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Associated Press

Florida unit investigating Medicaid fraud gets high marks

 Florida is among one of the nation’s top states in recovering money from health care providers suspected of Medicaid fraud.

Data released earlier this month by the federal government shows that Florida’s Medicaid Fraud Control Unit recovered more than $165 million during the 2016 federal fiscal year.

That placed Florida second behind the state of New York. Florida was 11th overall in the nation in the amount of convictions won by its Medicaid Fraud Control Unit, according to information compiled by the federal government.

The state’s Medicaid Fraud Control Unit reports to Attorney General Pam Bondi but the costs are split between the state and federal government.

Federal authorities have called Florida, especially South Florida, one of the “hot spots for health care fraud” in the nation.

Trump admin’s contract notices call for 30-foot-high wall at Mexican border

The Trump administration wants to build a 30-foot-high border wall that looks good from the north side and is difficult to climb or cut through, according to a pair of contract notices posted to a government website further detailing President Donald Trump’s promise to build a “big, beautiful wall” at the Mexican border.

The notices were made public late Friday by Customs and Border Protection, the Homeland Security Department agency that will oversee the project and eventually patrol and maintain the wall. The proposals are due to the government by March 29.

One of the CBP contract requests calls for a solid concrete wall, while the other asks for proposals for a see-through structure. Both require the wall to sunk at least six feet into the ground and include 25- and 50-foot automated gates for pedestrians and vehicles. The proposed wall must also be built in a such a way that it would take at least an hour to cut through it with a “sledgehammer, car jack, pick axe, chisel, battery operated impact tools, battery operated cutting tools, Oxy/acetylene torch or other similar hand-held tools.”

The government will award a contract based on 30-foot-wide sample walls that are to be built in San Diego.

This is the latest step in the Trump administration plan to build a border wall. Last month CBP put out a call for “concept papers” to design and build prototypes by March 10.

Trump has bragged in recent days that the wall is ahead of schedule, though it’s unclear from the latest contract notices if any firms have submitted wall proposals or if any such submissions have been rejected.

The government has not said where the wall will be built, though the contract notices suggest some pieces of a new wall could replace existing fencing that stretches over about 700 miles of the roughly 2,000-mile border. The current fencing of mixed construction, including 15-foot steel posts set inches apart that are designed to keep people from crossing and shorter posts that are intended to block cars. Border Patrol agents are constantly repairing holes in the structure.

Trump has long promised that Mexico would pay for the wall, which he has said is necessary to stop the flow of immigrants crossing the border illegally and drug smugglers.

This week the president sent a budget proposal to Congress that included a $2.6 billion down payment for the wall. The total cost for the project is unclear, but the Government Accountability Office estimates it would cost about $6.5 million a mile for fence to keep pedestrians from crossing the border and about $1.8 million a mile for a vehicle barrier.

Congressional Republicans have said Trump’s wall would cost between $12 billion and $15 billion and Trump has suggested $12 billion.

An internal report prepared for Homeland Security Secretary John Kelly estimated the cost of building a wall along the entire U.S.-Mexico border at about $21 billion, according to a U.S. government official who is involved in border issues. The official spoke on condition of anonymity because the report has not been made public.

That report proposed an initial phase that would extend fences 26 miles and a second wave that would add 151 miles, plus 272 “replacement” miles where fences are already installed, according to the official. Those two phases would cost $5 billion.

It is unclear how soon Congress might act on that request or how much money lawmakers will ultimately approve for the wall. Democrats and some Republicans have said a border-long wall is unnecessary.

The Department of Homeland Security reported earlier this month that the number of border arrests dropped about 44 percent from January to February, the lowest monthly tallies since at the least the start of the 2012 budget year.

Aramis Ayala anti-death penalty stand surprises many

The Florida prosecutor who thrust herself into the forefront of the anti-death penalty movement is a political novice who was elected just seven months ago.

Aramis Ayala, a Democrat and former public defender and assistant state attorney, surprised many of her own supporters when she announced this week that her office would no longer seek capital punishment in a state that has one of the largest death rows. In response, the state’s Republican governor promptly transferred a potential death penalty case — the killing of a police officer and a pregnant woman earlier this year — to another Florida prosecutor.

“I understand this is a controversial issue, but what isn’t controversial is the evidence that led me to my decision,” said Ayala, the first black state attorney elected in Florida.

She said there is no evidence that shows the death penalty improves public safety for citizens or law enforcement, and it’s costly and drags on for years for the victims’ families.

Advocates seeking to abolish the death penalty said Ayala sent a powerful message. Her decision reflects decreasing support for capital punishment in the U.S., said Karen Clifton, executive director of the Catholic Mobilizing Network to End the Use of the Death Penalty.

“There are some prosecutors who in practice are following her lead. They just haven’t spoken out like she has,” Clifton said. “It would be wonderful if they spoke out and we could have a louder voice.”

Ayala spent the first decade or so of her career as an assistant state attorney and public defender. She was a prosecutor in the state attorney’s office for Orange and Osceola counties for about two years before she decided to seek the top job. The county is home to Walt Disney World and other tourist attractions and has grown more liberal over the past two decades.

Ayala was a political newcomer last year when she took on her former boss, then-State Attorney Jeff Ashton, who had been one of the prosecutors in the Casey Anthony case. Anthony was acquitted of murder in the death of her 2-year-old daughter, Caylee.

Ayala didn’t run on an anti-death penalty platform when she campaigned, since at the time Florida’s death penalty law was in question after the U.S. Supreme Court declared it unconstitutional. A new death penalty bill was signed into law this week.

She instead emphasized during her campaign that she would engage with average citizens if elected. She acknowledged that her husband had served time in prison for drug conspiracy and counterfeiting checks years ago.

Even some of Ayala’s supporters said Friday they were taken aback by her decision.

Lawson Lamar, a former state attorney and sheriff, who backed her run for office, said: “Anyone who raises their hand and takes the oath to be state attorney must be able to go with the death penalty even if they feel it’s distasteful.”

Ayala’s campaign was helped by a Washington-based political action committee with ties to liberal Hungarian-born U.S. billionaire George Soros. The committee gave Ayala’s campaign almost $1 million, as well as millions of dollars to candidates in local races around the nation.

When asked if the donations influenced her decision, she said it did not.

Florida has 381 inmates on death and shows no sign of slowing down future prosecutions. The other state attorneys in Florida issued a statement Friday saying they would continue to seek the death penalty.

Rafael Zaldivar, whose son was murdered in Orlando in 2012, said Ayala’s decision is part of a political agenda and has no place in the state attorney’s office. He demanded her resignation.

“She is an activist. She isn’t a prosecutor. She has an agenda,” said Zaldivar, whose son’s killer was sentenced to death in 2015. Questions over Florida’s death penalty law have cast doubt over the sentence. His case is currently on appeal.

After Ayala announced her decision, Gov. Rick Scott transferred the case of Markeith Loyd from her authority to another state attorney in a neighboring district. Loyd is charged in the killing of police Lt. Debra Clayton, as well as Sade Dixon, who was Loyd’s pregnant ex-girlfriend.

Dixon’s mother said she supported Ayala’s decision, saying the death penalty would drag out the process for her family.

“I would love for him to die right now, but that isn’t going to happen,” Stephanie Dixon-Daniels said at a news conference outside the Orange County Courthouse.

Ayala’s decision could play into any future political aspirations. In California, then-District Attorney Kamala Harris faced similar circumstances a dozen years ago when she decided not to pursue the death penalty against a man accused of killing a San Francisco police officer. Harris went on to become the state’s attorney general and a U.S. senator.

Prosecutors: No crime in Florida inmate’s hot-shower death

Prosecutors in Florida have found no evidence of a crime in the death of a prison inmate left for nearly two hours in a hot shower, concluding that he died accidentally in part because of undiagnosed heart disease and suffered no burn injuries.

The memo released Friday by the office of Miami-Dade State Attorney Katherine Fernandez Rundle ends a lengthy criminal probe into the 2012 death of 50-year-old Darren Rainey, a mentally troubled man serving a two-year sentence on a cocaine charge.

An attorney for Rainey’s family, Milton Grimes of Los Angeles, said in a statement that the family is “disappointed and heartbroken” no charges will be brought.

“This is not justice for Darren, for his family, nor for the mentally ill who have been subject to similar abuse and mistreatment,” Grimes said.

The investigation found no evidence that officers at the Dade Correctional Institution regularly used the hot shower to punish or torture inmates, as some of them claimed after Rainey’s death. Assistant State Attorneys Kathleen Hoague and Johnette Hardiman said in the 72-page memo that one inmate’s assertions that Rainey was screaming for help and had been scalded to death were unfounded.

“The evidence fails to show that any correctional officer acted in reckless disregard of Rainey’s life,” they wrote.

Rainey was taken to the shower on June 23, 2012, after he had smeared feces on himself, the walls of his cell and his bedsheets. The shower, which was operated from an adjoining room by a corrections officer to prevent inmates from turning it off, was activated but Rainey refused to stand under the water, according to the memo.

Officer Roland Clarke told Rainey he couldn’t go back to his cell until he washed off. Finally, Rainey said he would comply and asked for soap, which he was given, the memo says.

After starting to wash, Rainey said, “No, I don’t want to do this,” and leaned on a wall away from the water, Clarke told investigators. Officers continued to check on him, and finally after about two hours the decision was made to take Rainey out of the shower, but he was found lying face up in about 3 inches (8 centimeters) of water with no pulse and not breathing.

One inmate, Harold Hempstead, said he heard Rainey yelling and kicking at the shower door, saying, “I’m sorry. I won’t do it any more” and “I can’t take it no more.” The prosecutors found Hempstead’s claims, which he repeated to several news outlets, were not supported by other evidence, including video footage from inside the prison.

“Hempstead’s testimony is inherently unreliable and therefore not credible,” Hoague and Hardiman wrote.

Several witnesses said Rainey’s skin appeared to be peeled back or reddish in some spots — one inmate claimed he looked like a “boiled lobster” — but an autopsy found this “slippage” was most likely caused by friction or pressure on his moist and warm skin. This could have happened during efforts to revive him, such as chest compressions, or when officers carried him out of the shower initially, the memo said.

The medical examiner, Emma Lew, attributed Rainey’s death to a combination of his schizophrenia, heart disease and confinement in the small shower space. She said schizophrenic people can have nervous system reactions that trigger a heart attack if they have an underlying condition.

“It is not substantiated that the temperatures inside the shower room were excessively high,” Lew wrote.

The prosecutors determined that corrections officers did not commit murder or manslaughter in Rainey’s death and that taking him to the shower was appropriate under the circumstances.

“Placing an inmate who has defecated upon himself in a shower to decontaminate himself is not conduct that is criminally reckless,” they wrote. “There was no evidence of any intent to harm Rainey.”

Florida’s economy still growing, but budget cuts loom

Florida’s economy is continuing to grow according to new preliminary estimates from state economists.

State officials are meeting Friday to draw up new forecasts to predict how much the state will collect in taxes.

The forecasts will be used by state legislators when writing this year’s budget.

Preliminary forecasts prepared by economists predict the state’s main budget account will grow by as much as 4.5 percent during the fiscal year that ends in June. Those forecasts estimate growth of around 4 percent for the 2017-18 fiscal year.

If the forecasts hold, legislators could have nearly $180 million more to spend.

But it probably won’t be enough to stop legislators from considering budget cuts. Citing a potential shortfall over the next few years, House Republicans are planning to cut $1.4 billion.

Republished with permission of The Associated Press.

Donald Trump adviser Roger Stone involved in hit-and-run

Longtime Trump adviser Roger Stone says a car he was riding in this week in Florida was struck by a hit-and-run driver.

In a statement to The Associated Press, Stone described the incident as “suspicious,” coming as he is under scrutiny for his communication with the Russian-linked hacker Guccifer 2.0.

Stone tweeted that he was uninjured in the crash except for blurry vision in his right eye.

Stone says the car he was riding in was “T-boned” by a large, gray four-door car with a tinted windshield.

The Broward Sheriff’s Office says the driver the vehicle did not stop or make any attempt to exchange information. Police says Stone was a passenger in a car driven by John P. Kakanis, 29, of Hallandale Beach, Florida.

Republished with permission of the Associated Press.

Winners and losers in Donald Trump’s first budget plan

Military spending would get the biggest boost in President Donald Trump’s proposed budget. Environmental programs, medical research, Amtrak and an array of international and cultural programs — from Africa to Appalachia — would take big hits, among the many parts of the government he’d put on a crash diet.

The budget proposal out Thursday is a White House wish list; it’ll be up to Congress to decide where money goes. If Trump gets his way, there will be more losers than winners among government departments and programs.

Some programs would tread water: WIC grants — money to states for health care and nutrition for low-income women, infants and children — are one example. Monday for states grants for water infrastructure projects would be held level as well.

Some others would lose everything: Trump proposes to eliminate money for the Corporation for Public Broadcasting, the national endowments for the arts and the humanities and more than a dozen other independent agencies financed by the government.

A sampling:

WINNERS

—The Pentagon. Trump proposes a 10 percent increase in the massive defense budget, adding $52 billion in military spending in one year top expand personnel, equipment and capability. Another $2 billion would go to nuclear weapons.

—Veterans Affairs. Up 5.9 percent. That’s an additional $4.4 billion, driven by ever-growing health care costs.

—Homeland Security. Up 6.8 percent. That’s $2.8 billion more. Most of the increase, $2.6 billion, would be to help kick-start Trump’s promised border wall. The president has repeatedly said Mexico would pay for the wall; Mexican officials are adamant that they won’t. Trump also wants an extra $1.5 billion for more immigration jails and deportations, and $314 million to hire 1,500 immigration enforcement and border patrol agents.

—The National Nuclear Security Administration, which oversees the maintenance and safety of the nuclear arsenal and its research labs. The agency would grow by 11.3 percent, or $1.4 billion, so that it takes up more than half the Energy Department’s budget, which would shrink overall.

—Opioid prevention and treatment: a proposed $500 million increase in the Health and Human Services Department to counter the epidemic and more money for the Justice Department to combat the problem.

—School choice: $1.4 billion more to expand school choice programs, bringing spending in that area to $20 billion, even as the Education Department’s overall budget would be cut by $9 billion, or 13 percent.

LOSERS:

—EPA, facing a 31.4 percent cut, or $2.6 billion. The plan would cut 3,200 jobs at the agency, eliminate a new plan for tighter regulations on power plants, and “zero out” programs to clean up the Great Lakes and the Chesapeake Bay.

—Health and Human Services, facing the largest cut in dollar terms: $12.6 billion, or 16.2 percent. The plan would cut $5.8 billion from the nearly $32 billion National Institutes of Health, the nation’s premier medical research agency, bringing its total to $25.9 billion. It’s not clear what research on diseases or disorders would lose the most money, although the budget plan specifically calls for elimination of a division that focuses on global health. Already, the NIH’s budget hasn’t kept pace with inflation over the last decade, making it dramatically harder for scientists around the country to win money for research projects into potential new treatments or better understanding of disease.

—State Department and U.S. Agency for International Development. Down 28 percent, or $10 billion. Foreign aid would be reduced, as would money to the U.N. and to multilateral development banks including the World Bank. Some foreign military grants would be shifted to loans.

—Labor Department. A more than 20 percent cut, or $2.5 billion. To be eliminated: a $434 million program that has helped more than 1 million people 55 and older find jobs, according to the department. The blueprint says the Senior Community Service Employment Program is inefficient and unproven.

—Agriculture Department. A nearly 21 percent cut, or $4.7 billion, achieved in part by cutting land acquisition in the National Forest System, rural water infrastructure and statistical capabilities at the department. Trump also proposes reduced staff in county USDA offices, an idea that fell flat in Congress when President Barack Obama proposed a similar reduction.

—Transportation Department. Trump proposes a cut of nearly 13 percent, or $2.4 billion. Amtrak, local transit agencies, and rural communities that depend on federal subsidies to obtain scheduled airline service would take the brunt. Trump would eliminate subsidies for Amtrak long-distance train routes, which would most likely mean the end of those routes since they are generally not profitable. Money for the Federal Transit Administration grant program for new light rail and subway construction would be eliminated except for multi-year projects the government has already committed to help fund.

—Internal Revenue Service: After years of cuts, the IRS budget would be cut again — by $239 million from this year’s spending levels. The IRS budget is down about $1 billion from its height in 2010. Since then, the agency has lost more than 17,000 employees. As a result, the chances of getting audited have rarely been so low.

—Commerce Department. A 16 percent or $1.5 billion cut. The plan would eliminate more than $250 million in National Oceanic and Atmospheric Administration grants, including a program that helps coastal communities adapt to climate change, deal with invasive species and maintain healthy water and fisheries. Also on the chopping block: the Economic Development Administration, which provides federal dollars to foster job creation and attract private investment; and the Minority Business Development Agency, which is dedicated to helping minority-owned business get off the ground and grow. The Trump administration says the two agencies duplicate work done elsewhere.

—School programs: The plan would eliminate a $1.2 billion initiative that supports before- and after-school programs as well as summer programs.

—Independent agencies supported by tax dollars. If Trump prevails, a hefty contingent of entities would lose all federal money and be shut. Among them, the public broadcasting corporation, the Appalachian Regional Commission, the Chemical Safety Board, the United States Institute of Peace, the National Endowment for the Arts, the National Endowment for the Humanities, the Corporation for National Community Service and the African Development Foundation. That foundation was established by Congress and provides seed money and other support to enterprises in some 20 countries on that continent.

Republished with permission of The Associated Press.

House GOP health bill facing fresh House committee test

The White House and Republican leaders are talking to rank-and-file lawmakers about revising the GOP health care overhaul, hoping to keep a rebellion by conservatives and moderates from snowballing and imperiling the party’s showpiece legislation.

Four days after a congressional report projected the bill would pry coverage from millions of voters, signs of fraying GOP support for the legislation were showing. The measure would strike down much of former President Barack Obama‘s 2010 overhaul and reduce the federal role, including financing, for health care consumers and is opposed uniformly by Democrats.

In a fresh test of Republicans’ willingness to embrace the legislation, the House Budget Committee was considering the measure Thursday. Republicans expressed confidence the bill would be approved, but the vote could be tight. The panel can’t make significant changes but was expected to endorse non-binding, suggested changes to nail down votes.

The bill would eliminate the tax penalty that pressures people to buy coverage and the federal subsidies that let millions afford it, replacing them with tax credits that are bigger for older people. It would cut Medicaid, repeal the law’s tax increases on higher earning Americans and require 30 percent higher premiums for consumers who let coverage lapse.

Overt GOP opposition grew after the nonpartisan Congressional Budget Office projected Monday that the legislation would push 24 million Americans off coverage in a decade and shift out-of-pocket costs toward lower income, older people. Obama’s law has provided coverage to around 20 million additional people

House Speaker Paul Ryan, R-Wis., told reporters Wednesday that leaders could now make “some necessary improvements and refinements” to the legislation. But he declined to commit to bringing the measure to the House floor next week, a schedule Republican leaders have repeatedly said they intended to keep.

At a late rally in Nashville Wednesday, President Donald Trump said: “We’re going to arbitrate, we’re all going to get together, we’re going to get something done.”

Vice President Mike Pence met with House GOP lawmakers and pressed them to unite behind the legislation.

“‘It’s our job to get it out of here and get it to the Senate,'” Pence told Republicans, according to Rep. Dennis Ross, R-Fla. That would let Trump pressure “Democrats in these red states to come on board,'” Ross said, referring to Republican-leaning states where Democratic senators face re-election next year.

But insurgents still abound.

Conservatives want to end Obama’s expansion of Medicaid to 11 million additional low-income people next year, not 2020 as the bill proposes. They say a GOP proposed tax credit to help people pay medical costs is too generous, and they want to terminate all of Obama’s insurance requirements, including mandatory coverage of specified services like drug counseling.

Rep. Mark Meadows, R-N.C., head of the hard-line conservative House Freedom Caucus, continued pushing for changes. He claimed at least 21 members of his group would oppose the measure as written; the bill would fail if 22 Republicans join all Democrats in opposing it.

But underscoring the push-pull problem GOP leaders face in winning votes, moderates feel the tax credits are too stingy, especially for low earners and older people. They oppose accelerating the phase-out of the Medicaid expansion and are unhappy with long-term cuts the measure would inflict on the entire program.

Terminating the Medicaid expansion in 2020 and not 2018 “is sacrosanct to me,” said moderate Rep. Tom MacArthur, R-N.J.

In a new complication, Sen. Charles Grassley, R-Iowa, said the measure lacked the votes to pass in the Senate, where Republicans hold a precarious 52-48 majority. That left House members angry over being asked to take a politically risky vote for legislation likely to be altered.

Moderates “don’t like the idea of taking a vote in the House that may go nowhere in the Senate,” said Rep. Charlie Dent, R-Pa.

Amid the maneuvering, a federal report said more than 12 million people have signed up for coverage this year under the very statute that Republicans want to repeal. That figure underscored the potential political impact of the GOP’s next move.

Republished with permission of The Associated Press.

Rick Scott wants repeal but stays quiet on GOP health plan

Gov. Rick Scott, who urged President Donald Trump to move quickly on a health care plan, is sidestepping questions on a Republican health care bill that has set off an intense reaction in Washington.

But Scott is also so far refusing to endorse the measure crafted by top GOP legislators in the U.S. House as a replacement to President Barack Obama‘s health care law. Instead he said Tuesday, “I’m encouraged that there’s a real good conservation going on up in D.C.”

“I know there’s a debate about all the numbers, I’m going to continue to work on getting a good bill,” said Scott, who also met with House Speaker Paul Ryan last week to discuss the health care legislation.

Scott would not answer specific questions on the new study by the nonpartisan Congressional Budget Office that estimates the GOP plan would increase the ranks of the uninsured by 14 million people next year alone, and 24 million over a decade. He is also refusing to delve into the possible impact the bill may have on Florida’s Medicaid program, which relies on billions in federal aid each year.

Scott’s reluctance to get into the debate over the legislation is a marked departure from just a few weeks ago where he was openly calling on Trump and Republican leaders to act. He has constantly called “Obamacare a mess” yet he has refused to say what should happen to the millions who are getting coverage under the plan. Nearly 2 million Floridians enrolled this year for health insurance coverage through the federal health care exchange.

Scott, who was first elected to office in 2010, launched his political career amid the initial wave of opposition to the Obama overhaul. The former health care executive launched a group called Conservatives for Patient Rights that ran television ads against the law.

During his first term in office, Scott made a dramatic turnaround and threw his support behind expanding Medicaid that was a key element of the Obama overhaul. But after he was re-elected he abandoned that stance.

Florida has never drawn down the federal money available for Medicaid expansion due to strong opposition from Republicans in the Florida House including House Speaker Richard Corcoran.

CDC: Don’t donate sperm in 3 Florida counties due to Zika

Men from three Florida counties shouldn’t donate sperm because of a small risk of spreading Zika, U.S. health officials said Monday.

The guidance had previously applied to Miami-Dade County, the only place in Florida where there’s evidence mosquitoes spread the virus. But infections were reported in people in South Florida who couldn’t clearly be linked to Miami-Dade.

On Monday, the Centers for Disease Control and Prevention said the advice should extend to two counties north of Miami — Broward and Palm Beach. The recommendation applies to men who lived or traveled in those counties since June 15.

Zika is mainly spread by mosquito bites, but it can also be spread through sex. People can be infected without getting sick, and the virus can remain in semen for months.

There is no evidence of a pregnant woman being infected by Zika through a sperm donation, and such a risk is considered low, CDC officials said. Infection during pregnancy can lead to severe brain-related birth defects.

The Food and Drug Administration regulates sperm donations, and previously advised sperm banks they shouldn’t accept donors if they had been diagnosed with Zika or had been to an area with widespread Zika within the past six months. Sperm banks should consider the CDC’s new advice discouraging donations from men in the three counties, an FDA spokeswoman said.

There are 12 sperm donor banks in the three South Florida counties, CDC officials said. While blood donations can be tested for Zika, there’s not a good test for semen, according to the FDA.

The last case of mosquito transmission of Zika in Florida was in December. But officials think it’s possible the bugs will start spreading it again this summer. Some 221 people got Zika from mosquitoes in the continental U.S. last year, most in the Miami area. There were six cases in Texas.

There’s no evidence that mosquitoes in Broward or Palm Beach were spreading it, said Dr. Denise Jamieson, who is leading CDC’s Zika emergency efforts. She said officials suspect the local infections occurred in Miami-Dade.

“A lot of times people may not realize when they crossed the county line,” she said.

Since a large outbreak in Brazil, would-be moms and their sex partners have been told to avoid travel to Zika areas, use condoms or abstain from sex.

Republished with permission of The Associated Press.

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