bargaining and unions, but the ballot initiative “goes too far.”

    In legal battles over the initiative, Republican Attorney General Bill Schuette and Snyder filed a brief against it — a rare move for a sitting governor.

    Schuette, elected in 2010 with support from the state’s wealthiest executives and real estate and banking PACs, released a memo criticizing the “trojan horse-style” proposal that would “abrogate in whole or in part more than 170 Michigan laws.”

    The Michigan Chamber of Commerce has given at least $130,000 to a ballot committee called Citizens Protecting Michigan’s Constitution, which has led the opposition. The committee shares a Lansing address with the Chamber.

    The fund also has also added $30,000 sums from the Detroit and Grand Rapids chambers of commerce, the Michigan Manufacturers Association, the Association of Builders and Contractors, and Business Leaders for Michigan, which raises money from the state’s top executives.

    Chamber CEO Richard Studley told a Michigan radio station in June that the proposal is “a dangerous distraction at a time when business and labor and Democrats and Republicans should be working together to move our state forward.”

    Despite substantial support from Michigan’s business elite, the group has raised $345,000 — only a fraction of the pro-union Protect our Jobs' haul.

    The state’s Supreme Court overruled objections by the governor and the measure’s opponents in early September, clearing the way for the bargaining rights initiative.

    The Chamber-funded group, meanwhile, has taken to the airwaves, launching ads warning voters that the state’s constitution is being auctioned off to “wealthy interest groups trying to grab more money and power.”

    “The claim being made by the other side is more applicable to the folks funding their campaign,” said Protect our Jobs’ Lijana.

    He notes that a statewide campaign to collect more than a half-million signatures represents the level of “grassroots enthusiasm” for the ballot initiative.

    A second group opposing the constitutional amendment called Protecting Michigan Taxpayers cropped up June 11 and a month later bought $1 million worth of TV, radio, and online ads in the state blaming “Washington union bosses” for “tinkering with our constitution.”

    Its campaign finance filings are signed by Jared Rodriguez, former senior vice president of the west-Michigan Grand Rapids Chamber of Commerce.

    Rodriguez is also the current president of the West Michigan Policy Forum, a clearinghouse for business leaders funded by chambers of commerce from around the state. His 2010 op-ed in a Michigan paper touted the Policy Forum’s resolution to endorse the anti-union right-to-work law, and undo labor laws that have “discouraged businesses from investing in Michigan.”

    Repealing emergency law

    Thanks to union mobilization, Michigan voters will also decide whether to repeal Snyder’s Public Act 4, the emergency manager law described as the “emergency dictator” law by labor leaders.

    A union-funded group called Stand up for Democracy raised $184,000, almost entirely from the public employees union AFSCME, which it used to fund field staff, collect signatures, and fight an ensuing legal battle to place the measure on the ballot.

    In August, the state Supreme Court approved the ballot measure, suspending the law until the election, and sparking a renewed power struggle in four cities and three school districts that were being run by state-appointed managers.

    A state ballot committee called Citizens for Fiscal Responsibility led the legal challenge to the Public Act 4 repeal effort, claiming that the petitions used had a font size that did not comply with state regulations. The group is run by John Llewellyn, vice president of government relations at the Michigan Bankers Association.

    State filings show the group was funded entirely by a shadowy nonprofit organization run by three state GOP operatives. One is Rob Macomber, who was state director of Mitt Romney’s primary campaign in Michigan. The other two, Steve Linder and Jeffrey Timmer, are partners at a Michigan-based Republican public relations firm called the Sterling Corp.

    Timmer also sat on the state’s Board of Canvassers, and cast one of the two votes halting the emergency manager repeal effort when it came before the board for approval in April.

    Citizens for Fiscal Responsibility plans to take the fight outside the courtroom and onto the airwaves — though the group has yet to launch ads opposing the repeal effort. The funders of this effort are not disclosed the public.

    “I won’t be sharing a list of donors,” said Llewelyn.

    Cities up for grabs

    When Snyder’s emergency law was frozen in place, city officials wasted no time going after emergency managers in the wake of the decision. Members of the Flint and Pontiac city councils and the Detroit school board held meetings and attempted to reclaim their elected office and decision-making powers.

    Attorney General Schuette released a legal opinion saying the state would revert to an older, less expansive emergency law called Public Act 72, even though Public Act 4 expressly repeals that older law.

    Snyder’s administration quickly re-appointed managers in Pontiac, Ecorse and Benton Harbor, and appointed a new manager in Flint, all with fewer powers under the state’s older emergency law. The move came amid protests in Pontiac, Flint, and Detroit.

    Detroit’s elected school board has resumed meetings, claiming that Emergency Manager Roy Roberts no longer has power. Roberts used that sweeping power to impose terms on the teachers union in July. The contract raises class size limits dramatically, and kept a 10 percent pay cut in place.

    The Pontiac City Council voted in late August to dismiss emergency manager Louis Schimmel, overriding a veto by Mayor Leon Jukowski. Schimmel, a former advisor to Michigan’s leading free-market think tank, the Mackinac Center, shrugged off the vote, claiming that he retained power under the state’s earlier law.

    Local media outlets report that Schimmel plans to sell the city’s golf course, privatize its public works department, and get voters to approve a tax hike in November, but he’s already dissolved the city’s fire and police departments and put a large chunk of the city’s real estate portfolio, including libraries, up for sale.

    “I’ve done most of the work I needed to do under Public Act 4,” Schimmel told The Oakland Press in August.

    The state’s unions have claimed a victory just by landing the initiatives on the ballot. The next phase will play out on the airwaves, as Chamber-backed groups accuse D.C.-based unions of pushing a “special interest” agenda on the rest of Michigan voters.

    “Our checking account happens to be in D.C.,” says AFSCME’s Roehrig, “but the union is from every city in America.”

    According to the Federal Communications Commission, Protect our Jobs has ads of its own reserved in major media markets in Michigan, contrasting the needs of everyday union teachers with the state’s “corporate special interests.”

    Says Lijana, “This battle is not going to go away.”

    Thousands of protesters rallied at the Michigan Capitol in Lansing, Mich., last spring to oppose Gov. Rick Snyder's policies. Paul Abowd http://www.publicintegrity.org/authors/paul-abowd http://www.publicintegrity.org/2012/09/24/10958/national-unions-and-chamber-commerce-face-michigan

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    The months-long Center for Public Integrity investigation into the Medicare program has uncovered a textbook example of the expensive consequences of  what’s known as “regulatory capture.” Doctors and hospitals are likely being overpaid billions of dollars, which is hastening the depletion of the Medicare trust fund, because lawmakers and regulators put lobbying and professional groups representing health care providers in charge of writing the rules that determine reimbursement.  

    And to make matters worse, to maximize revenue and profits, some doctors and hospitals have figured out how to game the system to their financial advantage by abusing what has been held out as a means to improve care and reduce administrative costs —electronic health records.  

    “Regulatory capture” is a term that describes an all-too-common situation at both the federal and state levels in which special interests — in this case groups like the American Medical Association — dominate regulatory bodies that set the rules and make important decisions affecting them. In many regards,  the Centers for  Medicare and Medicaid Services (CMS) has become a “captured agency” as a result of decisions made decades ago — with the full blessing of both the White House and Congress — to pretty much let health care providers determine how — and how much — they will be paid.

    A previous investigation by the Center revealed how in the 1990s CMS effectively turned over many of its payment policy decisions to an obscure committee of the AMA, despite the obvious conflict of interest.  In doing so, CMS officials fell for the argument that no one knows better how to set rules that will affect special interests than representatives of those same special interests. I have seen this play out in the same way regarding insurance company regulation. Many state insurance commissioners come straight from the insurance companies they are charged with regulating.  

    This week’s series, “Cracking the Codes,” makes clear some of the consequences of this state of affairs. Another sort of  billing scale for doctors, involving so-called  Evaluation and Management codes, was  unveiled two decades ago as part of a secretive deal between Medicare officials and the AMA. The doctors’ group wanted Medicare to reimburse doctors for the “thinking part” of medicine, or their skill in diagnosing and treating illness, as well as the time required. Medicare administrators believed the new system would reduce billing abuses and save taxpayers cash by setting measurable standards that physicians would follow.  

    The Center’s review of a decade’s worth of data shows that those coding standards have been subject to widespread abuse and manipulation to make doctors more money. And it is not that lawmakers and regulators have been in the dark about this. Year after year, audit after audit, government oversight officials have found blatant stealing from the treasury and yet CMS has done nothing about it — other than to make excuses.

    Many of the abuses appear to involve a practice known as “upcoding,” in which health care providers use codes with higher levels of reimbursement than is appropriate for the care they really provided to patients. The Office of Inspector General of the Department of Health and Human Services recognizes that upcoding is a chronic and costly problem. But it has largely done nothing either, primarily because it is under-resourced to combat fraud and seems to believe that upcoding is not as costly as other abuses, particularly in the area of medical durable equipment.

    The government is also not doing anywhere close to an adequate job of monitoring the use of electronic health records (EHRs), even though a big chunk of money from the economic stimulus bill — some $30 billion — is being doled out to help doctors and hospitals pay for the technology to use EHRs. The government, mainly the Office of National Coordinator for Health Information Technology, never imposed any controls over the IT industry as technology companies scrambled to rake in billions of dollars from taxpayers.

    As the Center’s series points out, many experts have argued that the lack of any fraud controls in EHR software would likely spawn a new wave of billing fraud and abuse. But those critics have been shouted down by a chorus of health IT doctors and geeks, big tech companies and others who argued, not without some justification, that EHRs are needed to get medicine into the modern age.

    The bottom line is that left to their own devices and without adequate oversight, doctors and hospitals can and do charge more for less. Much has been made of the argument that patients are largely to blame for skyrocketing health care costs because of their unhealthy lifestyles and overuse of medical services. The Center’s investigation shows how doctors and hospitals are also to blame by cranking up their billing without increasing care.

    Wendell Potter http://www.publicintegrity.org/authors/wendell-potter http://www.publicintegrity.org/2012/09/24/10961/opinion-center-series-demonstrates-dangers-captured-regulators

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    The National Association of Realtors, a major outside spender in the election, reported $500,000 in television ads supporting Rep. Brad Sherman, D-Calif., in his quest to be elected in California’s 30th District.

    Sherman faces a challenge from another incumbent Democrat, Rep. Howard Berman, thanks to redistricting and California’s top-two primary system. That new system pitted all candidates — regardless of party affiliation — against each other during the June primary, with the top two vote-getters moving onto the general election.

    Friday’s $500,000 investment came from the National Association of Realtors’ traditional political action commitee, though the group also has a super PAC called the National Association of Realtors Congressional Fund.

    The National Association of Realtors is the primary trade group representing realtors and is also a powerful lobbying group. In 2011, it spent more than $22 million on lobbying, according to the Center for Responsive Politics. This election cycle, the PAC has spent $1.2 million on independent campaign expenditures, and the super PAC has spent $2.5 million. This makes the Realtors’ outside spending comparable to the National Rifle Association.

    In addition to the PAC’s $500,000 in support of Sherman, its super PAC has spent $564,000, making him one of the group’s favorite candidates. The group tends to favor Republican candidates, but it is officially nonpartisan, backing whichever candidates support its agenda of increasing home ownership, extending loans and maintaining mortgage interest deductions.

    In May, the National Association of Realtors spent more than $709,000 ensuring Rep. Gary Miller, R-Calif., won his primary in California’s 31st District, as the Center for Public Integrity previously reported. Miller is the founder of a homebuilding company and oversees the real estate industry as a member of the House Financial Services Committee.

    Sherman also sits on that committee. He is a member of the Subcommittee on Insurance, Housing and Community Opportunity and also the Subcommittee on Capital Markets and Government Sponsored Enterprises. Both of these committees deal with issues of interest to realtors, including disaster insurance and Fannie Mae and Freddie Mac.

    Sherman sponsored a bill in 2011 to amend the Flood Insurance Reform Act, a goal that coincides with the National Association of Realtors. He has also been involved in a handful of other bills relating to home ownership.

    People in the real estate industry are the top contributors to Sherman’s campaign, according to Center for Responsive Politics. Members of the real estate industry and various real estate PACs have directly contributed nearly $110,000 to his campaign.

    His opponent Berman has received a bit more from the real estate industry. But most of that $125,000 has come from individuals, not PACs, a sign that Berman holds less of an appeal to the real estate industry itself. Berman does not sit on any committees that deal with housing or insurance issues.

    In other outside spending news:

    • Planned Parenthood Action Fund, a nonprofit, reported spending $2.1 million supporting President Barack Obama and opposing GOP presidential nominee Mitt Romney.
       
    • Pro-Romney super PAC Restore Our Future reported spending nearly $2.1 million on ads opposing Obama.
       
    • Ohio Families United, a super PAC supporting Sen. Sherrod Brown, D-Ohio, reported spending $263,000 opposing Ohio Treasurer Josh Mandel, Brown’s Republican challenger.
       
    • The conservative Republican Jewish Coalition reported spending $1.6 million on ads opposing Obama. The nonprofit is set to release a mini-documentary questioning Obama’s dedication to Israel.
       
    • House Majority PAC, a super PAC supporting Democratic U.S. House candidates, reported spending $691,000 total against Republican candidates in a number of districts. In “Choices,” the group criticizes Rep. Jeff Denham, R-Calif., in California’s 10th District. “Oath” opposes Rep. Joe Heck, R-Nev., and supports Nevada state Rep. John Oceguera, a Democrat, for their positions on abortion and women’s health.
       
    • Majority PAC, which supports Democratic Senate candidates, reported spending $1 million against former professional wrestling executive Linda McMahon, the Republican candidate for U.S. Senate in Connecticut, as well as against Rep. Denny Rehberg, the Republican candidate for U.S. Senate in Montana.
       
    • YG Action Fund, a conservative super PAC spun off from House Majority Leader Eric Cantor’s Young Guns movement, opposes Rep. John Barrow, D-Ga., with “Two Faces,” a carnival-themed ad. “One of Us” opposes Rep. Mark Critz, D-Pa., and “Flush Frankel” opposes former Florida Rep. Lois Frankel for U.S. House in Florida’s 22nd District. The ads cost a total $958,000.
       
    • A new ad from the anti-abortion nonprofit Susan B. Anthony List calls Obama an “abortion radical.”
       
    • Liberal nonprofit Patriot Majority USA released a new ad criticizing Charles and David Koch, the businessmen who are expected to spend millions to advance conservative causes in the election. Patriot Majority launched a national bus tour on Saturday to stop the Kochs’ “greed agenda.”
       
    • The Congressional Leadership Fund, a conservative super PAC, opposes Rep. Betty Sutton, D-Ohio, for her ties to House Minority Leader Nancy Pelosi, R-Calif., in a new ad, which cost $457,000. The group also released “Look,” featuring an animated lamp, urging voters to “shine a light” on the record of Texas state Rep. Pete Gallego, a Democrat, who is challenging Republican Rep. Francisco “Quico” Canseco for U.S. House in Texas’s 23rd District. The ad cost $180,000.
       
    • Liberal super PAC American Bridge 21st Century released “A $enator for Himself,” a web video criticizing former Wisconsin Gov. Tommy Thompson, who is running for U.S. Senate in the state. The ad highlights Thompson’s partnership at lobbying powerhouse and international law firm Akin Gump. While Thompson has never been a registered lobbyist, Politifact concluded that he has used his influence and connections to help firms on Capitol Hill.

    Who paid for that political ad? You might be surprised by the answer. Email us and we will try to find out. Describe the advertisement — was it mean or nice? Will it affect your vote? When and where did it run and what were the names of the candidates? And PLEASE tell us what the disclaimer at the end says, and we will check it out.

    A home for sale is shown in Homestead, Fla. Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/24/10962/daily-disclosure-realtors-spend-big-california-race

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    Top federal officials are stepping up scrutiny  for doctors and hospitals that may be cheating Medicare by using electronic health records to improperly bill the health plan for more complex and costly services than they deliver.

    U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five medical groups of their intention to ramp up investigative oversight, including possible criminal prosecutions, by letter on Monday.

    The government action follows The Center for Public Integrity’s “Cracking the Codes”  series,  published last week. The year-long investigation found that thousands of medical professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees.

    The Center’s probe uncovered a broad range of costly billing errors and abuses that have plagued Medicare for years—from confusion over how to pick proper payment codes to outright overcharges. The findings indicated that Medicare billing problems are worsening as doctors and hospitals switch to electronic health records.

     “There are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled,” the letter states, adding: “There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvements in the quality of care.”

    The letter said that “false documentation of care is not just bad patient care; it’s illegal.” The Centers for Medicare and Medicaid Services, which oversees the program “is specifically reviewing billing through audits to identify and prevent improper billing.” The letter went on to say that CMS is “initiating more extensive medical reviews to ensure that providers are coding…accurately.”

    The letter adds that “law enforcement will take appropriate steps to pursue health care providers who misuse electronic health records to bill for services never provided. The Department of Justice, Department of Health and Human Services, the FBI and other law enforcement agencies are monitoring these trends and will take action where warranted.”

    Most of the five groups sent the letter on Monday had no comment. The American Hospital Association said it agreed that upcoding should not be tolerated, but added that “more accurate documentation and coding does not necessarily equate with fraud.”  The group also asked federal officials to develop national guidelines for hospital emergency department and clinic visits —a request the group said it hade made 11 times since 2001.

    The group said it does not question the need for auditing to identify billing errors, but added that “the flood of new auditing programs…is drowning hospitals with a deluge of redundant audits, unmanageable medical record requests and inappropriate payment denials.”  

    The suggestion that digital medical gear has fueled a rise in potentially improper medical billing is a touchy one for the Obama administration, which has championed electronic health records as a means to both improve the quality of medical care and cut costs. The administration is spending more than $30 billion in economic stimulus funds to help doctors and hospitals purchase the gear. More than half the nation’s hospitals have received some payments from the program, according to HHS.

    But critics have also noted that digital medical and billing equipment can with the touch of a button create an exquisitely detailed medical file and thus present a challenge to government auditors concerned about preventing fraud.

    The letter sent Monday was the first acknowledgment by top federal officials that the digital era may spawn more costly Medicare fraud and billing abuse. In the past, federal officials have largely accepted the explanations of doctors and hospitals that higher-level billings are mainly the result of patients on Medicare getting sicker and older and taking more time to treat—even though there’s little evidence to back that view.

    Sebelius and Holder took aim at the common practice of using electronic health record software to “clone” documentation from previous medical visits “in order to inflate what providers get paid.”

    “We will not tolerate health care fraud,” the letter states. “The President initiated in 2009 an unprecedented cabinet-level effort to combat health care fraud and protect the Medicare trust fund and we take those responsibilities very seriously,” the letter states.

    Medicare’s shaky finances also have emerged as a presidential campaign issue, with both Barack Obama and Mitt Romney promising to tame its spending growth while protecting seniors. But there’s been little talk about the impact of billing and coding practices in driving up costs, and what to do about them.

    Medicare pays doctors for office visits using five escalating payment codes, which range from a minimal visit of about five minutes for about $20 to about $140 paid for more complex treatments that generally take 40 minutes or more of face-to-face time with the doctor. Federal officials expect doctors to report a range of the five codes because some patients require more time and effort to treat than others. Medicare uses the scales to pay for more than 200 million office visits each year and other doctor services that cost taxpayers more than $33 billion.

    But doctors over the past decade have increasingly spurned lower-level codes for ones that pay better —even though there’s little hard evidence that they spent more time with patients or that patients were sicker and required more complicated  and time-consuming care. Hospitals also use the billing codes, and the Center found similar problems with billing for emergency room services.

    More than 7,500 physicians billed the two top-paying codes for three out of four office visits in 2008, a sharp rise from the numbers of doctors who did so at the start of the decade, the Center’s data analysis found. Officials said such changes in billing can signal that some doctors are billing for more complex services than they delivered, a practice known as “upcoding.”

    As the government has invested more heavily in electronic health records, hundreds of technology firms have begun marketing digital records system, often doing so by promising doctors and hospitals that they can significantly boost revenues with the devices.

    Most manufacturers and the hospitals using the gear contend that the digital gear merely allows them to more efficiently bill for their services, which in the past were often done by hand.

    In 2010 alone, Medicare paid for more than six million more patient visits at the second highest level code, 99214, than the year before. That upsurge cost Medicare more than $1 billion, government records show.

    CMS acting Administrator Marilyn Tavenner earlier this year confirmed that the agency planned to contact as many as 5,000 doctors it identified as billing outside norms, but said the effort was “not intended to be punitive or sent as an indication of fraud.”

    She said the agency would focus on the top ten high billers in each Medicare region as a first step, but that it might cost the agency more to investigate suspicious claims than it could collect.

    The agency, Tavenner wrote in a letter published in a May Inspector General’s report , “must take into account the respective return on investment of medical review activities.”

    The five medical groups sent the letter are: the American Hospital Association, the Association of Academic Health Centers, the National Association of Public Hospitals and Health Systems, the Federation of American Hospitals.

    The association of public hospitals said in a statement that it “shares the government’s goal of a health care system that offers high-quality, affordable care. Our hospitals and health systems adhere to high ethical standards and reject practices that might result in fraudulent or improper claims. We stand ready to help regulators understand fully the many aspects of electronic health record use in the hospital setting as they consider actions to ensure proper billing practices.”

    Health and Human Services Secretary Kathleen Sebellius, with attorney general Eric Holder. Fred Schulte http://www.publicintegrity.org/authors/fred-schulte Joe Eaton http://www.publicintegrity.org/authors/joe-eaton http://www.publicintegrity.org/2012/09/24/10971/impact-cabinet-officials-signal-crackdown-medicare-billing-abuse

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    In Oak Creek, Wis., a fence slashed with holes surrounds a barren 300-acre complex of buckling former factories where the soil and groundwater are polluted with arsenic and other chemicals.

    Asbestos sprayed for almost six miles from a shuttered textile mill in Sprague, Connecticut when children trying to free a canoe set it on fire.

    A toxic cocktail of volatile organic compounds, petroleum, hydrocarbons and metals lies along the banks of Massachusetts’s Malden River.

    Despite about $1.5 billion in federal grants and loans doled out by the Environmental Protection Agency over 19 years, hundreds of thousands of abandoned and polluted properties known as “brownfields” continue to mar communities across the country. Some sites are contaminating groundwater, while at others the toxins’ impact on the communities are unknown.

    The shortcomings are due to limited funds, a lack of federal oversight, seemingly endless waits for approvals and dense bureaucratic processes that make it difficult for poor and sparsely populated neighborhoods to compete against larger and middle-class communities that have the means to figure them out, an investigation by six nonprofit newsrooms has found.

    In a written response, the EPA said its Brownfields Program “is not intended to address all of the brownfield sites in the U.S.”

    The agency defines a brownfield as “real property, the expansion, redevelopment, or reuse of which may be complicated by the presence or potential presence of a hazardous substance, pollutant, or contaminant.”

    The stated goals of its Brownfields Program are to fund the cleanup of contamination, to improve the quality of life of blighted communities and to provide economic stimulus.

    But an investigation by nonprofit newsrooms across the country, which was coordinated by the Investigative News Network, found problems in every community examined.

    Among the findings:

    • In Connecticut, only 19 brownfields properties have been completely cleaned up and certified since 1994, despite close to $60 million in brownfield-related grants and loans by the Environmental Protection Agency -- including $12 million aimed directly at removing or containing pollutants -- and millions more by the state. Even some projects with ready developers languish because of gaps in grant cycles.
    • In Massachusetts, most of the clean-up funds have gone to former mill towns in suburban areas, where developers are eager to build, rather than to minority urban communities. Even more disconcerting, the “licensed site professionals” who monitor the cleanups are paid by developers, eliciting criticism about potential ethical conflicts and lack of oversight. The state only takes a closer look at sites if a problem is detected in paperwork -- a rare occurrence, critics claim.
    • In Wisconsin, which boasts a well-regarded program, the state brownfields chief says it will take decades to clean up the thousands of contaminated sites, whose ranks have grown during the recession.

    What’s more, the EPA doesn’t know how many of these abandoned properties across the country exist, where they are or how many have been cleaned up. Its public database is riddled with errors and omissions, the Wisconsin Center for Investigative Journalism discovered.

    High-ranking EPA officials declined interviews for this article. The agency ultimately supplied written responses, many of which did not address underlying questions or criticisms, but rather repeated that the agency “provides funding and technical assistance” to others who assess, clean and redevelop brownfield sites.

    Justin Hollander, an associate professor in urban planning and environmental policy and planning at Tufts University and author of several books on brownfields, said the investigation’s findings support what he’s long thought: that the program’s emphasis on developer-blessed projects is misguided.

    “What we need is a new model,” he said. “In cases where the money is spent and the site is remediated and rebuilt, that's a good thing but it happens to so few sites that most people who live near brownfields have not seen the benefits."

    In national surveys by the U.S. Conference of Mayors and partly funded by the EPA, the most frequently reported impediment to brownfield redevelopment cited time and again has been a lack of cleanup funds.

    The EPA reports that it denies two out of three requests for funding.

    Lack of monitoring

    Even in those cases where it has provided grants or loans for cleanups, the EPA does not know how well the contamination has been remediated.

    That’s because the EPA’s brownfields program merely hands out grants and loans. The federal government has not established standards for Brownfields cleanups. The EPA does not even verify that the work was done, according to a 2011 report by its Office of Inspector General.

    The Inspector General audited 35 cases and found that in none of them did the EPA require the documentation to prove that cleanups met environmental standards.

    “This occurred because the Agency does not have management controls requiring EPA [staff] to conduct oversight” to even assure that the reports meet documentation requirements, according to the report. “Consequently, decisions about uses of redeveloped or reused brownfields properties may be based on improper assessments. Ultimately, threats to human health and the environment could go unrecognized.”

    The Inspector General also questioned EPA’s ability to step in and do long-term oversight of land that’s been cleaned, especially when states or the new owners aren’t prepared to do the job themselves.  

    In a follow-up report, the Inspector General said the agency promised to start training recipients and its own staff to better conduct “due diligence” in these areas by the end of this year. The agency declined to address questions about the criticisms for this story.

    EPA officials rely on states to set and enforce environmental standards in brownfields cleanups. Some increasingly cash-strapped states are relying on the developers themselves to hire consultants to verify the properties were cleaned up.

    In Connecticut, for instance, licensed environmental contractors are the primary oversight for 80 percent of brownfields redevelopment projects; the state checks up on paper, but rarely in person. Massachusetts’ Department of Environmental Protection previously inspected brownfields cleanups, but due to budget cuts it now mostly reviews paperwork filed by consultants hired by the developers.

    Environmentalists in Connecticut worry that this system is “by and for” the contractors, said Roger Reynolds, senior attorney for the Connecticut Fund for the Environment.

    “Carrots and sticks have to be part of every incentive system,” he said. “Hopefully, you can do 90 percent of it with carrots, but you’ve got to have the sticks.”

    Plastic vapor barriers and other soil containment measures are all that states require in some types of redevelopment.

    But sometimes, such efforts fail or the science changes. New York’s Department of Environmental Conservation decided to reopen hundreds of Superfund, brownfield, and other sites that had been remediated to investigate potential new threats from vapor intrusion, something that had not been considered at the time of the “cleanups.”  The reviews are ongoing, but the agency has already found mitigation will be necessary at more than 70 sites.

    Investors in Michigan were horrified to learn that trichloroethylene remained in the soil under the condominium they’d purchased, which was built at the site of an abandoned factory, court records show. The soil had been covered up, rather than removed. “The site later turned out to be seriously contaminated,” read an October 2011 ruling from the Michigan Court of Appeals. (Frank and Tonya Alfieri successfully sued their real estate agent for failing to disclose the pollution.)

    There can be real and serious consequences to communities that live with these contaminated properties.

    An environmental report earlier this year found that pedestrians who frequently walk past a former chemical company site on the Brooklyn-Queens border in New York City may be exposing themselves to an increased risk of cancer.

    “There are so many chemicals in our society, and having these highly toxic sites is clearly a hazard and needs to be taken care of,” said Reynolds, of the Connecticut Fund for the Environment.  

    Program began in 1993

    The EPA began its brownfields program with a $200,000 demonstration project to encourage redevelopment in Cleveland, Oh. in 1993, followed by two grants for the same amount to Richmond, Va. and Bridgeport, Conn. in 1994, according to EPA documents. By 1995, it had received more than 100 applications for cities competing for funds.

    In a report to the Senate Subcommittee on Superfund, Toxics and Environmental Health last October, program director David R. Lloyd said that in its history, the program has awarded about 2,000 grants for environmental testing, “made more than 24,500 acres ready for reuse,” created more than 72,000 jobs and  “leveraged more than $17.5 billion in economic development” through grants and low-interest revolving loans.

    “EPA will continue to implement the Brownfields Program to protect human health and the environment, enhance public participation in local decision making, build safe and sustainable communities through public and private partnerships,” he said, “and demonstrate that environmental cleanup can be accomplished in a way that promotes economic redevelopment.”

    The EPA Brownfields Program’s budget must be approved by Congress. The $167 million appropriated last fiscal year went to grants for projects, grants to states, municipalities and tribes, loans and administrative overhead.

    Developers and state and local officials said the grants are a valuable piece in the patchwork of federal and state funds they must pull together to pay for redevelopment in blighted areas. States have developed their own programs, some supplementing EPA funds with state or municipal money or special taxes.

    But each EPA brownfields cleanup grant is so small – typically capped at $200,000 – that the program’s ability to influence what kinds of projects go forward is limited. In many cases, the grants are a bonus or seed, depending on what point in the process they arrive. Since its inception, the EPA’s brownfields program has funded fewer than 900 cleanups across the country, according to its latest report.

    The agency is supposed to favor those communities that struggle the most.

    Federal law states that in weighing grant proposals, among the factors the EPA should consider is “the extent to which a grant will meet the needs of a community that has an inability to draw on other sources of funding for environmental remediation and subsequent redevelopment of the area in which a brownfield site is located because of the small population or low income of the community.”

    In worksheets EPA officials use to evaluate grant applications, “community need” makes up 15 out of a maximum 107 points. How much sway a community’s poverty level had in any individual grant is impossible to know because the agency won’t provide the information publicly.

    When asked by the Investigative News Network for score sheets through a public records request, the EPA produced documents that were so heavily redacted that they might as well have been blank. It said the narrative assessments by its staff are part of the “deliberative process” and thus not public record.

    The agency did not answer questions about how many of its grants go to poor neighborhoods. It said it awards “nearly half” to communities with fewer than 100,000 residents.

    Urban policy experts and state officials say that the EPA and state programs in effect function less as environmental protection programs than building programs. Projects must find willing developers, investors or other grants to show viability before the agency will award a cleanup grant.

    “The brownfields projects, at the end of the day, are real estate transactions and real estate projects and if the development has no likelihood of success, that process will likely not result in a cleanup,” said Graham Stevens, brownfields coordinator for Connecticut’s Department of Energy and Environmental Protection.

    Municipalities point out that one huge benefit of these redevelopments is that they return idle land to the tax rolls, generating revenue that ultimately benefits the communities.

    Hollander, the Tufts University professor and author, said that the program will never clean up enough properties to make a significant difference because it’s too expensive.

    “The problem is just so massive that using the [developer-driven] model to deal with all the brownfields would bankrupt the federal government,” he said.

    Hollander said communities would be better served if federal money was spent creating parks, bird sanctuaries and other green spaces where plants can be used to clean up the soil, instead of multi-million dollar developments.

    “When you look at the amount of money spent to subsidize the development of a shopping mall on a former brownfield, you can create a safer soil in hundreds of other locations that would be a better use of that money,” he said.

    Unknown number of brownfields

    The EPA states that 450,000 to 1 million brownfields properties lie fallow across the country, a range it attributes to the U.S. Conference of Mayors. EPA officials said the agency doesn’t “spend any time counting” polluted parcels.

    Many communities have not inventoried their properties and the EPA said it doesn’t know where they all are. Its public database contains about 17,000 records, generally only those that EPA has funded for assessments or cleanups, and the data are provided by the grant-seekers.

    Since 1995, the EPA has awarded more than twice as much in grants for assessments than cleanups -- $480 million compared to $158 million, according to Lloyd’s 2011 testimony to a Senate subcommittee. It has given out an additional $400 million in loans, the agency said, but those must be paid back. It’s also given $508 million directly to states and tribes over the years and handed out another $37 million for job training, the agency said.

    Assessment and cleanup grants are capped at $200,000, with some room for exceptions.

    “That’s not enough money,” said Jennifer Fencl, environmental services director for the East Central Iowa Council of Governments. The grants, she said, are “incredibly competitive because there are so many brownfields.”

    Furthermore, the application for funding is so cumbersome that some municipalities hire consultants or band together to form regional groups to compete for the limited funds.

    “The grant application is extremely dense; it’s incredible,” said Chuck Betts, executive director of the Keokuk Chamber of Commerce in Iowa. “It will take at least a year to write.”

    Worse, communities often don’t know the program exists, are bewildered by the application process or have had trouble attracting a developer, the investigation found.

    Impoverished neighborhoods are naturally less appealing to developers -- and, ironically, are more likely to be the site of particularly noxious sites to begin with, according to Dr. Daniel Farber, director of Northeastern University’s Environmental Justice Research Collaborative.

    “Generally, communities with less economic power are usually targeted for the disposal of hazardous waste” and other unwanted businesses, he said. Often, a business may abandon a poorer neighborhood, leaving behind a legacy of toxins and pollutants.

    As a result, poor Americans are both more likely to live with polluted sites and less likely to be able to attract a means to turn them around, despite the existence of the brownfields program.

    Dozens of severely polluted, low-income communities across the country have never received grants, a computer analysis of EPA data for the Investigative News Network by a Duke University professor showed.

    By contrast, some savvy communities have had no problem getting repeated grants.

    Coralville, Iowa, has a brownfields coordinator on staff working on its $40 million Iowa River Landing District development, which will ultimately include townhouses, hotels, a theater, an arena and medical clinic at the site of a former truck stop, warehouses and scrap yard.

    The town of 19,000 residents is squarely middle class, situated near the University of Iowa, with 14 percent living below the poverty line, according to the 2010 census. Since 1999, Coralville has received $1.9 million in grants -- the most of any city in the state -- from the EPA to conduct 109 site assessments and seven cleanups.

    “I always joke when we’re hiring a new coordinator around grant-writing time that there’s no pressure on you, but everyone before you has gotten the grant,” City Engineer Dan Holderness said.

    And the number of brownfields in America continues to grow.

    In Massachusetts, officials said 1,200 new spots of contamination are discovered annually.

    In a 2011 grant application for federal funding, the Wisconsin Department of Natural Resources said the recent recession has caused a “startling” number of plant closings.

    It is, the report said, “an entirely new generation of brownfields.”

    Kate Golden, Wisconsin Center for Investigative Journalism; MacKenzie Elmer, Iowa Center for Public Affairs Journalism; and Jake Mooney, City Limits contributed to this article.

     Once one of the largest textile mill in the U.S., this 16.5 acre site in Sprague Conn., is a brownfield site, owned by the town. Officials, who are concerned that the site is a safety hazard, have been looking for a developer for years.  Gwyneth Shaw http://www.publicintegrity.org/authors/gwyneth-shaw Beverly Ford http://www.publicintegrity.org/authors/beverly-ford-0 Evelyn Larrubia http://www.publicintegrity.org/authors/evelyn-larrubia http://www.publicintegrity.org/2012/09/25/10970/epas-brownfields-program-coming-short

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    Republican Rep. Rick Berg, of North Dakota, once the favorite to replace retiring Democratic Sen. Kent Conrad, has found himself in a tight race, and spending by outside groups is flowing.

    Berg faces former state Attorney General Heidi Heitkamp, a Democrat.

    The Republican congressman absorbs a one-two punch today in ads from the Democratic Senatorial Campaign Committee and Patriot Majority USA.

    Patriot Majority USA, a liberal nonprofit, released “More Proof,” which features the AARP’s criticisms of the Medicare plan Berg supports — Rep. Paul Ryan’s “premium support” plan in which the government gives seniors a set amount of money to buy private insurance.

    The DSCC’s “No Change” also focuses on Medicare. It says that while Berg promised that those who are already 55 and older will not see a change in their health care costs, that claim is “absolutely not true,” according to the ad.

    Ryan’s budget plan reopens the Medicare Part D “doughnut hole” for prescription drugs — a range of costs in which seniors are responsible for paying for all their medications out-of-pocket, Factcheck.org says.

    North Dakota, a state that The New York Times predicted as “Berg’s to lose,”  is solidly Republican when it comes to presidential voting, but the Senate seat has been held by a Democrat since 1960.

    The Associated Press reports that Heitkamp’s ties to the state’s booming energy industry, which has kept unemployment the lowest in the country, has kept her competitive. Her folksy attitude has only upped her appeal to North Dakota voters.

    Heitkamp has also faced a stream of attack ads. Like the anti-Berg ads, her health care position, especially her support of the Affordable Care Act, dominates the airwaves (see Crossroads’ GPS “Your Vote,” for example).

    The National Republican Senatorial Committee also reported spending $310,000 on ads opposing Heitkamp yesterday. The ads have not yet been posted online.

    The Senate race in North Dakota has attracted $5.1 million in outside spending, according to the Center for Responsive Politics, with top spending coming from the DSCC, the NRSC and Majority PAC, a Democratic super PAC.

    In other outside spending news:

    • The DSCC released two other spots: the first opposes former Republican Wisconsin Gov. Tommy Thompson, who is running for U.S. Senate, saying he puts special interests ahead of the state. The second, “Obvious,” critcizes businessman Jason Plummer, the Republican running in Illinois’ 12th District, for his Medicare stance.
       
    • Conservative super PAC FreedomWorks for America released a new round of ads on Monday, including two ads that oppose Sen. Bob Casey, D-Pa., for not being more supportive of natural gas drilling, and an ad supporting Casey’s opponent, former coal executive Tom Smith. The super PAC also released an ad opposing the Senate run of Rep. Joe Donnelly, D-Ind.; an ad opposing former Surgeon General Richard Carmona, the Democratic candidate for U.S. Senate in Arizona; and “Senator Space Cadet” opposing Sen. Bill Nelson, D-Fla.
       
    • House Majority PAC, a super PAC supporting Democrats running for U.S. House, released five news ads criticizing Republican candidates: “Anything” opposes businessman Randy Altschuler in New York’s 1st District; “Neon” opposes Arizona state Sen. Jonathan Paton in Arizona’s 1st District; “Upside Down” opposes Rep. Scott Rigell, R-Va.; “Doors” opposes Rep. Bobby Schilling, R-Ill.; and “Higher and Less” opposes Paradise Valley, Ariz., councilman Vernon Parker in Arizona’s 9th District. The super PAC also reported spending $381,000 opposing Republican Rep. Jeff Denham in California’s 10th District.
       
    • The National Rifle Association of America Political Victory Fund, a PAC, released “Boot Brown out of Office,” an ad opposing Sen. Sherrod Brown, D-Ohio.
       
    • Conservative nonprofit American Future Fund’s new ad “Promises” places clips from President Barack Obama’s 2008 campaign speeches alongside his campaign speeches this year.
       
    • Let Freedom Ring, a conservative nonprofit that has attacked Obama on child soldiers and the Muslim Brotherhood, released “1967 Borders,” which criticizes Obama for supporting the restoration of the pre-1967 borders for Palestinians. He is the first president to formally endorse the policy.
       
    • Conservative super PAC YG Action Fund, a spinoff from the Republican “Young Guns” group, released “Turning the Corner,” a radio ad supporting former congressional aide Richard Hudson, the Republican candidate for U.S. House in North Carolina’s 8th District.
       
    • Americans for Limited Government, a conservative nonprofit, released a web video called “Obama’s Blunders: Disabilities and Other Government Assistance,” which, among other things, suggests that people on public assistance are “scamming taxpayers.”

    Who paid for that political ad? You might be surprised by the answer. Email us and we will try to find out. Describe the advertisement — was it mean or nice? Will it affect your vote? When and where did it run and what were the names of the candidates? And PLEASE tell us what the disclaimer at the end says, and we will check it out.

    The Democratic Senatorial Campaign Committee's new ad claims Rep. Rick Berg isn't telling the truth about the effects of a "premium support" Medicare system on those who are already enrolled. Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/25/10973/daily-disclosure-north-dakotas-berg-absorbs-one-two-ad-punch

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    Americans for Prosperity, a conservative nonprofit funded by the billionaire Koch brothers, launched a new issue advocacy campaign criticizing President Barack Obama Monday.

    The organization reported spending $205,000 on radio ads highlighting what the group calls Obama’s “failing agenda.”

    The buy will ramp up to $1.3 million, according a press release, with radio ads and calls to voters targeting 13 states. The campaign is coupled with a national bus tour.

    Issue ads can name a candidate but do not expressly advocate a yes or no vote. They must be reported to the Federal Election Commission as “electioneering communications” if, as with the new Americans for Prosperity spots, they come within 60 days of a general election.

    Issue advertising all but disappeared when a federal district court required donors to the campaigns be identified. An appeals court, however, recently suspended that decision. Issue ads, unlike “express advocacy” ads can be interpreted as educational and not subject to IRS limits on political activity.

    Americans for Prosperity, known for being financed by the billionaire industrialist brothers Charles and David Koch, is one of the top outside spenders in the election.

    It has spent $30.9 million on independent expenditures, the kind of ads that urge a yes or no vote, according to the Center for Responsive Politics. The entire sum has been spent opposing Obama, but Americans for Prosperity has spent unreported millions more on U.S. congressional races.

    The appeals court decision means Americans for Prosperity, and other politically active nonprofits like the U.S. Chamber of Commerce, American Action Network and American Future Fund, may return to anonymously funded “educational” issue ads, most of which nonetheless make a clear political statement.

    In other outside spending news:

    • AFSCME PEOPLE, a political action committee of the American Federation of State, County and Municipal Employees, released “The Man” opposing Rep. Dan Lungren, R-Calif. and “Struggling,” opposing Rep. Dan Benishek, R-Mich. “Funder,” from AFSCME directly, opposes Rep. Chip Cravaack, R-Minn. The PAC also reported spending $263,000 on canvassing expenses in opposition to Republican Rep. Nan Hayworth in New York’s 19th District.
       
    • Conservative super PAC American Crossroads released “Where,” opposing Sen. Bill Nelson, D-Fla., at a cost of $1.6 million.
       
    • Its sister nonprofit Crossroads GPS spent $2.8 million opposing Democratic U.S. Senate candidates Rep. Joe Donnelly of Indiana, Rep. Shelley Berkley of Nevada, Sen. Sherrod Brown of Ohio, Sen. Bill Nelson of Florida, and former Virginia Gov. Tim Kaine. It also paid for media opposing Rep. Tim Bishop of New York, who is running for re-election to the U.S. House.
       
    • SEIU COPE, the PAC of the Service Employees International Union, released “$6,400,” which opposes Rep. Steve King, R-Iowa, for supporting Rep. Paul Ryan’s Medicare plan.
       
    • The super PAC Planned Parenthood Votes released “Cynthia’s Story,” in which a woman tells how her checkup at a Planned Parenthood clinic detected her cancer. The ad opposes GOP presidential nominee Mitt Romney, who has suggested cutting federal funding to the program.
       
    • The Democratic Senatorial Campaign Committee released two ads on Tuesday opposing North Dakota Rep. Rick Berg, who is running for Senate, which come on the heels of anti-Berg ad “No Change,” as the Daily Disclosure reported Monday.
       
    • Conservative nonprofit Americans for Limited Government posted three web videos, one criticizing Sen. Claire McCaskill, D-Mo., for a “lifestyle of the tax and spenders,” another calling former Virginia Gov. Tim Kaine’s leadership style as “chiKAINEry,” and the third tracking Sen. Jon Tester’s evolution from “innocent farmer to beltway bandit.”
       
    • Conservative super PAC YG Action Fund released “Jet Set Mike,” which criticizes Rep. Mike McIntyre, D-N.C., for his world travels while in office.
       
    • "Now Hiring" from House Majority PAC opposes Chris Collins, the Republican candidate for U.S. House in New York's 27th District.

    Who paid for that political ad? You might be surprised by the answer. Email us and we will try to find out. Describe the advertisement — was it mean or nice? Will it affect your vote? When and where did it run and what were the names of the candidates? And PLEASE tell us what the disclaimer at the end says, and we will check it out.

    William Koch shows his art collection on display at the Museum of Fine Arts in Boston in 2005. Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/26/10976/daily-disclosure-koch-backed-nonprofit-educates-voters-about-obama

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    Japan, Taiwan, and China have been contesting ownership of five deserted islets and three rocks in the East China  Sea since oil reserves were detected nearby more than forty years ago. But new tensions were stoked this month when the Japanese government nationalized the islands by purchasing them from a Japanese family. 

    This week, both Taiwan and Japan sent vessels there, prompting the Japanese to shower the rivalrous boats with water balloons launched from slingshots. Okay, not really. It wasn't balloons that Japan fired, but the hi-tech version of a middle-schooler's backyard weapon: a water cannon.

    Although the United States transferred the islands' post-war administration to Japan in 1971, its official position on their sovereignty now is neutral, a stance that came under question in this fun exchange at a press conference Tuesday, Sept. 25, by George Little, the acting Assistant Secretary of Defense for Public Affairs:

            Q:  George, U.S. forces and Japanese self-defense forces are conducting a joint exercise on Guam, simulating the defense of a small island against an unnamed aggressor.  Does this have anything to do with the recent tensions between Japan and China over the Senkakus? 

                MR. LITTLE:  This is merely an exercise, and I wouldn't tie it in any way to island disputes….. 

                Q:  George, having the Marines train the Japanese on how to hit the beach and take an island, how does that jibe with the overall position stated that the U.S. does not take a position in these island disputes? 

                MR. LITTLE:  Repeat the first part of your question for me. 

                Q:  The Marines are training Japanese how to hit the beach to take an island. 

                MR. LITTLE:  The Japanese are our allies.  We work with them on a daily basis.  We have -- we have bases in Japan.  It's natural for us to help the Japanese and to exercise with them.  I wouldn't construe this particular event as in any way tied to the island dispute. 

    In this photo released by Taiwan's Central News Agency, a Japan Coast Guard patrol boat, front, comes in close proximity with a Taiwan Coast Guard patrol boat Sept. 25 near the disputed islands called Senkaku in Japan and Diaoyu in China, in the East China Sea. R. Jeffrey Smith http://www.publicintegrity.org/authors/r-jeffrey-smith http://www.publicintegrity.org/2012/09/26/10982/east-china-sea-training-merely-exercise-says-pentagon

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  • 09/26/12--12:00: Giving you the truth

  • The 2012 presidential contest will be the most expensive - and most secretive - election of the modern era. Thanks to federal court decisions, corporations, billionaires and labor unions can spend as much as they want to fill the airwaves with half-truths and outright propaganda.

    Sadly, much of the media is missing this story and instead obsessing over scripted, corporate-funded national conventions, where the biggest news was Clint Eastwood interrogating an empty chair.

    The Center for Public Integrity is dedicated to giving you the most credible information possible - not available from other news outlets. We’re not focused on the parade of celebrities and sound-bite gaffes. We are focused on uncovering the shadowy groups that are determined to decide who the next president and members of Congress will be through a historic influx of special-interest cash, the result of the now-famous "Citizens United" Supreme Court ruling.

    This is investigative reporting that I believe you care about and the kind of critical journalism that separates the Center for Public Integrity from the for-profit daily news chatter. And it's why I'm asking you to take a role in ensuring that this reporting continues by contributing today.

    At the Center for Public Integrity, we are a watchdog for the public, not for insiders and shareholders. We take the time to write impartial, nonpartisan stories that give you the real truth.

    But the truth has a price - research, reporting, writing, editing, fact-checking and publishing all cost money. We hope you consider it a price worth paying so we may continue to give you reporting that holds government, corporations and special interests accountable to you.

    Your $10 or $30 or $50 tax-deductible contribution is needed now to help us find and expose the reality behind the propaganda that impacts us all.

    Thank you,

    John Dunbar

    Managing Editor, Politics

    P.S. The Center is different from most media organizations, as well as many nonprofits. We're not corporate-funded. And we don't take one penny from governments, labor unions, anonymous donors or other special interests. That is why your support is so important.

     

     


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    A new ad from a veterans’ outside spending group and a major Democratic super PAC accuses Arizona Republican Rep. Jeff Flake of failing to support members of the armed services.

    “Congressman Flake voted to send us to that war,” says Steven Lopez, an Iraq war veteran, in the new ad, “and then voted against us when we returned home.”

    Flake and former Surgeon General Richard Carmona, a Democrat, are facing off to replace retiring Republican Sen. John Kyl in an increasingly competitive race.

    Uniform” from VoteVets Action Fund, a nonprofit, and Majority PAC draws attention to Flake’s vote against the 2008 GI Bill, which expanded benefits to Iraq war veterans. The bill, now law, provides tuition to public universities for qualified veterans, among other provisions.

    The ad launches today and will air for one week at a cost of $280,000, according to a press release.

    Flake’s campaign is fighting back. On Tuesday, responding to similar claims made by the Carmona campaign, posted a statement from Republican Sen. John McCain, a Vietnam War veteran and former POW, calling the line of attack “false and negative.” The statement is accompanied by a list of veterans’ bills the congressman did vote for.

    The VoteVets ad notes Flake’s vote for a 2003 budget that cut veterans’ benefits and for a 2010 vote against another veterans’ education bill that, among other things, provides vocational training for veterans. As a nonprofit, the group is not required to disclose its donors.

    The anti-veteran attacks began this week with an ad from Carmona, a veteran himself, and a strongly worded statement from the Democratic Senatorial Campaign Committee.

    Carmona has made veterans’ support a major aspect of his campaign. “Vets for Carmona,” an arm of his campaign, is chaired by an Army lieutenant general and two major generals. The website features a place for veterans to add their names to Carmona’s endorsements list. Carmona also has the endorsement of the Veterans Alliance for Security and Democracy, which tends to support Democratic veterans.

    The U.S. Senate race in Arizona has seen $1.8 million in outside spending, but $1.2 million was directed at Wil Cardon, Flake’s wealthy opponent in the Aug. 28 GOP primary, according to the Center for Responsive Politics.

    Flake has a slight lead in the polls, according to Real Clear Politics, but the gap is closing.

    VoteVets  Action Fund also spent $270,000 supporting the U.S. House run of Democrat Tulsi Gabbard, a former Hawaii state representative. Gabbard has served two deployments to the Middle East and is a commander in the Hawaii Army National Guard.

    In other outside spending news:

    •  “More Government Isn’t the Solution” from the U.S. Chamber of Commerce opposes former Attorney General Heidi Heitkamp, the Democrat running for U.S. Senate in North Dakota.
       
    • Pro-Mitt Romney super PAC Restore Our Future released “Kindergarten” opposing President Barack Obama.
       
    • Super PAC Priorities USA Action, which supports Obama, and AFSCME PEOPLE, the political action committee of the American Federation of State, County and Municipal Employees, released “47%,” a radio ad criticizing Romney for his secretly videotaped statement at a private fundraising event where he said 47 percent of Americans “believe they are entitled to health care, to food, to housing, to you-name-it.”
       
    • SEIU COPE, the political action committee of the Service Employees International Union, reported spending $332,000 opposing Romney, Rep. Steve King, R-Iowa, and Rep. Bobby Schilling, R-Ill.
       
    • Conservative nonprofit Crossroads GPS reported spending $1.1 million against U.S. Senate candidate Rep. Tammy Baldwin, D-Wis., $130,000 against Obama, and has plans to spend $3.7 million against four Democratic senatorial candidates. The $3.7 million campaign includes “Big” opposing Rep. Shelley Berkley in Nevada; “Pressure” opposing Rep. Joe Donnelly in Indiana; “When” opposing Sen. Sherrod Brown in Ohio; and “Addicted” opposing former Virginia Gov. Tim Kaine.
       
    • Conservative super PAC Ending Spending Action Fund released “Why I Changed My Vote” and “Reason,” which oppose Obama.
       
    • House Majority PAC, a Democratic super PAC, reported spending $129,000 opposing Randy Altschuler in New York, a Republican running for Congress, plus an additional $437,000 opposing Republican U.S. House candidates Mia Love, the mayor of Saratoga Springs, Utah, Joe Coors, a Colorado businessman, Rep. Scott Rigell of Virginia and North Carolina state Sen. David Rouzer.
       
    • Running” from Americans for Job Security, a conservative nonprofit, opposes Obama.
       
    • The Florida-focused super PAC Treasure Coast Jobs Coalition released “Add Up,” which opposes Democrat Patrick Murphy, Republican Rep. Allen West’s challenger in Florida’s 18th District. Murphy is the president of an environmental cleanup firm.
       
    • The Democratic Congressional Campaign Committee reported spending $3.6 million opposing Republican candidates for U.S. House in numerous districts. The DCCC also released an ad opposing former Virginia Sen. George Allen, a Republican running for U.S. Senate.
       
    • The Democratic Senatorial Campaign Committee released “Wall Street’s Favorite Senator,” which opposes Sen. Dean Heller, R-Nev. The ad cost $575,000.

    Who paid for that political ad? You might be surprised by the answer. Email us and we will try to find out. Describe the advertisement — was it mean or nice? Will it affect your vote? When and where did it run and what were the names of the candidates? And PLEASE tell us what the disclaimer at the end says, and we will check it out.

    VoteVets and Majority PAC released "Uniform," which builds on a new line of attack against Rep. Jeff Flake, the Republican candidate for U.S. Senate in Arizona - that he does not support veterans. Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/27/10990/daily-disclosure-arizona-congressman-targeted-veterans-group

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    KADENA AIR BASE, Japan (AP) — Years before F-22 pilots began getting dizzy in the cockpit -- before one struggled to breathe in advance of a fatal crash, before two more went on television to say they refused to fly it -- a small circle of U.S. Air Force experts knew something was wrong with the costly stealth fighter jet.

    Coughing among pilots and fears of contaminants in their breathing apparatus led the experts to suspect flaws in the oxygen-supply system of the F-22 Raptor, especially in extreme high-altitude conditions. They formed a working group a decade ago to deal with the problem, creating a unique brain trust.

    Internal documents and emails obtained by The Associated Press show they proposed a range of solutions by 2005, including adjustments to the flow of oxygen into pilot's masks. But that key recommendation was rejected by military officials who expressed reluctance to add costs to a program already well over budget.

    "This initiative has not been funded," read the minutes of their final meeting in 2007.

    Minutes of the working group's meetings, PowerPoint presentations and emails among its members reveal a missed opportunity for the Air Force to improve pilot safety in the 187-plane F-22 fleet before a series of high-profile problems damaged the image of the aircraft and led to a series of groundings. Its production was halted last spring and the aircraft has never been used in combat.

    The Air Force says the F-22 is safe to fly — a dozen of the jets began a six-month deployment to Japan in July — but flight restrictions remain in place, preventing its use in high-altitude situations where pilots' breathing is under the most stress.

    The working group urged various repairs that the Air Force has only recently embraced. One, a backup oxygen system, is expected to be in place by the end of the year, along with a new oxygen valve in the pilots' vests. The working group also proposed changes in warning systems to alert pilots to system failures, and urged better tracking of potential health hazards to pilots and ground crew caused by the planes’ stealthy coating — issues that remain under Air Force scrutiny.

    The Air Force now concedes that while its own experts were tackling the F-22's issues, it was too aggressive in cutting back on life-support programs intended to ensure pilots' safety. It is now in the process of rebuilding them.

    The F-22's gradual return to regular flight operations follows an exhaustive investigation over the past year by the Air Force, NASA, experts from Lockheed Martin, which produces the aircraft, and other industry officials.

    But the documents obtained by AP show many of the concerns raised in that investigation had already been outlined by the working group, which was formed in 2002 when the fighter was still in its early production and delivery stage.

    It called itself RAW-G, for Raptor Aeromedical Working Group, and brought together dozens of experts in life support, avionics, physiology and systems safety, along with F-22 aircrew and maintainers.

    The group was founded by members of the F-22 community concerned about how the unique demands of the aircraft could affect pilots. The fighter can evade radar and fly faster than sound without using afterburners, capabilities unmatched by any others. It also flies higher than its predecessors and has a self-contained oxygen generation system to protect pilots from chemical or biological attack.

    According to the Air Force, RAW-G was created at the suggestion of Daniel Wyman, then a flight surgeon at Florida's Tyndall Air Force Base, where the first F-22 squadron was being deployed. Wyman is now a brigadier general and the Air Combat Command surgeon general.

    By the time RAW-G got going, some pilots were already experiencing a problem called "Raptor cough" — fits of chest pain and coughing dating back to 2000 that stem from the collapse of overworked air sacs in the lungs.

    The group concluded that the F-22's On-Board Oxygen Generation System — or OBOGS — was giving pilots too much oxygen, causing the coughing. The more often and higher the pilots flew after being oxygen-saturated, group members believed, the more vulnerable pilots affected by the condition would be to other physiological incidents.

    RAW-G recommended more tests and that the F-22's oxygen delivery system be adjusted through a digital controller and a software upgrade.

    "The schedule would provide less oxygen at lower altitudes than the current schedule, which has been known to cause problems with delayed ear blocks and acceleration atelectasis," the technical term for the condition that leads to the coughing, according to the minutes from RAW-G's final meeting.

    RAW-G members had spent two years pushing for the change in the oxygen schedule — the amount of oxygen pumped into pilots' life-support systems — but the necessary software upgrade never came through.

    "The cost was considered prohibitive in light of other items that people wanted funded for the F-22," said Kevin Divers, a former Air Force physiologist who spearheaded RAW-G until he left the service in 2007 and the group disbanded.

    Divers believes the cost would have been about $100,000 per aircraft.

    The link between oxygen saturation at lower altitudes and the recent spate of hypoxia-like incidents at high altitudes remains a matter of debate, and it is likely that there are other contributing factors. Both the Air Force and the NASA, however, now concur that the F-22's oxygen schedule needs to be revised.

    At a House subcommittee hearing this month, Clinton Cragg, the chief engineer for NASA's Engineering and Safety Center, said the current schedules provide too much oxygen at lower altitudes — as RAW-G warned — and also agreed with RAW-G that testing was insufficient "even back to the beginning of the program."

    Lt. Col. Tadd Sholtis, a spokesman for the Air Combat Command at Virginia's Langley-Eustis Air Force Base, the home base for the F-22s deployed in Japan, said the RAW-G group was not meant to last indefinitely. He said it was set up to help officials at Tyndall get up to speed on the medical aspects of flying the F-22, and disbanded "after several meetings and a safe transition to regular F-22 operations at Tyndall."

    But even in the last days of the group, its members were identifying more work that needed to be done. In an email to Divers before RAW-G's final meeting, Wyman said health hazards for F-22 pilots and ground crew needed more study.

    "I am interested in the potential physiologic/health issues related to flying and fixing the F-22s," he wrote. He added that increased gravitational forces during accelerated turns, high speeds and high altitudes, noise and the "low observable" materials used to give the aircraft its stealth qualities "might lead to new health issues."

    By then, the F-22 was just one of the aircraft RAW-G was concerned with. Minutes from the final meeting include "action items" identifying potential issues with the F-35 and the CV-22 Osprey, and a suggestion that RAW-G's work be carried on with higher-level oversight so that it would have more clout. But after Divers left the service, no one took up the torch.

    The Air Force says it believes improvements now being put into place make the planes safe to fly under limited restrictions. It is now refitting all pilot life support gear, redesigning the vests so that modified versions can be introduced in the fall, and adding the automated backup oxygen system in the cockpit by the end of the year.

    In the meantime, the F-22s in Japan must fly under 44,000 feet so that the flawed vests will not be required, and are on a 30-minute "tether," meaning they must be within 30 minutes of an emergency landing site.

    "While we cannot eliminate risk from flight operations, we are confident the F-22 is safe now and on a path to being as safe as any other fighter we fly," Sholtis said.

    The Air Force says there have been no breathing-related incidents in the F-22 fleet since March 8, though the aircraft has marked more than 9,000 sorties, or 12,000 flight hours, since then.

    But Gregory Martin, who led the study into its oxygen problems for the Air Force Scientific Advisory Board investigation that began in 2011, told the House subcommittee that "over the past 20 years, the capabilities and expertise of the USAF to perform the critical function of Human Systems Integration have become insufficient."

    Martin said the program's decline cost the Air Force expertise on life support systems, altitude physiology and pilot health and safety. He said that was compounded by "inadequate research, knowledge, and experience for the unique operating environment of the F-22."

    Maj. Gen. Charles Lyon, the Air Combat Command's director of operations, concurred with those conclusions at a news conference last month. "We probably overshot the mark on how much downsizing we did in this study of physiology," he said.

    Divers considers the demise of RAW-G to be emblematic of that decline. "The RAW-G became a brain trust, for sure, and it pushed various things that otherwise would have been completely ignored or not even brought up as an issue," Divers said. "All of that died in 2007."

    In this April 30, 2012, file photo, an Air Force F-22 Raptor displays it's weapons bays as it goes through maneuvers during a demonstration at Langley Air Force Base in Hampton, Va. http://www.publicintegrity.org/2012/09/27/10991/documents-show-air-force-neglected-concerns-about-f-22-pilot-safety

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    Americans for Job Security, a conservative nonprofit organized as a trade association, reported that its ad “Running” cost $8.2 million, a significant figure considering the group’s total take in its 2010 fiscal year was $12 million, according to its most recent tax filing.

    “Running,” released Wednesday, is the group’s first reported presidential ad of the election. It shows a mother jogging down the street as she says in the voiceover that she’s “running to forget” the bad economy, her husband’s layoffs and the national debt.

    “The future is getting worse under (President Barack) Obama,” she says.

    The ad is airing in six swing states.

    Americans for Job Security is run by president Stephen Demaura, the former director of the New Hampshire State Republican Committee, out of an Alexandria, Va., office shared with the Republican media buying firm Crossroads Media, the Los Angeles Times discovered.

    Crossroads Media was co-founded by former Americans for Job Security president Michael Dubke. Dubke is also a partner at Black Rock Consultancy, a GOP consultancy he co-founded with Carl Forti, the political director of super PAC American Crossroads and nonprofit Crossroads GPS.

    Forti was Republican presidential nominee Mitt Romney’s political director in 2008 and is co-founder of the pro-Romney super PAC, Restore Our Future.

    Crossroads Media and McCarthy Hennings Media, the firm known for the infamous “Willie Horton” ad that contributed to the demise of Democratic presidential hopeful Michael Dukakis’s campaign in 1988, are behind Americans for Job Security’s new ad. Crossroads Media and McCarthy Hennings is also the primary team behind ads from Restore Our Future as well as American Crossroads and Crossroads GPS.

    Because it is a nonprofit, Americans for Job Security is not required to publicly disclose its donors. This has led to complaints with the IRS and the Federal Election Commission.

    Watchdog Public Citizen argued in 2008 that the group should lose its nonprofit status because it violated IRS rules by dedicating a substantial amount of time and money to election activities. Staff lawyers for the FEC later found “reason to believe” the group violated FEC rules by failing to register as a political committee and disclose its donors. Republican commissioners blocked any further action, according FactCheck.org.

    Americans for Job Security was launched in 1997 with seed money from the American Insurance Association and the American Forest and Paper Association, according to National Public Radio.

    Several donors have been revealed, including Americans for Limited Government, the Wellspring Committee and the Center to Protect Patients’ Rights, according to the Center for Responsive Politics. All three are nonprofits that don’t disclose donors. The Center to Protect Patients’ rights has funneled millions to conservative nonprofits.

    Americans for Job Security describes itself as an “independent, bipartisan, pro-business issue advocacy organization,” but it spends almost entirely on ads opposing Democrats.

    In other outside spending news:

    • Liberal hedge fund manager George Soros* announced he will give $1.5 million in contributions to pro-Democratic super PACs, including $1 million to the pro-Obama group Priorities USA Action, The New York Times reported Thursday. The remaining $500,000 will be split between Majority PAC and House Majority PAC, according to news reports, which are dedicated to electing Democrats to Congress.
       
    • Profanity alert: “Wake the F*** Up,” a new Web short, stars actor Samuel L. Jackson speaking in verse and teaming up with a young girl to rally her family behind Obama. The piece was produced by the super PAC Jewish Council for Research and Education, the same people who brought you “The Great Schlep,” starring comedian Sarah Silverman in 2008.
       
    • American Unity PAC, a Republican super PAC that supports equal rights for lesbian, gay, bisexual and transgendered people, reported spending $518,000 against former Democratic Rep. Bill Foster in Illinois’ 11th District. Foster’s Republican opponent, Rep. Judy Biggert, has a history of supporting LGBT rights. American Unity PAC’s primary backer is hedge fund manager Paul Singer of Elliott Management, a fiscal conservative whose son is gay. The expenditure paid for the ad “Red Flag,” among other things.
       
    • Quantum of Easing,” a James Bond-styled web video from American Crossroads, opposes Obama. “Stamp” from its sister nonprofit Crossroads GPS opposes Rep. Tammy Baldwin, R-Wis., the Democratic candidate for U.S. Senate in Wisconsin. The GPS ad buy cost $1.2 million.
       
    • The National Association of Realtors Congressional Fund, a super PAC, reported spending $423,000 in support of Reps. Brad Sherman, D-Calif., Michael Fitzpatrick, D-Pa., and Gary Miller, D-Calif. All three are on the House Financial Services Committee, which oversees housing issues.
       
    • The U.S. Chamber of Commerce reported spending $2 million opposing the re-election of Sen. Bill Nelson, D-Fla., and $390,000 opposing former North Dakota Attorney General Heidi Heitkamp, the Democrat running for U.S. Senate in the state.
       
    • House Majority PAC reported spending $2.1 million opposing Republican candidates for U.S. House in 13 districts.
       
    • AFSCME PEOPLE, the political action committee of the American Federation of State, County and Municipal Employees, released “Flight,” a television ad opposing Rep. Jim Renacci, R-Ohio, and “Carolyn,” a radio ad opposing Rep. Dan Benishek, R-Mich. AFSCME the union reported spending $584,000 on its new radio ad “Donor” opposing Rep. Chip Cravaack, R-Minn.
       
    • The nonprofit League of Conservation Voters spent $600,000 on the Western-themed “Congressman Canseco: What’s Wrong with Washington,” which attacks Rep. Francisco “Quico” Canseco, R-Texas.
       
    • SEIU COPE, the PAC of the Service Employees International Union, released “Wrong for Missouri,” attacking Rep. Todd Akin, the Republican candidate for U.S. Senate in the state. Akin was also hit with a $494,000 TV ad buy from Women Vote!, the political action committee of the abortions rights group EMILY’s List.
       
    • Ending Spending Action Fund, a conservative super PAC, reported spending $1 million on ads opposing Obama and supporting Romney. The group is backed by billionaire J. Joe Ricketts.
       
    • American Future Fund, a conservative nonprofit, reported that it spent $694,000 on social media promotion for its ad “Promises,” released Tuesday.

    *The Center for Public Integrity has received financial support from Soros’s Open Society Foundation. See the Center’s list of donors here.

    Who paid for that political ad? You might be surprised by the answer. Email us and we will try to find out. Describe the advertisement — was it mean or nice? Will it affect your vote? When and where did it run and what were the names of the candidates? And PLEASE tell us what the disclaimer at the end says, and we will check it out.

    Americans for Job Security enters the presidential election with an $8.2 million ad buy for "Running." Rachael Marcus http://www.publicintegrity.org/authors/rachael-marcus http://www.publicintegrity.org/2012/09/28/10995/daily-disclosure-non-disclosing-nonprofit-spends-82-million-anti-obama-ad

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