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Home care cutbacks put strain on elderly

Without the adult day health care centers, Almonor’s only choice would be to leave her mother, who has diabetes and mild dementia, alone at their Holliston, Mass., home. Hiring a home health aide would cost about $21 an hour.

Obama Misstated Story About Mother’s Health Care, New Book Says

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July 14, 2011 11:43 AM

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ABCNews.com

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ABC News’ Mary Bruce (@marykbruce) reports:

During his 2008 presidential campaign and the fight for health care reform, President Obama often told the story of his mother Stanley Ann Dunham and how she spent the months before her death fighting with insurance companies who tried to deny her coverage based on a pre-existing condition.

That story is now being called into question by a new book which says Dunham in fact had health insurance when she died from ovarian cancer in 1995.

“My mother, when she got sick with ovarian cancer, she had just gotten a new job, and the insurance company was saying, ‘Well, maybe this is a pre-existing condition, so maybe we don’t have to pay your medical bills.’ So I know what it’s like to see a loved one suffer not just because they’re sick, but because of a broken health care system. This is personal for me,” then-candidate Obama said at a March 2008 campaign event in Pennsylvania.

In “A Singular Woman: The Untold Story of Barack Obama’s Mother,” former New York Times reporter Janny Scott reveals that, although Obama claims Dunham was denied coverage because of a preexisting condition, she was actually only denied disability coverage.

The revelation is not being denied by the White House, the New York Times reported Thursday.

Dunham, an anthropologist, was working in Jakarta in 1994 when she began suffering from intense abdominal pains. At the time, she was working for the American company Development Alternatives, which provided her with health insurance.

An Indonesian doctor originally diagnosed Dunham with appendicitis and she debated going out of the country for an appendectomy. “‘You’ve got health insurance, that’s taken care of. We can cover the airfare. We can cover a few hundred dollars,” Scott reports Dunham’s boss telling her at the time. Ultimately, Dunham stayed in Jakarta for the surgery.

In January 1995, an increasingly ill Dunham left Indonesia for Honolulu. Just days after her arrival, a gastroenterologist concluded her problem was not gastrointestinal and referred her to an oncologist who diagnosed her with third-stage uterine and ovarian cancer.

Shortly thereafter, she underwent a total hysterectomy and started a series of six monthly chemotherapy treatments. “In Honolulu, Ann pressed on gamely. According to her correspondence, Barry Barack helped her with insurance forms and letters in the immediate aftermath of her surgery,” Scott writes.

According to the book, however, Dunham’s insurance continued to cover her medical expenses when she was in Hawaii. “The hospital billed her insurance company directly, leaving Ann to pay only the deductible and any uncovered expenses, which, she said, came to several hundred dollars a month. To cover those charges as well as living expenses, she filed a separate claim under her employer’s disability insurance policy. That policy, however, contain a clause allowing the company to deny any claim related to a preexisting medical condition,” Scott explains.

CIGNA, Dunham’s insurer, investigated whether her cancer was a pre-existing condition and later denied her claim based on an earlier visit to a gynecologist. Dunham then informed CIGNA that she was turning the case over to “‘my son and attorney, Barack Obama.’”

July 14, 2011
in Mary Bruce, President Obama
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1fd76 corner top left Obama Misstated Story About Mothers Health Care, New Book Says1fd76 corner top right Obama Misstated Story About Mothers Health Care, New Book Says

OF COURSE OBAMA LIED —- In fighting for his Obamacare… HALF the stories he told were at least partially fabricated!! — I’ve read about several examples!! — So the question is… how can you trust a man that LIES SO EASILY to the American people??????? ——– He ALSO said these whoppers… “No new taxes for those earning less than $250k” (LIE!!)… when he said “Our healthcare reform bill will reduce the deficit” (LIE!!)… when he said “3 million Jobs Created or Saved” (LIE!!!)… “if you like your healthcare plan, you can keep it” (LIE!!!)… “I will close Guantanamo Bay” (LIE!!!)… “we will be out of Iraq within 16 months” (LIE!!)… “we will be the party of transparency” (LIE!!!)… “No more lobbyists” (LIE!!!)… ETC!!!

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Posted by: TheLoyalOpposition | Jul 14, 2011 2:02:18 PM

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“This is just yet another example of a politician manipulating a story for political street cred.”

Street cred?? This story exposes Obama for the lying fraud that he is. It goes to the very core of his character (or lack thereof). He won’t be able to run away from this. This story has some very strong legs.

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Posted by: J.R. | Jul 14, 2011 2:02:17 PM

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The book ” Obama Desconstructed ” throws more revealing light on the subject.

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Posted by: Randolph Mckenzi | Jul 14, 2011 1:57:20 PM

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He said he watched her fight with insurance companies to cover the care she was getting.

Posted by: Paul Bxton | Jul 14, 2011 12:57:58 PM

Then he lied Paul, pure and simple. Her care was covered and he would have known that. Otherwise we are to believe that the President of the United States does not know the difference between disability insurance and health insurance. This as he just ram-rodded throught the worst piece of healthcare legislation based in part on this story.

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Posted by: J.R. | Jul 14, 2011 1:57:06 PM

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“Then again, just because you’re an American doesn’t mean you’re necessarily smart.”

Posted by: Art | Jul 14, 2011 12:46:45 PM

That’s true. Look at how many Americans were fooled by meaningless bumper sticker rhetoric like “Hope and Change” and “Yes We Can!”

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Posted by: Chuck | Jul 14, 2011 1:51:46 PM

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If Obama was a cEo of a company, he’d be put in jail for FRAUD with all the lies he tells.

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Posted by: Footie Hill | Jul 14, 2011 1:51:13 PM

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This is just yet another example of a politician manipulating a story for political street cred.

It doesnt change the fact the current health care system is broken and obamacare will not fix it.

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Posted by: Will i am | Jul 14, 2011 1:49:17 PM

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POSTED BY: CATHERINE | JUL 14, 2011 1:20:32 PM

Hold your horses, CATHERINE. No one needs to be sued. According to other reports I’ve read about this, the author got much information from correspondence Ms. Dunham had with friends throughout the illness.
Besides, we can’t even have access to Obama’s school records…no way you’d get info any other way on this story. You didn’t honestly think the MSM would have been willing to put their efforts forth and check on something the Great One said, did you?

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Posted by: Shoe | Jul 14, 2011 1:37:17 PM

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I have to wonder how the media got this information. Under HIPAA rules, that would be considered private. If CIGNA released them, they can be sued.

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Posted by: Catherine | Jul 14, 2011 1:20:32 PM

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Okay, let’s take this step by step:
1) “My mother, when she got sick with ovarian cancer, she had just gotten a new job, and the insurance company was saying, ‘Well, maybe this is a pre-existing condition, so maybe we don’t have to pay your medical bills.’ So I know what it’s like to see a loved one suffer not just because they’re sick, but because of a broken health care system. This is personal for me,” then-candidate Obama said at a March 2008 campaign event in Pennsylvania.

2) n “A Singular Woman: The Untold Story of Barack Obama’s Mother,” former New York Times reporter Janny Scott reveals that, although Obama claims Dunham was denied coverage because of a preexisting condition, she was actually only denied disability coverage.

3) Shortly thereafter, she underwent a total hysterectomy and started a series of six monthly chemotherapy treatments. “In Honolulu, Ann pressed on gamely. According to her correspondence, Barry Barack helped her with insurance forms and letters in the immediate aftermath of her surgery,” Scott writes.

Notice this sentence: According to her correspondence, Barry Barack helped her with insurance forms and letters in the immediate aftermath of her surgery,” Scott writes.

Now, if Obama was helping her with insurance forms and letters, he would have KNOWN that her health insurance was INDEED paying her bills. It was the DISABILITY insurance that was in question. Yet, in the numerous times he repeated this story, he STILL continued to lie. Good grief people, wake up.

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Posted by: Shoe | Jul 14, 2011 1:19:52 PM

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“I remember in the last month of her life, she wasn’t thinking about how to get well, she wasn’t thinking about coming to terms with her own mortality, she was thinking about whether or not insurance was going to cover the medical bills and whether our family would be bankrupt as a consequence,” Obama said in September 2007.

“She was in her hospital room looking at insurance forms because the insurance company said that maybe she had a pre-existing condition and maybe they wouldn’t have to reimburse her for her medical bills,” Obama added in January 2008.

“The insurance companies were saying, ‘Maybe there’s a pre-existing condition and we don’t have to pay your medical bills,’ ” Obama said in a debate with Republican opponent Sen. John McCain in October 2008.

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Posted by: wheresmymoney | Jul 14, 2011 1:07:19 PM

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He never said she did not have health insurance, just that she worried about what the insurance company would do and what they would not pay for.
Posted by: smoochie | Jul 14, 2011 12:54:05 PM

Please re-read the article.

“My mother, when she got sick with ovarian cancer, she had just gotten a new job, and the insurance company was saying, ‘Well, maybe this is a pre-existing condition, so maybe we don’t have to pay your MEDICAL bills.’

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Posted by: wheresmymoney | Jul 14, 2011 1:03:07 PM

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The lies of omission are just as evil as outright lies. BHO has this down pat.

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Posted by: Gunz2fun | Jul 14, 2011 1:03:02 PM

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I’m not at all what you would call a fan of Obama but the disability thing and several hundred dollars a month back in 1995 would have presented a real problem to someone who probably didn’t have much money.

There are plenty of real issues to criticize Obama about. This isn’t one of them.

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Posted by: whatever | Jul 14, 2011 12:59:34 PM

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Obama didn’t say his mother had no health insurance. He said he watched her fight with insurance companies to cover the care she was getting.

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Posted by: Paul Bxton | Jul 14, 2011 12:57:58 PM

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just that she worried about what the insurance company would do and what they would not pay for.
=====

So what do you think was the point of the story? That somehow he could pass a law getting rid of worry?

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Posted by: MayBee | Jul 14, 2011 12:57:15 PM

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My husband died from melanoma. We had health insurance but worried too when the provider was calling us and asking us to let them manage his treatments etc, We worried all the time if they would pay. They were looking to cut costs and I had to fight with the insurance company way after my husband passed. He never said she did not have health insurance, just that she worried about what the insurance company would do and what they would not pay for.

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Posted by: smoochie | Jul 14, 2011 12:54:05 PM

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Just like he misstated that there are 57 states. The guy’s a clod.

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Posted by: Cobralord | Jul 14, 2011 12:54:05 PM

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Just another Obama lie, what’s new!

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Posted by: gunner_1959 | Jul 14, 2011 12:53:53 PM

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“The hospital billed her insurance company directly, leaving Ann to pay only the deductible and any uncovered expenses, which, she said, came to SEVERAL HUNDRED DOLLARS A MONTH.”

Living expenses are talked about separately.

This clearly states ALL of her medical expenses were NOT covered.

It says

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Posted by: Travis | Jul 14, 2011 12:52:47 PM

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“Clearly, all of her medical expenses were not covered. That’s exactly what it says. You’re being picky, so be precise.”

Compare:

“My mother, when she got sick with ovarian cancer, she had just gotten a new job, and the insurance company was saying, ‘Well, maybe this is a pre-existing condition, so maybe we don’t have to pay your medical bills.’”

Q.E.D.

President Obama said her mother’s medical bills were not paid *because of* a pre-existing condition, not because of an insurance deductible or uncovered expenses (which still can occur under Obamacare).

Be honest, Travis (or whoever you are).

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Posted by: dave | Jul 14, 2011 12:52:10 PM

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GALLUP: Satisfaction with ‘ways things are going’ drops to 16% as Democrats bail…

Lowest since month after Obama took office…

Kind of feeling sorry for this president now.. everyone is abandoning him except ABC, NBC and CBS

(snickers..not really)

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Posted by: Yep I said that | Jul 14, 2011 12:50:29 PM

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Obama said:
” “I remember in the last month of her life, she wasn’t thinking about how to get well, she wasn’t thinking about coming to terms with her own mortality, she was thinking about whether or not insurance was going to cover the medical bills and whether our family would be bankrupt as a consequence,” Obama said in September 2007.”

His family could not have been bankrupt as a consequence. Another lie/fabrication/misstatement.

Any unpaid bills would have gone against her estate, but her adult children were in no way responsible for them.

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Posted by: MayBee | Jul 14, 2011 12:50:01 PM

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Gay GOP Candidate Calls Bachmann A Liar, ‘Hypocrite And Bigot’

Big fun in Republican country. Judgementals in action.

Zane, please stay with the subject. Not sure if you’re a liberal but it’s so like them to change subject when they can’t defend.

Posted by: Dianne93101 | Jul 14, 2011 12:42:52 PM

This is a free country Dianne, I’ll talk about whatever I choose.

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Posted by: Zane | Jul 14, 2011 12:48:24 PM

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..come on, kids, read the damned article. She had medical coverage, the insurer paid bills based on her medical problem. The disability coverage insurer refused to pay for the stated reason…..man, you kids should read your own coverage. Obama did lie during the campaign….you know, like his effort yesterday to threaten that Social Security and other govt. benefit checks wouldn’t/couldn’t be paid unless his johnny-come-lately “big thinking” handling of the deficit problem was considered. His last “big thinking” idea, Obamacare, unless re-worked, will cost us all big bucks. The man is in over his head…….we want a leader, not a demagogue….for those of you who couldn’t pass the test on the Obama’s mom’s insurance coverage, demagogue should be fairly clear to you if you look in up in the dictionary.

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Posted by: justj joey | Jul 14, 2011 12:46:45 PM

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I’d take a hundred palin’s to one obama anyday.

Posted by: Wayne | Jul 14, 2011 12:43:43 PM

Very scary to even hear you say that. Then again, just because you’re an American doesn’t mean you’re necessarily smart.

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Posted by: Art | Jul 14, 2011 12:46:45 PM

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Travis- disability insurance is not healthcare insurance. Obamacare doesn’t even address disability insurance.

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Posted by: MayBee | Jul 14, 2011 12:45:57 PM

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And to think that we were told not to vote for palin because she was an idiot. I’d take a hundred palin’s to one obama anyday. Can’t do any worse, and that is a FACT.

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Posted by: Wayne | Jul 14, 2011 12:43:43 PM

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“The hospital billed her insurance company directly, leaving Ann to pay only the deductible and any uncovered expenses, which, she said, came to SEVERAL HUNDRED DOLLARS A MONTH. To cover those charges AS WELL AS living expenses, she filed a separate claim”

Posted by: Travis | Jul 14, 2011 12:36:06 PM

Why did you make a cut off mid sentence? Because it clearly states DISABILITY INSURANCE?

“under her employer’s DISABILITY insurance policy. That policy, however, contain a clause allowing the company to deny any claim related to a preexisting medical condition,” Scott explains.”

She stated she turned the matter over to her attorney son.

Obama lied to the country.

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Posted by: wheresmymoney | Jul 14, 2011 12:42:17 PM

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Travis- Cigna was not her medical insurance provider. Her medical bills were paid.
____________________________

“The hospital billed her insurance company directly, leaving Ann to pay only the deductible and any uncovered expenses, which, she said, came to SEVERAL HUNDRED DOLLARS A MONTH. To cover those charges AS WELL AS living expenses, she filed a separate claim”

Clearly, all of her medical expenses were not covered. That’s exactly what it says. You’re being picky, so be precise.

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Posted by: Travis | Jul 14, 2011 12:36:06 PM

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And this was THE guy that was supposed to be so smart that people fainted in his presence. That he was bringing this new change of hope to Washington. This new “superman” way of cleaning up and never lying. Offering all this never-seen-before transparency.

We were duped.

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Posted by: Wayne | Jul 14, 2011 12:34:39 PM

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Why tell the truth when a lie works so much better.
One term and gone!

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Posted by: Po Cho | Jul 14, 2011 12:34:34 PM

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Gay GOP Candidate Calls Bachmann A Liar, ‘Hypocrite And Bigot’

Big fun in Republican country. Judgementals in action.

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Posted by: Zane | Jul 14, 2011 12:31:30 PM

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Travis- Cigna was not her medical insurance provider. Her medical bills were paid.
Mary Bruce did not make clear that Cigna was the disability insurance provider.

Obama’s mother was not denied treatment nor payment for her treatment.

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Posted by: MayBee | Jul 14, 2011 12:30:48 PM

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Posted by: Travis | Jul 14, 2011 12:14:49 PM

If it is too hard for you to read the entire article, at least read the paragraph BEFORE the one you copied and pasted. It CLEARLY says she was filing a claim for DISABILITY.

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Posted by: wheresmymoney | Jul 14, 2011 12:29:48 PM

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Chicago politicians our all like this.
you only get the part of the story that works for them. ABC you grew a set today publishing this story, just maybe, maybe
you are realizing now about who is going
down and how hard. Better to be on the other side of this mess.

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Posted by: deadwrestler | Jul 14, 2011 12:28:36 PM

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Liar Liar pants on fire !!

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Posted by: agnes | Jul 14, 2011 12:18:17 PM

1fd76 corner top left Obama Misstated Story About Mothers Health Care, New Book Says1fd76 corner top right Obama Misstated Story About Mothers Health Care, New Book Says

“CIGNA, Dunham’s insurer, investigated whether her cancer was a pre-existing condition and later denied her claim based on an earlier visit to a gynecologist. “

Sound pretty straight forward to me. Still, the haters will feast, it’s like a vampire addiction for them.

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Posted by: Travis | Jul 14, 2011 12:14:49 PM

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This clown President is a living lie!

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Posted by: Cav16 | Jul 14, 2011 12:11:23 PM

1fd76 corner top left Obama Misstated Story About Mothers Health Care, New Book Says1fd76 corner top right Obama Misstated Story About Mothers Health Care, New Book Says

“CIGNA, Dunham’s insurer, investigated whether her cancer was a pre-existing condition and later denied her claim based on an earlier visit to a gynecologist. “

This is pure semantics. The president spoke honestly about something deeply personal. Sad to see such venom and hatred spewed so easily, over nothing.
Posted by: Joe Brown | Jul 14, 2011 12:01:18 PM

No Joe, he didn’t speak honestly. His words were:

‘Well, maybe this is a pre-existing condition, so maybe we don’t have to pay your medical bills.’

The medical bills were NEVER denied. Only disability from her company.

Pointing out that the president lied is not venom and hatred.

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Posted by: wheresmymoney | Jul 14, 2011 12:11:20 PM

1fd76 corner top left Obama Misstated Story About Mothers Health Care, New Book Says1fd76 corner top right Obama Misstated Story About Mothers Health Care, New Book Says

It was a wonderful and inspiring piece of campaign rhetoric.

Why let facts get in the way?

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Posted by: Oliver Shagnasty | Jul 14, 2011 12:05:27 PM

1fd76 corner top left Obama Misstated Story About Mothers Health Care, New Book Says1fd76 corner top right Obama Misstated Story About Mothers Health Care, New Book Says

“CIGNA, Dunham’s insurer, investigated whether her cancer was a pre-existing condition and later denied her claim based on an earlier visit to a gynecologist. “

This is pure semantics. The president spoke honestly about something deeply personal. Sad to see such venom and hatred spewed so easily, over nothing.

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Posted by: Joe Brown | Jul 14, 2011 12:01:18 PM

1fd76 corner top left Obama Misstated Story About Mothers Health Care, New Book Says1fd76 corner top right Obama Misstated Story About Mothers Health Care, New Book Says

He either lied, didn’t understand insurance, or didn’t pay any attention to her request for him to help her.

Those are the options.
And this is the guy who spearheaded our big health insurance overhaul. Distressing.

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Posted by: MayBee | Jul 14, 2011 11:59:13 AM

1fd76 corner top left Obama Misstated Story About Mothers Health Care, New Book Says1fd76 corner top right Obama Misstated Story About Mothers Health Care, New Book Says

Not an outright lie (well you can’t get any closer without it being a lie) just an exaggeration of the facts…….much like the man himself.

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Posted by: curmudgeon man | Jul 14, 2011 11:57:27 AM

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misstated? How about LIED??

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Posted by: Dianne93101 | Jul 14, 2011 11:55:33 AM

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You just can’t bring yourself to say the LIED, can you Mary? Mistated? The media covers again.

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Posted by: wheresmymoney | Jul 14, 2011 11:53:02 AM

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The Debt Ceiling and Health Care as a Right

Juxtaposing the present negotiations on the debt ceiling with health care as a right displays a fecundity of thought that may well assist in the presently ongoing divide between slashing entitlements and raising revenues. Here’s how.

About three years ago now, I published that health care should be a right for all Americans (though I am sure I am not the first one to say this). Teddy Kennedy at the 2008 Democratic convention echoed the same thought. Back on the campaign trail in Nashville in October 2008, Obama and McCain were asked how each viewed health care — as a right, privilege or responsibility. Obama was clear: health care is a right. Since then, many of those in Congress have mouthed the same words.

When I wrote about health care being a right, I was not referring to anything in the country’s founding documents, though it being enveloped in the concept of the right to life, liberty and the pursuit of happiness does come to mind. After all, without our health we cannot do anything; we cannot be productive to ourselves, our families, our communities, even to our employers or to the nation in a global sense. Health care is unique in the sense that we all have it, and it is just as important to any one American as it is to the next. The passage in March 2010 of what has become known as “Obamacare” was a step in the right direction to satisfy this goal, but this law only addresses accessibility to the health care marketplace, not affordability to health care by all. Now, of course, the mandate feature of that act (where everyone must purchase health insurance) is being challenged legally and will arrive in the Supreme Court some day quite soon. The mandate was never Obama’s first choice — he wanted a public option, but the health and insurance industry wanted the mandate to pay for what the law provides that was never provided for before, so to get his health care bill into law, he needed to do some good old fashioned horse-trading.

Those who require health care include the nation’s seniors. Medicare is the governmental program started in 1965 to do just that. Without Medicare, millions of those 65 and older would not be able to afford health care. Now, though, it seems that those who oppose Obama want to start “slicing and dicing” Medicare as part of cutting the cost of entitlement programs before any debt ceiling is raised.

To be sure, in order to slash the budget, much will have to be done, and every sector of the economy will feel some pain — from those who rely on a defense department budget for a living to those who do not want any more oil drilling to those making zillions of bucks and everything in between. To be fair, social entitlements are part of this mix. But withdrawing, downsizing or eliminating benefits for our older population that requires them to stay healthy is anathema to our belief that health care for all Americans should be a right. The right to be and stay healthy for anyone 65 and over is just as critically important as the health care benefits anyone in Congress has access to who votes shortly on the debt ceiling. To think or do otherwise by anyone in Congress is incredulous, and is to not recognize the forest for the trees. To those in Congress, your arrogance will show if you think your health and ability to maintain it is more important than the health of the senior population who put you into office.

But if the barber’s shears are taken to Medicare in even an inconsequential way, then why not now consider inserting into Obamacare the public option, or something quite akin to it? No, I do not speak of having the government run an insurance company to compete with the private market; only having it provide seed money to an entity that will become self-sustaining in the years to come and that will provide true competition to those companies offering health care insurance to cover all Americans — including our senior population. True competition lowers the cost of any product, including health insurance. In this way, while there might be some trimming to Medicare as part of the present debt reduction negotiations, at least seniors (and all of us) will know that an alternative would be available with a public option that in years to come will not use any taxpayer money to fund or run it.

Juxtaposing health care as a right and the debt ceiling is not such a bad idea after all.

Report: Health insurers owe Fla. $3 million

 Report: Health insurers owe Fla. $3 million

Private health insurers overstated how much they spent on patient care and owe Florida health officials $3.1 million in refunds for a government children’s health care program, according to a recent federal report.

Under a joint state-federal program called the State Children’s Health Insurance Program, Florida’s Agency for Health Care Administration pays private insurers to provide health insurance for families who aren’t eligible for Medicaid but can’t afford private insurance. Insurance companies are required to spend at least 85 percent on medical services. If an insurer spends less, it must refund 50 percent of the shortfall to the state.

But between 2003 and 2007, eight of roughly two dozen reports from private health insurers inaccurately reported how much was spent on patient costs and avoided paying state and federal health officials the difference, according to a report by the Department of Health and Human Services’ inspector general. Florida health officials should have received $3.1 million in refunds during that time. The report recommends the state repay the federal government its share — $2 million — and increase oversight going forward.

The inspector general report blamed the mistakes on the state’s lax oversight, saying the state agency and its contractor, Florida Healthy Kids Corporation, lacked policies requiring staff to review reports and “reconcile them to supporting records.”

The findings were sent to HHS authorities for “any action deemed necessary,” according to the report.

Florida Healthy Kids Corporation, which oversees the insurance program for the state, said in a May letter to federal health officials it had recouped the bulk of the funds from the insurers and returned most of the $2 million federal share to the state.

AHCA told The Associated Press it had repaid federal health officials all but $25,000 and was in the process of returning the last chunk. A spokeswoman also said Florida Healthy Kids Corporation had improved oversight, but declined to elaborate.

The report comes a month after Gov. Rick Scott signed a law putting the state’s nearly 3 million Medicaid patients into the hands of private health companies. Patients and doctors complained they couldn’t get appointments and were denied medications during a problematic pilot program in five counties.

The latest oversight has critics questioning whether AHCA is equipped to ensure for-profit companies are not lining their pockets with state funds instead of spending it on patient care.

“The job of government is to oversee services that the private sector cannot provide, not to enable private companies to run to the bank with a quarter of the taxpayers’ money,” said Rep. Elaine Schwartz, a Democrat from Hollywood.

It’s not the first time the children’s health program has had trouble.

Tampa-based WellCare Health Plans Inc. was charged with engaging in an elaborate scheme to defraud the Florida Medicaid program and Florida Healthy Kids Corporation of about $40 million. WellCare avoided criminal prosecution after agreeing to pay $80 million in restitution in 2009.

“AHCA will have its work cut out to monitor the activities of health plans all over the state,” said Laura Goodhue, head of patient advocacy group Florida CHAIN.

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Online: http://www.oig.hhs.gov/oas/reports/region4/41006123.pdf