Ob lub tsev kho mob npaj tsev neeg pab cov poj niam tau nyiaj tsawg tau hais tias lawv cov haujlwm yuav muaj kev pheej hmoo nyiaj txiag loj yog tias cov neeg soj ntsuam hauv lub xeev tau lees paub tias lawv tau them nyiaj ntau dhau Medicaid los ntawm $ 3.5 lab, feem ntau yog rau cov tshuaj tiv thaiv kev yug menyuam thiab cov khoom siv.
Beth Hartung, tus thawj tswj hwm ntawm Wisconsin Family Planning and Reproductive Health Association, tau hais tias cov neeg soj ntsuam cov kev taw qhia tseem yuav yuam kom lwm tus kws kho mob hauv tsev neeg hauv tib txoj kev pab Medicaid thov kom them rov qab tus nqi qis dua rau kev tswj kev yug me nyuam - tsis pub ib feem ntawm cov nyiaj uas pab lwm tus. cov kev pab kho mob yug me nyuam lawv muab rau cov neeg tau nyiaj tsawg.
"Kuv txoj kev xav yog tias yog peb ib leeg tau raug tshuaj xyuas nws yuav tawm mus ib yam nkaus. Peb txhua tus ua haujlwm tib yam, "Hartung tau hais. "Nws yuav txhais tau tias, ncaj ncees, tias peb txhua tus yuav kaw."
Tus kws kho mob loj tshaj plaws hauv lub xeev no yog Planned Parenthood of Wisconsin. Tus thawj coj ntawm pej xeem txoj cai Nicole Safar tau hu cov kev tshuaj xyuas "kev kaw tsev kho mob" thiab hais tias nws muaj kev txhawj xeeb tias cov tsev kho mob raug tsom rau kev nom kev tswv.
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Tus Thawj Saib Xyuas Kev Noj Qab Haus Huv General Alan White tiv thaiv nws cov neeg soj ntsuam xaiv cov hom phiaj thiab lawv qhov kev tshawb pom. Txoj kev them nqi tshuaj ntawm qhov teeb meem yog kwv yees li $ 110 lab ib xyoos ntawm $ 7 billion Medicaid pob nyiaj siv.
"Qhov kev tswj hwm no, lub koom haum no tau siv zog ntau rau kev txhim kho kev ncaj ncees, thiab (cov neeg soj ntsuam) ua rau nws mob siab heev," White hais. "Thiab tiv thaiv cov neeg them se ntawm Wisconsin yog lawv lub luag haujlwm tseem ceeb."
Hauv kev tshawb pom ua ntej tshaj tawm rau cov tsis muaj txiaj ntsig thaum Lub Yim Hli, Lub Chaw Haujlwm Saib Xyuas Kev Tshawb Fawb General tau sau tias Family Planning Health Services Inc. overbilled Medicaid los ntawm $ 2.3 lab, thiab NEWCAP Inc. los ntawm $ 1.2 lab, txij xyoo 2010 txog 2011.
Wausau-based FPHS pab txog 6,000 tus neeg hauv ib xyoos hauv cuaj lub nroog. Oconto-based NEWCAP Inc.'s Community Health Services division xyoo tas los tau pab txog 3,500 tus neeg hauv rau lub nroog. Tsis yog lub koom haum muab kev rho menyuam tawm. Ob leeg ua haujlwm nyob rau hauv cov cheeb tsam uas raug xaiv kom muaj kev tsis txaus ntawm cov kws kho mob.
FPHS thiab NEWCAP tau teb thiab tos kom hnov los ntawm OIG. Yog tias lub chaw haujlwm xa daim ntawv ceeb toom xav kom rov qab tau nyiaj, cov pab pawg tuaj yeem thov rov hais dua.
Cov kws tshuaj ntsuam xyuas tau nyuaj rau cov nqi them rov qab rau kev tiv thaiv qhov ncauj uas cov kws kho mob hais tias lub xeev nws tus kheej tau teeb tsa thiab yog qhov lawv cov phooj ywg siv.
Lub xeev tseem tab tom thov nyiaj vim tias cov chaw muab kev pabcuam nkag mus thov tsis raug. Nws hais tias cov kws kho mob tsis tau sau cov nqi them rau cov tshuaj. Tab sis cov neeg muab kev pabcuam hais tias lub xeev tus kheej cov ntaub ntawv thov nkag nkag tsis suav nrog txoj hauv kev nkag mus rau tus nqi.
Cov ntaub ntawv hais txog qhov chaw kho mob siv Medicaid's 340B kev pab them nqi tshuaj, nyob rau hauv uas cov tuam txhab tshuaj yuav tsum tau muab cov tshuaj txo nqi rau cov chaw muab kev nyab xeeb.
Rau cov kws kho mob hauv tsev neeg, tsoomfwv tau them 90 feem pua ntawm cov nqi tshuaj, thaum lub xeev them 10 feem pua.
Qhov kev puas tsuaj ntawd kuj txhais tau hais tias lub xeev sawv rov qab los kuj tsawg. Tab sis Dawb hais tias tsis yog lub ntsiab lus; nws lub chaw haujlwm tau tshawb xyuas cov xwm txheej uas tsis muaj nyiaj hauv lub xeev koom nrog.
Nws tau hais tias "Peb yuav tsum tiv thaiv ob lub xeev cov neeg them se thiab tsoomfwv cov neeg them se," nws hais.
Safar tau hais tias Planned Parenthood sau nqi tib yam uas NEWCAP thiab FPHS raug them ua - tab sis rau ntau tus neeg siv khoom, thiab yog li ntawd nyiaj ntau dua. Planned Parenthood hais rau lub tuam tsev hais tias nws tau them nqi li cas hauv kev tshawb fawb xyoo 2011 tab sis tsis tau raug tshuaj xyuas.
Safar tau hais tias "Kev tshuaj xyuas tsis yog txoj hauv kev los hloov pauv li cas peb tau them nqi," Safar hais. "Qhov no yog txoj hauv kev hauv qab-radar los thaiv kev nkag mus rau kev tswj hwm kev yug menyuam."
Dawb raug nug seb qhov kev tshuaj xyuas ntawm cov pab pawg tshwj xeeb puas tsim nyog yog tias lub tuam tsev paub txog kev siv nyiaj siv los ntawm NEWCAP thiab FPHS tau nthuav dav hauv cov tsev kho mob npaj tsev neeg - lossis seb nws puas yog lub cim qhia tias lub tuam tsev saib xyuas kev noj qab haus huv yuav tsum qhia meej nws cov cai.
White tau hais tias "Qhov ntawd yuav tsis nyob hauv thaj tsam ntawm qhov chaw ua haujlwm no ua," White hais.
Lawmakers txhawj nws yog politic
Ob tus neeg tsim cai lij choj ywj pheej, Rep. Chris Taylor ntawm Madison thiab Sen. Dave Hansen ntawm Green Bay, tau sau OIG thaum Lub Kaum Hli 27 hais tias "zoo li tsis muaj kev cai lij choj" rau cov lus thov.
Lawv tau hais kom lub chaw ua haujlwm tsim cov npe qhib kev tshawb xyuas los ua pov thawj tias nws tsis yog qhov cuam tshuam rau cov neeg muab kev pabcuam lossis cov neeg ua haujlwm los ntawm cov poj niam.
Dawb yuav tsis teb li cas NEWCAP thiab FPHS tshwj xeeb raug xaiv rau kev tshuaj xyuas tab sis tsis lees paub tias nws tsis yog nom tswv. Tsis muaj kev tsis txaus siab ntawm kev dag ntxias tawm tsam NEWCAP lossis FPHS, lossis thov tias lawv tsis tau muab kev tiv thaiv kev yug menyuam.
DHS tau muab cov ntaub ntawv qhia tias lub chaw ua haujlwm 3,950 qhib kev tshuaj xyuas, tsuas yog ob qho no koom nrog tsev kho mob npaj tsev neeg siv 340B cov nqi tshuaj. Peb caug kev ntsuam xyuas kev npaj tsev neeg tau ua tiav - tsawg dua 1 feem pua ntawm tag nrho, lub tuam tsev tau sib cav, thiab feem ntau yog tsoomfwv xav tau.
White hais tias "Tsis muaj ib qho xwm txheej twg yuav lub chaw haujlwm no yuav tshuaj xyuas qhov tsis txaus ntseeg ntawm cov neeg muab kev pabcuam rau cov poj niam," White hais.
Taylor, yav dhau los tus thawj coj ntawm pej xeem txoj cai ntawm Planned Parenthood of Wisconsin, tau hais tias nws xav tsis thoob vim Gov. Scott Walker cov thawj coj thiab Republican-tswj txoj cai lij choj tau "ua phem rau kev tswj hwm kev yug menyuam."
Tsib Lub Tsev Kho Mob Npaj Niam Txiv raug kaw tom qab Pawg Neeg Saib Xyuas Kev Cai txiav nyiaj txiag rau lub koom haum, kev txav mus los dav qhuas los ntawm pro-life advocates.
Cov thawj coj ntawm Walker kuj tseem cuam tshuam lub xeev Family Planning Council, uas nyob rau hauv Doyle cov thawj coj yog qhov chaw rau cov neeg ua haujlwm thiab cov neeg muab kev pabcuam los qhia cov ntaub ntawv.
Nrog rau lub Kaum Ib Hlis 4 hnub kev xaiv tsa tam sim ntawd, Planned Parenthood tau xa cov neeg xaiv tsa ob nplooj ntawv glossy mailer emblazoned nrog ib lub pob ntim tshuaj tiv thaiv qhov ncauj hauv qab lub npe, "SCOTT WALKER: EXTREME ON BIRTH CONTROL THIAB ABORTION."
Nug kom tawm tswv yim txog tus cwj pwm hnyav ntawm Walker, Laurel Patrick, tus tswv xeev tus xov xwm tus tuav ntaub ntawv, teb tias:
"Ntawm tag nrho cov ntsiab lus tseem ceeb, DHS tau muab cov ntaub ntawv hais txog qhov teeb meem no ntsig txog kev soj ntsuam raws li ib feem ntawm nws cov nqi los tiv thaiv Wisconsin cov neeg them se, uas them se tseem fwv thiab xeev, los ntawm kev siv tsis raug lossis yuam kev hauv kev xyaum rau cov kev pab cuam pej xeem xws li Medicaid. , FoodShare, FamilyCare thiab lwm yam kev pab cuam. "
Walker beefed mus soj ntsuam
Cov kev tshuaj xyuas los ntawm ib lub koom haum tub ceev xwm uas tau nthuav dav heev nyob rau hauv Walker, uas tau nquag hais tias uas tshem tawm pov tseg, kev dag ntxias thiab kev tsim txom yog qhov tseem ceeb.
Tom qab lub xeev Legislative Audit Bureau thiab Milwaukee Journal Sentinel tau tshaj tawm kev saib xyuas tsis txaus thiab kev dag nyob rau hauv qhov kev pab cuam FoodShare, Walker tau tshaj tawm qhov qub Medicaid qhov kev pabcuam kev ncaj ncees, hloov nws lub npe rau Chaw Haujlwm Saib Xyuas Kev Ruaj Ntseg thiab tau tshaj tawm ncaj qha rau DHS tus tuav ntaub ntawv.
Dawb, uas yog tus thawj coj ntawm chav kuaj xyuas qub, raug ntiav los khiav OIG tshiab. Lub chaw haujlwm tam sim no muaj 110 txoj haujlwm ua haujlwm puv sijhawm.
Txhim khu kev tiv thaiv kev dag ntxias yog ib qho ntawm yim sab saum toj tseem ceeb rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv, thiab kev tshawb nrhiav kev them nyiaj ntau dhau yog qhov ntsuas tseem ceeb. OIG qhov tseeb tshaj tawm cov txheeb cais ntawm FoodShare thiab Medicaid kev tiv thaiv kev dag ntxias hais tias lub chaw ua haujlwm tau txheeb xyuas $ 5.3 lab nyiaj khaws cia hauv xyoo dhau los.
Cov kws kho mob sib cav tias cov kev pab cuam npaj tsev neeg yog kev nqis peev zoo hauv lawv tus kheej txoj cai. Safar suav cov lej los ntawm Guttmacher lub koom haum, ib pawg neeg tawm tswv yim txog kev sib deev thiab kev noj qab haus huv, hais tias rau txhua $ 1 tsoomfwv siv rau kev npaj tsev neeg, nws txuag tau $ 7 los ntawm kev txo qis kev xeeb tub thiab kev sib kis ntawm kev sib deev.
Qhov teeb meem: Tus nqi ntawm kev yug menyuam
Cov neeg soj ntsuam tau ua txhaum rau cov chaw muab kev pab vim tsis sau nqi Medicaid rau tus nqi tiag tiag ntawm txhua pob tshuaj tiv thaiv qhov ncauj, ntxiv rau tus nqi xa khoom.
Cov tsev kho mob npaj tsev neeg tswj xyuas tias kev tswj kev yug me nyuam yuav tsum tau them nqi sib txawv.
Molly Fuller, CEO ntawm FPHS tau hais tias "Nws tau raug luam tawm, nws tau hais qhia, nws tau nkag siab ntau xyoo," "Nws tsuas yog tam sim no nyob rau hauv qhov kev tshuaj xyuas no uas muaj cov txheej txheem sib txawv."
Lawv hais tias lub xeev yeej tsis tau hais kom lawv taug qab cov nqi no ib tus zuj zus, thiab hais kom lawv them nqi rau txhua lub hlis ntawm cov tshuaj tiv thaiv kev yug menyuam ntawm "ib txwm thiab kev coj ua raws li tus nqi siab tshaj plaws," uas lub xeev tau teeb tsa ntawm $ 26.02 hauv 2009 thiab sib txuas lus los ntawm nws ForwardHealth Update, ib tsab ntawv xov xwm.
Tus nqi ntawm lub sijhawm tau muab piv rau cov uas nyob sib ze.
Diane Welsh, tus kws lij choj yav dhau los rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv uas sawv cev rau NEWCAP thiab FPHS, tsis kam tawm tswv yim rau tsab xov xwm no. Tab sis cov neeg muab kev pabcuam tau muab cov ntawv luam tawm ntawm nws cov ntawv xov xwm nrog OIG sawv cev rau lawv.
Ua ntej xyoo 2010, Welsh tau sau tseg, Pawg Saib Xyuas Kev Npaj Tsev Neeg thiab cov neeg ua haujlwm hauv xeev tau sib tham txog kev teeb tsa tus nqi them rau kev tswj kev yug menyuam. Welsh nyob rau pawg sab laj.
Tus nqi yuav tsum siab dua li ib txwm rau cov kws muag tshuaj, vim tias kev tso tshuaj tiv thaiv kev yug menyuam yog ntau dua li tsuas yog muab qee cov tshuaj. Cov kws kho mob yuav tsum coj cov neeg mob cov ntaub ntawv kho mob tag nrho thiab txheeb xyuas cov kev xaiv tshuaj tiv thaiv zoo tshaj plaws. Rau cov khoom siv hauv tsev menyuam, cov kws saib xyuas neeg mob lossis kws kho mob yuav tsum raug cob qhia thiab muaj ntawv tso cai. Nyob rau hauv luv luv, kev sib cuam tshuam zoo li mus ntsib kws kho mob lub chaw ua hauj lwm tshaj ib tug mus rau lub tsev muag tshuaj.
Tab sis cov thiab lwm yam kev pabcuam hauv cov tsev kho mob tsis tau them rov qab los ntawm Medicaid, yog li qhov nyiaj rov qab ntau dua rau kev tswj kev yug menyuam pab lawv kom tsis txhob poob nyiaj, raws li Jennifer Waloway, NEWCAP tus thawj coj ntawm cov kev pabcuam kev noj qab haus huv hauv zej zog.
Welsh tau sau tias "kev cuam tshuam kev nom kev tswv" ntawm kev teeb tsa tus nqi xa khoom siab dua li cov kws muag tshuaj tau txais, thiab "lub nra hnyav ntawm cov chaw kho mob me kom tsim tau zoo thiab saib xyuas tus nqi tiag tiag ntawm txhua yam khoom" yog qhov tseem ceeb. Lub xeev txiav txim siab tsis teeb tus nqi raws li tus nqi ntxiv rau tus nqi.
OIG's White sib cav hais tias lub xeev tsab ntawv xov xwm tsis siv rau 340B cov nqi siv tshuaj - nws tau raug coj mus rau "cov chaw kho mob npaj tsev neeg" - thiab yog li tsis cuam tshuam. Yuav luag txhua lub tsev kho mob npaj tsev neeg tau tso npe rau hauv 340B txoj haujlwm.
Nws tau hais tias "Peb tseem tsis muaj ntaub ntawv qhia tias lawv tuaj yeem sau nqi txawv dua li tus nqi tau los tiag," nws hais.
Nws kuj tau hais tias hauv kev tshuaj xyuas tsis sib xws, lwm lub koom haum tau ua pov thawj rau OIG qhov kev txaus siab tias lawv cov nqi tshaj cov nqi xa tawm.
Nws tau hais tias "Peb yuav saib tus nqi xa khoom tsim nyog," nws hais. "Yog tias lawv xav tuaj rau peb thiab sib tham txog qhov ntawd, qhov ntawd yog lawv qhov kev txiav txim siab."
Waloway tau hais tias ib sab ntawm $ 1.2 lab, NEWCAP tej zaum yuav tau kaw nws lub tsev kho mob npaj tsev neeg yog tias nws yuav tsum tau them nqi raws li tus neeg soj ntsuam txoj kev.
"Kuv tsis nkag siab tias lawv tuaj yeem cia siab tias leej twg yuav muaj kev vam meej hauv kev lag luam thaum txhua yam koj tuaj yeem them yog tus nqi tau. Tsis muaj leej twg tuaj yeem ua lag luam zoo li ntawd, "Waloway hais. "Peb tuaj yeem tau txais cov neeg tuaj yeem pab dawb, tab sis koj tsis tuaj yeem khiav txhua yam los ntawm kev tuaj yeem pab dawb."
$26.02: Puas yog ntau?
Tus nqi them rau cov kws kho mob hauv tsev neeg tau them Medicaid feem ntau yog qis dua qhov nyiaj them rov qab ntau tshaj plaws hauv khw muag tshuaj tuaj yeem them cov kev pab cuam rau tib cov tshuaj.
Waloway hais ib qho piv txwv. Ib hlis tus nqi ntawm Yaz, ib qho tshuaj tiv thaiv qhov ncauj nrov, raug nqi nws lub tsev kho mob $ 12.61 tam sim no; Raws li tus kws kho mob 340B, nws tuaj yeem them Medicaid $26.02. Lub tsev muag tshuaj yuav tau yuav lub pob ntawm tus nqi siab dua, yog li nws tuaj yeem them Medicaid qhov siab kawg ntawm $ 124.88.
Cov khw muag tshuaj tuaj yeem them Medicaid $49.28 rau ib pob ntawm cov tshuaj noj qis, Lutera. NEWCAP yuav lawv ntawm $13.00 wholesale rau ib lub hlis twg, thiab tsub nqi Medicaid $26.02.
Cov nqi yuav mus qhov twg?
Lub xeev tau hais tias cov tsev kho mob yuav tsum tau nkag mus rau tus nqi tiag tiag ntawm txhua cov tshuaj rau txhua qhov kev thov. Tab sis cov neeg zov me nyuam tawm tsam tias tsis muaj qhov chaw ua li ntawd hauv lub xeev tus kheej lub computer.
Tom qab kev tshuaj xyuas pib, tus neeg ua haujlwm tshiab tau ntiav NEWCAP cov peev nyiaj tau hu xov tooj rau lub xeev lub xov tooj kub rau cov chaw kho mob Medicaid thiab nug seb yuav sau tus nqi li cas kom raug.
Cov neeg ua haujlwm hauv xov tooj kub tau hais rau nws tias tsis muaj txoj hauv kev nkag mus rau nws, raws li NEWCAP's Waloway.
Dawb tau hais tias nws tau raug qhia tias tsis yog daim ntawv lossis hluav taws xob them nqi hluav taws xob tau "tso" nyob rau hauv yuav ua li cas cov nqi nkag, tab sis hais tias, "Kuv yuav tsis tuaj yeem muab cov lus teb raug rau koj tam sim no."
Proportionality ntawm kev soj ntsuam tiv thaiv
Cov neeg tshawb xyuas tab tom nrhiav qee cov nyiaj rov qab los ntawm qhov tseem ceeb ntawm kev ua txhaum cov ntaub ntawv: ploj lawm National Drug Codes.
NDCs yog siv los txiav txim cov nyiaj rov qab uas cov tuam txhab tshuaj yuav tsum them rau Medicaid. Tab sis nyob rau hauv qhov kev pab cuam 340B, vim hais tias cov tshuaj twb tau luv nqi, tsis them rov qab.
Lub xeev txawm li cas los xij xav kom muaj cai rau cov tshuaj uas muab tshuaj.
Cov kws kho mob tau nug seb nws puas ncaj ncees rau cov neeg soj ntsuam kom rov ua dua tag nrho cov lus thov rau qhov yuam kev no.
Dawb hais tias tsoomfwv thiab lub xeev txoj cai lij choj xav tau nws.
"Peb lub luag haujlwm yog nrhiav kev rov qab los," nws hais.
Txoj hauv kev rau kev tshuaj xyuas ntawd ntshai NEWCAP tawm ntawm kev nthuav dav nws cov kev pabcuam kev nyab xeeb xyoo no, Waloway tau hais.
NEWCAP vam tias yuav pib muab kev sib koom tes saib xyuas ua ntej yug menyuam rau cov poj niam uas tau nyiaj tsawg hauv Oconto County. Medicaid them nyiaj rov qab rau tsev kho mob ib pob nyiaj rau cev xeeb tub, txawm tias lawv muab kev pabcuam dab tsi.
Tom qab ntawd Waloway tau kawm tias lwm lub koom haum hauv zej zog tau raug tshuaj xyuas rau nws txoj kev saib xyuas ua ntej yug menyuam - thiab yuav tsum tau rov qab tag nrho cov nyiaj rau cev xeeb tub uas lawv cov ntaub ntawv tsis zoo. NEWCAP muab nws cov phiaj xwm tuav tseg.
"Kev them rov qab tam sim no tsawg heev los pib nrog, tab sis yog tias lawv yuav rov qab tag nrho cov nyiaj nws yuav tsis tsim nyog," nws hais.
Zaj dab neeg no tau raug kho vim yog cov ntaub ntawv tshiab muab los ntawm ib lub hauv paus. Tus nqi rau ib hlis tus nqi ntawm Yaz thiab Lutera, ob hom kev tiv thaiv qhov ncauj, yog $12.61 thiab $13.00, tsis yog $4.46 thiab $1.76, raws li Jennifer Waloway ntawm NEWCAP.
Cov nonprofit Wisconsin Center rau Kev Tshawb Xyuas Xov Xwm (www.WisconsinWatch.org) koom tes nrog Wisconsin Cov Xov Xwm Zej Tsoom, Wisconsin Cov Xov Xwm Rau Pej Xeem, lwm cov xov xwm tshaj tawm thiab UW-Madison Tsev Kawm Ntawv Xov Xwm thiab Kev Sib Txuas Lus. Txhua yam haujlwm tsim, tshaj tawm, tshaj tawm lossis tshaj tawm los ntawm Lub Chaw tsis tas yuav cuam tshuam cov kev xav lossis kev xav ntawm UW-Madison lossis ib qho ntawm cov koom tes.
Rov luam tawm peb cov ntawv dawb, hauv online lossis luam tawm, raws li daim ntawv tso cai Creative Commons.
Cov tsev kho mob no tab tom yuav tshuaj ntawm $1.76 thiab $4.46 ib hlis twg. Lawv tab tom thov nyiaj rov qab los ntawm tsoomfwv ntawm $ 26.02 ib hlis twg. Thiab lawv tsis xav tias yog overbilling tsoom fwv?
Nyob zoo? Puas muaj leej twg paub ua lej?