11/30/2012

Chance talk busts giant fraud scheme

  • A doctor and nurse have filed a whistleblower suit against DaVita Dialysis
  • The two claim the company was over-billing Medicare and Medicaid
  • They say the company was wasting medication and throwing it away
  • The company denies the claims, saying decisions were made in patients' best interests

(CNN) -- It started with a chance conversation between a doctor and a nurse several years ago. But that brief encounter may end up exposing what could be one of the largest Medicare frauds in U.S. history.

Dr. Alon Vainer, a medical director at dialysis clinics in Georgia, was discussing clinic procedures with one of the nurses, Daniel Barbir. The two men say they saw something they believed was very wrong: expensive medicine, and lots of it, was being tossed in the trash. And the clinic workers were being told to do it, the two men say,

"When we sat down and started talking about it and getting into details, we actually realized exactly what was going on," Vainer said.

The alleged waste was being carried out on a massive scale and, the nurse and the doctor said, they knew why almost immediately. They claim it was a way for their company, DaVita Inc., to defraud the government, overbill Medicare and Medicaid and make a fortune.

"We're talking in the hundreds of millions, easily," Vainer said. "The profit this company raked from those two schemes, only from those two drugs, was hundreds of millions of dollars."

The allegations of massive fraud have implications for all Americans. The alleged fraud would have involved Medicare and Medicaid patients, whose medicine is paid for by U.S. taxpayers.

Vainer and Barbir said the alleged fraud schemes they discovered were going on at the company's clinics all across the country -- at the time, about 2003 through 2010, more than 1,800 -- with tens of thousands of patients. It was enormous, they claim, and Vanier said it was all a deliberate strategy coordinated by the company.

"It was just a scheme in order to fraudulently increase and maximize and boost the Medicare revenue, Medicare payment, so therefore fraudulently increase their revenue," he said.

DaVita Inc., based in downtown Denver, is one of the nation's largest dialysis companies. The name means "Giving Life" in Italian. The company just moved into a brand new $101 million office tower, complete with fountains, gardens and even a suspended ski gondola inside for private meetings.

DaVita has grown in the past couple of years and now runs roughly 2,000 dialysis clinics across the country, which has added up to a $7 billion business. The dialysis empire is run by CEO Kent Thiry, who dresses like one of the Three Musketeers, has adopted a company slogan of 'One for all and all for one' and in company staff meetings leads his employees, who he calls villagers, in cheers of "DaVita!"

Thiry is reportedly paid an estimated $15 million a year, according to the Wall Street Journal, which has called him the best compensated CEO in Colorado.

Most of DaVita's revenue comes from a single source: taxpayers. More than two-thirds of DaVita's revenue comes from Medicare and Medicaid payments.

If Vainer and Barbir's allegations are true, the company threw away hundreds of millions of dollars of medicine, and taxpayers paid for it. And, if true, the alleged fraud schemes could represent one of the largest Medicare frauds in U.S. history.

Vanier explained to CNN how DaVita instructed its nurses to administer a 100-milligram dose of the iron drug Venofor.

"For example, if a patient requires this dose once per week, you'd administer 100 milligrams, waste nothing and charge Medicare for 100 milligrams," he said.

"But what DaVita did, instead of charge (for) one vial, they give 50 milligrams of this vial (and) put the residual into the trash." he said. With another vial, he said, the company would give 25 milligrams to a patient and put the rest in the trash, then repeat it with yet another vial, when one vial could have been given without waste.

The more vials DaVita used, the more the company was able to bill the government, the men say. Vainer and Barbir claim they tried to call attention to the massive waste and tried to get it stopped. But instead, they say, they were basically told to stop causing trouble and to continue following the company's protocols.

"That's what upset me the most," Barbir said. "and that's when I went to Dr. Vainer. I said, 'Dr. Vainer, I can't do that.'"

Barbir says he quit his job and left the clinic rather than continue where fraud was going on. Vainer claims the company punished him for speaking up.

"Of course, once they found out, they did not renew my medical directorship or my practice," Vainer claimed. "We are a three-physician practice, and it was a significant loss of revenue."

Today, both men have filed a whistleblower lawsuit under the U.S. False Claims Act on behalf of the U.S. government, charging DaVita with massive Medicare fraud. They stand to make millions if DaVita is found guilty.

DaVita's CEO wouldn't talk, but the company's attorney Kim Rivera did. When asked about the plaintiffs' allegation that DaVita had come up with so-called schemes to throw away drugs and maximize profits, Rivera said: "Well that's just wrong. If you look at the facts of the case, first of all, the doctors make the dosing decisions.... When you look at what the practices were -- decisions being made by doctors, based on what was in the best interest of their patients. And they took into account a variety of things.

"You can't just look at one issue. You have to look at things like infection control, what the patient's going to do, how the patient's going to do with particular doses. And so, during that entire time what we did, what the doctors did, was appropriate."

But other companies, including DaVita's main competitor, used smaller vials and smaller combinations at times, limiting what was thrown away.

DaVita reiterated its decisions to throw away medicine were for "sound clinical reasons" and "never to increase wastage."

Plaintiffs' attorneys Lin Wood and Marlan Wilbanks, who claim DaVita made as much as $800 million over-billing the government, say that DaVita's defense won't hold up in court.

"It's not just the taxpayers that are the victims here, it's the health care system," Wood said.

"It doesn't take a graduate degree to understand what's going on here," Wilbanks said. "This is just dishonesty."

DaVita denies that and vows to fight the case in court. But earlier this year, while denying it did anything wrong, DaVita settled a similar case in Texas for $55 million.

Pat Burns, with the watchdog group "Taxpayers Against Fraud," says the bigger problem is that even if a company gets caught cheating the government, the company executives never seem to face any punishment. Fines are paid and business continues as usual.

"The way it's set up right now, if the fraud is not caught, then taxpayers foot the bill, Burns said. "If the fraud is caught, stockholders foot the bill."

Burns and others have been arguing for much harsher treatment when companies are found guilty of defrauding the federal government. He points to record billion-dollar fines, particularly in the pharmaceutical business, that are paid, but executives don't get punished and the companies continue to do business with the government.

In fact, one of DaVita's defenses to CNN is that the federal government itself declined to charge the company with wrongdoing, even after reviewing the fraud allegations.

"The government has come in and thoroughly investigated what the allegations are, and in both cases the government decided to drop it and move on," Rivera said.

Federal prosecutors in Georgia declined to intervene in the case but stated in a letter that decision "should not be construed as a statement about the merits of the case."

The short-staffed U.S. Department of Justice declines to join lawsuits all the time, instead allowing private citizens who hire private lawyers to essentially prosecute for the government, Burns said.

"The U.S. Department of Justice simply doesn't have the people," Burns said. "It should have the people. I think we all would agree to that. It simply doesn't."

Which brings us back to the original meeting of one doctor and one nurse who now stand to make millions if these allegations of fraud are proven true.

The biggest winners, though, in their lawsuit could be taxpayers. The U.S. government will recover the bulk of whatever they win. They and others like them are essentially the U.S. taxpayers' deputies in the fight against health care fraud. Asked if they are surprised that they have to defend the U.S. taxpayer, Barbir said simply, "I'm not surprised. It's not easy to come forward and stand up and tell the truth, but it's the right thing to do."

The case is set for trial later next year.

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Gergen: Will Obama push us over cliff?

  • David Gergen says Republicans realize that elections have consequences
  • He says GOP accepted idea of higher tax revenues from wealthy, a big concession
  • There's a risk of the White House upping the ante and dooming a deal, he says
  • Gergen: Obama should look to compromises won by LBJ, Reagan, Clinton -- and Lincoln

Editor's note: David Gergen is a senior political analyst for CNN and has been an adviser to four presidents. A graduate of Harvard Law School, he is a professor of public service and director of the Center for Public Leadership at Harvard University's Kennedy School of Government. Follow him on Twitter.

(CNN) -- Forgive me, but haven't we seen this movie before in the aftermath of national elections? Usually, it doesn't end well.

In the weeks since his victory, President Barack Obama has argued -- correctly -- that voters are demanding that high-income Americans pay higher taxes as a way to reduce deficits. Some 60% in exit polls endorsed that proposition, and a Pew/Washington Post poll released this week found that 60% still support it. The president, then, has good reason to push the idea.

Opinion: How to bridge fiscal cliff

In a breakthrough, House Speaker John Boehner quickly lined up behind the idea of the wealthy paying more. He still disagrees with the president on how to get there, of course, but critics are losing sight of how far Boehner seems prepared to go. In private negotiations with Obama last year, the two men first agreed on raising $800 billion in new taxes over 10 years. When Obama pushed to see whether Boehner would go up another $400 billion to $1.2 trillion, the talks fell apart amid bitter recriminations and conflicting accounts of what happened.

David Gergen

Elections do make a difference:

Obama has now doubled the ante, asking for a total of $1.6 trillion in higher revenues over 10 years. Even though that is twice the revenues discussed last year, Boehner hasn't walked away.

He hasn't even blinked. Instead, word seeps out from Republican ranks that his members are asking to keep the final figure under $1 trillion even as others in Washington speculate that a compromise may be struck at halfway between $800 billion and $1.6 trillion, at $1.2 trillion.

Last summer, that would have been considered a huge victory for Democrats. Remember that Republicans haven't voted for significant tax increases since 1990 -- 22 years ago. To get them to the point where they seem prepared to accept as much as $100 billion a year in new taxes, aimed at the affluent, is remarkable.

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There are at least two sticking points. Obama has insisted that the first new revenues come from raising tax rates on couples who earn above $250,000; Boehner has insisted that, no, they should come from limiting personal deductions and closing loopholes. Democrats like Sen. Harry Reid say the deduction/loophole route won't yield enough revenue. The Washington Post editorial page argues that in fact, limiting deductions to $50,000 per taxpayer would raise about $750 billion over 10 years, nearly matching the $800 billion that would be raised through the proposed tax hikes on the top 2%.

In Washington of yore, when leaders sat down and negotiated face to face, those differences would seem highly bridgeable. Get part of the revenue by raising rates slightly (not all the way), and get the rest through deductions/loopholes. Both sides get some of what they want.

The other sticking point is that Republicans insist now that, as Obama would put it, the final grand bargain must be balanced. Big tax increases and big spending cuts must be voted on together so both sides are guaranteed concessions by the other.

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That, too, seems highly doable: In the negotiations last summer, Obama's team (see Bob Woodward's new book) put a number of significant entitlement reforms on the table, including Medicare, Medicaid and Social Security. Republicans are insisting that before they sign on any dotted line about higher taxes, Obama and the Democrats show what entitlement reforms they are willing to embrace. Frankly, that sounds entirely reasonable: It has been clear since Simpson-Bowles and numerous other efforts that big concessions must come from both parties.

In short, we have known the framework of a grand bargain for a long time, and in theory, we should be closer to it than ever. But this week, there is a palpable sense in Washington that the parties are drifting apart and chances of an agreement before Christmas are diminishing. Erskine Bowles, a former White House chief of staff and former co-chairman of Obama's debt commission, now puts the chances of a deal that prevents us from going over the fiscal cliff at only one in three.

Why has a grand bargain become so much harder than it should be? Last year, it was clearly the Republicans who were over-playing their hands, being obstinate when they should have been more flexible. (The deal they could have gotten then would have been considerably better than the one they are looking at now.) But frankly, it is the president and the Democrats who are over-playing their hands now.

Instead of turning the GOP willingness to deal on taxes into a win-win, the White House seemingly wants to humiliate them by insisting they cave entirely on increasing tax rates -- or take responsibility for going over the cliff. Instead of sitting down and negotiating directly with leaders from the other side in private getaways, as presidents like Lyndon Johnson and Ronald Reagan did, the president launches a campaign-style offensive against them.

The proposal that Treasury Secretary Timothy Geithner put before Republicans on Thursday, as reported by The New York Times, was clearly intended to score political points with Democrats rather than entice Republicans into serious negotiations. It was full of nonstarters. One example: It demanded that Republicans lock in to $1.6 trillion of higher taxes in December and in exchange said that spending cuts one-quarter that size would be the subject of talks next year. Come again?

What we are seeing, I regret to say, looks very much like a movie we have seen before: The side that wins an election thinks the public has given them permission to steamroll the other side, pushing through their favorite ideas willy-nilly. Sometimes, they partially succeed, but before long, there is a backlash, and Washington comes to another grinding halt.

We saw that back in the early '90s, when first the Clinton White House overreached, going too far left, and then after winning the midterms, the Gingrich Republicans overreached to the right. In the second Clinton term, they learned how to get along better and accomplished big things for the country.

The same story unfolded over the past four years as the Obama White House went beyond public tolerance in its first two years, and then Republicans, resurgent after the midterms, struck many voters as so obstructionist that they paid a price in this fall's elections.

Now, along comes a newly victorious Obama White House, and it is showing clear signs that it wants to test its new powers to their limit -- and, in Republican eyes, well beyond their limit.

Many Democrats are jubilant because they thought that in his first term Obama was a milquetoast in dealing with Republicans -- he was always giving away too much too soon, negotiating with himself.

But there is now a danger of over learning that lesson, becoming so combative and rigid that good faith negotiations become almost impossible. Old White House hands from the GOP side -- people who like our Presidents to succeed --are privately warning that if the White House and allied Democrats keep pushing so hard-fisted on deficits, Susan Rice and Senate filibuster rules, relations with Republicans on the Hill will become even more poisonous in the next four years than in the past.

Again, Obama is right when he argues that the voters have spoken: A majority clearly believes that in closing the deficits, taxes should go up on more affluent Americans. It is time. But he will be more successful in his second term if he takes guidance from how presidents like LBJ, Reagan and Clinton negotiated with congressional opponents -- and takes a night off to see "Lincoln."

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The opinions expressed in this commentary are solely those of David Gergen.

Bridge collapse derails train in New Jersey

Train tanker cars dangle from a collapsed railroad bridge near Paulsboro, New Jersey, on Friday.
Train tanker cars dangle from a collapsed railroad bridge near Paulsboro, New Jersey, on Friday.
  • NEW: 18 treated for respiratory issues; vinyl chloride can cause dizziness, headaches
  • Train cars carrying toxic chemicals crashed into a creek near the Delaware River
  • Nearby schools are on lockdown, and a hazardous materials team is on the scene
  • Residents in Paulsboro, New Jersey, are asked to stay indoors

(CNN) -- A bridge collapsed in the West Deptford area of New Jersey on Friday, sending several train cars carrying toxic chemicals crashing into a creek near the Delaware River, the U.S. Coast Guard said.

Vinyl chloride, a highly toxic and flammable chemical, is believed to be leaking into Mantua Creek, Petty Officer Nick Ameen told CNN. No serious injuries have been reported, but nearby schools are on lockdown, a borough emergency official said, and people in the immediate area have been evacuated.

A representative for Underwood Memorial Hospital told CNN that the hospital has treated 18 patients with respiratory issues.

A hazardous materials team is on the scene, said Glen Roemmich, a Paulsboro area emergency management coordinator.

Video of the train wreck from CNN affiliate WPVI showed two tanker cars dangling from the collapsed railroad bridge. Other cars were in the creek, partially sunken amid rising smoke.

Residents told WPVI that they smelled an odor in the area. People in the town of Paulsboro should stay indoors for now and keep windows closed, a Gloucester County spokeswoman said.

The Coast Guard is not in a search-and-rescue mode, Ameen said. Coast Guard crews, he said, are heading to the scene to stop the leak and begin cleaning it up.

A team from the National Transportation Safety Board, the nation's top transportation investigator, is on its way to the scene, the agency said.

Vinyl chloride is used to make plastic and vinyl products, including PVC pipes, according to the Environmental Protection Agency, which has labeled the chemical a Group A human carcinogen. "Short-term exposure to high levels of vinyl chloride in air has resulted in central nervous system effects, such as dizziness, drowsiness, and headaches," the EPA says on its website.

Paulsboro is southwest of Camden, about a 20-minute drive from Philadelphia.

Ouch! 10 ways fiscal cliff may hurt you

If an agreement can't be reached on the fiscal cliff, many Americans could see unwelcome cuts to health services.
If an agreement can't be reached on the fiscal cliff, many Americans could see unwelcome cuts to health services.
  • Government health programs will face automatic cuts if no agreement is reached
  • The cuts could affect medical research; food safety programs will also take a hit
  • Medicare and veterans' services are among those facing cuts

(CNN) -- If President Barack Obama and Congress cannot reach an agreement on the fiscal cliff, economic experts agree it would be devastating.

It would likely send the country back into recession, according to the Congressional Budget Office, and some 3.4 million jobs would be lost. And ultimately, it could hurt your physical and emotional health.

That's because the part of the government that handles health-related programs -- Medicare, medical research, food safety inspectors -- all would be automatically cut starting January 2 if there is no agreement on the Budget Control Act. If not amended in time, the move would abruptly remove $1.2 trillion from the federal budget.

The BCA essentially forces Congress and the president to reach a budget agreement before the end of the year. If they do not and they do not amend the BCA, the Office of Management and Budget estimates each government division would see about an 8.2% budget cut. Medicare would face a 2% cut.

Many, including health care economist Ken Thorpe, are anxious to see that scenario avoided.

"I hope they will reach agreement quickly and do it in a thoughtful way," said Thorpe, a professor of health policy and management at Emory University. "Then next year we can really work on these important structural issues to slow growth in these programs, rather than these across-the-board cuts that would arbitrarily make cuts. It's not the smartest way to do it."

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Ellie Dehoney, vice president of public policy and programs for Research!America, said her group has been hard at work visiting as many members of Congress as possible to stop across-the-board cuts. Her nonprofit is particularly concerned about cuts in medical research.

"Across-the-board cuts would put so many vital medical research programs at risk," Dehoney said. Her organization brought a handful of Parkinson's patients to meet with congressional officials. The patients told the representatives how medical advances made through research funded by the National Institutes of Health gave them hope for a cure for their Parkinson's and how much more research was necessary.

"Many we met with were clearly moved by their stories," Dehoney said. "We have seen bipartisan support for medical research funding overall, but in a few offices we still heard about the need for more 'shared sacrifice.' That's why we are still working with such urgency."

The individual departments that will see their budgets cut aren't commenting on specifics. But clearly something would have to give if these departments have less with which to work.

"I don't think there is a lot of cushioning in these program's budgets to just move money around to cover all the demand for these services," said Ted Marmor, professor emeritus of public policy and management at Yale. "It is a real problem when you already have this serious buildup of pressure on state budgets and family budgets with the recession. A one-time sharp drop in the budget would be devastating for a lot of people who depend on these programs."

That means there would be a cut in health services, although it's unclear which specific services would be cut; agencies referred questions back to the OMB and its report.

What is known is the cuts would happen quickly, since under the law most budgets have to be cut in the first year of the act.

"You wouldn't necessarily see the impact right at first, but agencies like the CDC will have to prioritize. Something will have to give, so you'd see a lab close here and a monitoring program end here, so down the road they won't able to monitor, say, a disease outbreak nearly as well as they can now," said Indivar Dutta-Gupta, who works with the Center on Budget and Policy Priorities.

"The problem is, we already are seeing historic low spending on these types of programs, and even if the Congress and the president do reach an agreement and stop sequestration, the big worry is there may be even bigger cuts to these programs in the compromises they make."

If the country does go over the fiscal cliff and an agreement cannot be reached, here are general 10 ways it would hurt programs the government provides to help keep you and others healthy. The following budget estimates come from the latest OMB analysis:

Medicare

Some 50 million people rely on Medicare to cover their health care costs. The federal health insurance program, which is available to all people 65 and older and people with permanent disabilities, has seen a huge increase in people needing its help. Fewer companies offer retiree health benefits (down to only 25% of the population, according to the nonpartisan Kaiser Family Foundation).

Automatically, 2% would be cut from this program's budget. While this is less than the general 8.2% across-the-board cuts for other federal programs, it would amount to a budget reduction of around $11 billion. That would mean payments to doctors, hospitals, long-term care facilities and nursing homes could be reduced significantly.

Health care providers already complain that the Medicare reimbursement rate is too low. Ultimately, those facilities could stop taking Medicare patients.

"Or there would be a cost shift," said Julie Barnes, director of health policy at the Bipartisan Policy Center. "That means, ultimately, they might have to charge private patients more. What else can they do? They've got to meet their expenses."

Food safety

The number of foods recalled because they were bad or dangerous hit one of the highest levels in four years in the fourth quarter of 2011, according to the ExpertRECALL Index.

Listeria, botulism, E. coli, Salmonella -- deadly problems for the food supply -- have all been caught by government food inspectors. Yet even with those inspections, tens of millions of people get sick every year and more than 3,000 people die each year from food poisoning, according to the Centers for Disease Control and Prevention.

An 8.2% cut would slash the budget for plant and animal health inspections by $71 million. The budget for the Food Safety and Inspection Service agency would lose more than a billion dollars from its budget. An additional $3 million would have to come out of the budget for inspectors who monitor the safety of our grain supply and stockyards. That could mean fewer inspectors -- and fewer inspections, which ultimately could mean a food supply that isn't as safe as it is now.

CDC

The Centers for Disease Control and Prevention's work touches many health aspects of daily life. Its nurses and doctors, epidemiologists and technologists work to prevent the spread of food-borne illnesses, to stop the spread of the flu and monitor disease outbreaks, to reduce the number of hospital-acquired illnesses, to increase immunizations and to create tools to help communities protect public health, among many other health-related efforts. It would lose more than $464 million from its overall budget.

NIH

Ultimately, this cut would impact academic labs and research institutions in every single state. The National Institutes of Health funds a wide variety of medical research. It spends millions to help scientists discover the root causes and cures for childhood diseases, cancer, autism, diabetes, lupus and many other illnesses.

Spending on biomedical and health research and development was already lower than it has been in years, according to Research!America. Cuts now could have a severe, long-term impact on research, which could lead to fewer cures and therapies to fight common diseases. This department would lose more than $2.5 billion from its budget.

Food for lower-income families

The Women Infant and Children Supplemental Nutrition Program, known as WIC, helps feed families who are considered a nutritional risk because they can't afford to buy food. The program also teaches people about nutrition and provides referrals for health services.

Some 16.4% of the U.S. population is considered "food insecure," according to FeedingAmerica.org. That's more than 48 million people.

About $543 million would be taken out of this program's budget.

Separately, child nutrition programs would be cut by $4 million. Commodity Assistance would lose $5 million. Other nutrition programs would lose $11 million. And the Supplemental Nutrition Assistance program would lose $8 million.

Maternal, Infant and Early Childhood Home Visiting Program

This is a home visiting program that helps pregnant women or women with children younger than 5 who may need additional help with maternal and child health issues. It also works to prevent abuse, neglect or child injuries because of an unsafe environment in the neighborhood or home.

Studies show this program reduces crime and incidents of domestic violence. It also increases a family's economic self-sufficiency. This program would see a $30 million reduction in its budget.

Office of Lead Hazard Control and Healthy Homes

Children in at least 4 million households are still being exposed to the dangers of lead, according to the CDC. Lead poisoning, which disproportionately hurts children, can curtail nervous system development, lead to behavioral disorders and cause headaches, anemia, seizures and even death.

The Office of Healthy Homes and Lead Hazard Control is a federal agency established to eliminate lead-based paint hazards in private homes and low-income housing. The Healthy Homes program also helps prevent disease and injuries that result from housing-related hazards such as radon, poor indoor air quality and even poor lighting that can lead to falls.

The CDC estimates more than 11,000 people die each year from preventable unintentional injuries, including falls, fires and poisonings in unsafe homes. This program would lose $10 million.

Department of Homeland Security, Office of Health Affairs

The Office of Health Affairs in the Department of Homeland Security is something Americans want to be fully operational if terrorists attack the country using chemical, biological, radiological or nuclear weapons. It serves as the department's authority for all medical and health issues. The office also provides experts to the department's leadership, builds national plans in case of terrorist attacks, helps first responders and protects the department itself from health threats. It would lose $14 million from its budget.

Gallaudet University

The leading undergraduate liberal arts education program for the deaf and hard of hearing is based in Washington. It has an international reputation for its education programs and for the kind of research it does related to deaf people. With an 8.2% budget cut, the college's funds would be reduced by $10 million.

"We are monitoring the situation closely and keeping the campus community informed as the situation develops," said Fred Weiner, interim assistant vice president for Administration and Finance at Gallaudet, in a statement sent to CNN.

Social Security

Since the start of the recession, there has been a marked increase in the need for federal disability insurance as provided by Social Security. According to the last available census data, more than 8 million people are considered too disabled to work and receive this benefit from the government.

Automatic cuts would dramatically reduce these services. The federal disability insurance budget alone would be cut $241 million for discretionary spending.

Egypt passes draft of constitution

  • Hundreds gather in Tahrir Square's tent city for Friday prayers
  • The president could order a referendum on the constitution in about 2 weeks
  • Assembly passes all 234 articles of a new draft constitution
  • Article 65 guarantees all Egyptians social security

Are you there? Share photos and video, but stay safe.

Cairo (CNN) -- As the sun rose over Cairo on Friday, an assembly charged with crafting Egypt's new constitution gave its final approval after 21 hours of haggling and the passage of all 234 articles.

The draft will be printed later in the day and presented to President Mohamed Morsy on Saturday, said Houssam al-Ghiryani, who heads the assembly.

But that doesn't mean Egypt's crisis is over.

The constitution, which would replace one scrapped in last year's revolution that led to Hosni Mubarak's ouster, needs to be approved by citizens, many of whom are angry at the government.

Hundreds of protesters gathered Friday around noon at Tahrir Square, where they held prayers after listening to a cleric brand Morsy a "pharaoh" over what many feel was an overbearing power grab by the head of state last week.

An Egyptian man delivers a speech as protesters gather in Cairo's Tahrir Square on Friday, November 30.An Egyptian man delivers a speech as protesters gather in Cairo's Tahrir Square on Friday, November 30.
A man shouts as protesters gather in Tahrir Square on November 30.A man shouts as protesters gather in Tahrir Square on November 30.
A man holds a copy of the Koran and a cross in Tahrir Square on November 30.A man holds a copy of the Koran and a cross in Tahrir Square on November 30.
Protesters run from Egyptian riot police during clashes near Cairo's Tahrir Square on Wednesday, November 28. Police fired tear gas into the square, where several hundred protesters spent the night after a mass rally to denounce President Mohamed Morsy's assumption of expanded powers. Activists have been camping out in Tahrir Square since November 23.Protesters run from Egyptian riot police during clashes near Cairo's Tahrir Square on Wednesday, November 28. Police fired tear gas into the square, where several hundred protesters spent the night after a mass rally to denounce President Mohamed Morsy's assumption of expanded powers. Activists have been camping out in Tahrir Square since November 23.
A protester carries a rock during clashes with police on Wednesday.A protester carries a rock during clashes with police on Wednesday.
Egyptians carry a giant national flag as tens of thousands take part in a mass rally in Cairo on Tuesday, November 27, against a decree by President Mohamed Morsy granting himself broad powers. Egyptians carry a giant national flag as tens of thousands take part in a mass rally in Cairo on Tuesday, November 27, against a decree by President Mohamed Morsy granting himself broad powers.
An Egyptian protester holds up a Quran and a figure of Christ on the cross during Tuesday's demonstration.An Egyptian protester holds up a Quran and a figure of Christ on the cross during Tuesday's demonstration.
Protesters continue to rally in Tahrir Square on Tuesday.Protesters continue to rally in Tahrir Square on Tuesday.
An Egyptian protester attempts to throw back a tear gas canister on Tuesday during clashes with riot police in Omar Makram Street, off Tahrir Square.An Egyptian protester attempts to throw back a tear gas canister on Tuesday during clashes with riot police in Omar Makram Street, off Tahrir Square.
Activists in Cairo's Tahrir Square on Monday, November 26, carry the coffin of Gaber Salah, an activist who died overnight after he was critically injured in clashes in Cairo. Salah, a member of the April 6 movement known by his nickname "Jika," was injured last week during confrontations between police and protesters on Cairo's Mohammed Mahmud street.Activists in Cairo's Tahrir Square on Monday, November 26, carry the coffin of Gaber Salah, an activist who died overnight after he was critically injured in clashes in Cairo. Salah, a member of the April 6 movement known by his nickname "Jika," was injured last week during confrontations between police and protesters on Cairo's Mohammed Mahmud street.
Thousands of activists attend the funeral of Gaber Salah on Monday.Thousands of activists attend the funeral of Gaber Salah on Monday.
Protesters clash with Egyptian police at Simon Bolivar Square on Sunday, November 25, in Cairo. Egypt's powerful Muslim Brotherhood called nationwide demonstrations in support of Islamist President Mohamed Morsy in his showdown with the judges over the path to a new constitution. Protesters clash with Egyptian police at Simon Bolivar Square on Sunday, November 25, in Cairo. Egypt's powerful Muslim Brotherhood called nationwide demonstrations in support of Islamist President Mohamed Morsy in his showdown with the judges over the path to a new constitution.
Egyptian protesters hurl stones at police at Tahrir Square on Sunday.Egyptian protesters hurl stones at police at Tahrir Square on Sunday.
Protesters gather at sit-in tents in Tahrir Square on Sunday. Protesters gather at sit-in tents in Tahrir Square on Sunday.
Egyptian President Mohamed Morsy waves to supporters in front of the presidential palace in Cairo on Friday, November 23. Thousands of ecstatic supporters gathered outside the presidential palace to defend their leader against accusations from rival protesters that he has become a dictator. Egyptian President Mohamed Morsy waves to supporters in front of the presidential palace in Cairo on Friday, November 23. Thousands of ecstatic supporters gathered outside the presidential palace to defend their leader against accusations from rival protesters that he has become a dictator.
Morsy supporters gather outside the presidential palace in Cairo on Friday. Morsy insisted that Egypt was on the path to "freedom and democracy," as protesters held rival rallies over sweeping powers he assumed that further polarized the country's political forces.Morsy supporters gather outside the presidential palace in Cairo on Friday. Morsy insisted that Egypt was on the path to "freedom and democracy," as protesters held rival rallies over sweeping powers he assumed that further polarized the country's political forces.
Protesters demonstrating against Morsy run from tear gas fired by Egyptian riot police during clashes in Cairo's Tahrir Square on Friday.Protesters demonstrating against Morsy run from tear gas fired by Egyptian riot police during clashes in Cairo's Tahrir Square on Friday.
Egyptian protesters throw rocks toward riot police on FridayEgyptian protesters throw rocks toward riot police on Friday
Egyptian supporters and opponents of Morsy clash in the coastal city of Alexandria on Friday.Egyptian supporters and opponents of Morsy clash in the coastal city of Alexandria on Friday.
A man throws a rock during clashes in Alexandria on Friday.A man throws a rock during clashes in Alexandria on Friday.
Thousands of demonstrators march through the streets of Cairo to protest against Morsy on Friday.Thousands of demonstrators march through the streets of Cairo to protest against Morsy on Friday.
Clashes rocked the coastal city of Alexandria on Friday.Clashes rocked the coastal city of Alexandria on Friday.
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
Egyptians protest over presidential powers
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Egyptians protest president's powersEgyptians protest president's powers
Egypt's crisis over within 15 days?
Making sense of Egypt's political crisis
Sign of the times in Egypt

Since then, throngs have taken to the streets to demonstrate against him and the constitutional group led by Muslim Brotherhood members.

Protests have been large, boisterous and occasionally violent, picking up steam after the president issued an edict last week that included making his decisions since taking office in June immune from judicial oversight.

The tent city pitched on a roundabout has spread across the traffic circle. As has become customary in recent weeks, food vendors set up stands in the middle of the street. Protest leaders trod the boards of a sound stage, belting out chants over microphones to the crowd.

The hasty nature of the call to approve the draft constitution added to Egyptian's discontent.

The snap vote prompted several walkouts, reducing the number of the original 100 assembly delegates. Those who resigned were replaced by members of the Brotherhood and allied Salafist Nour Party. Eighty-five members approved the draft.

The assembly was dominated by Islamists. All of the Coptic Christian members officially resigned as a bloc, and many of the others who departed were liberals.

The the rest of the constitutional assembly members took the departing members into consideration when discussing the various articles, said Essam El-Erian, a senior presidential adviser.

Critics call the maneuvering a case of the Muslim Brotherhood trying to hijack the constitution less than two years after Mubarak's ouster. Others interpret the vote as a way to quickly defuse anger about the president's recent decree granting himself expanded presidential powers.

Protesters to Morsy: Roll back your decree or leave

Morsy has appeared on state TV to promise Egyptians that his decrees would apply only to "sovereign" matters and go out of effect as soon as a new constitution is ratified in a public referendum.

He justified targeting the judiciary with an edict, accusing members of the judiciary of working to thwart gains made in the Arab Spring uprising. The executive and legislative branches of government have since been replenished, but many of the same judges still sit on the courts' benches, including Mubarak loyalists.

Some judges had threatened to disband the assembly writing the constitution.

The assembly convened Thursday and continued through the night and well into Friday morning as members voted on each article separately, discussed objections by dissenters and made alterations.

At the end of 21 hours, the assembly's head, Hossam al-Ghiriyani, asked the members if they agreed to the 234 articles. After a show of hands, he said: "Agreement by consensus. May God bless you." The room broke into applause, and everyone stood for the playing of the national anthem.

Opinion: A new Egypt must learn political compromise

Expert opinions on the new constitution ranged from angst to elation.

"The draft constitution will end the state of political division, because it will cancel the constitutional decrees that the president issued," said Dawood Basil, an expert in constitutional law from Cairo University. "I feel overwhelming joy after hearing the final wording of the articles."

"All Egyptians -- of all background -- were taken into account when efforts were made to put together this draft," said Ramadan Battikh, a professor of constitutional law at Ain Shams University.

Critics say the constitution could lead to excessive restrictions on certain rights, moving Egypt closer to Sharia law.

"As far as rights are concerned, the 1971 constitution was much better," said Dr. Mustapha Kamel Sayed, a Cairo University professor, referring to the old constitution still in place under Mubarak.

Heba Morayef, the Egypt director for Human Rights Watch, said "there aren't really any protections for women," for instance.

The preamble includes language pertaining to women, stating that they are equal to men but also accentuating their roles as mothers.

"There is no dignity for a nation which does not honor women; women and men are equal, for they are the fort of motherhood, half of the society and partners in all the gains and national responsibilities," it reads.

Citing the family as "the foundation of society," it guarantees free maternal health care and promises to reconcile "a woman's duties toward her family" and her job.

Other provisions distinctly protect individuals' civil rights, particularly in how they are treated by security forces and the judicial system.

They include wording to prevent arbitrary arrest and detention, and ensure due process by the courts, a sensitive topic in Egypt, as Mubarak and his loyalists are blamed for jailing and harshly mistreating innocents before and during last year's uprising.

Anyone jailed cannot be interrogated without an attorney present, and if detainees don't have one, the judicial system must appoint one.

Phone conversations, electronic correspondence and other communication cannot be tapped without a warrant.

Article 65 guarantees social security benefits to all Egyptians. Lawmakers could be seen applauding on Egyptian state TV after its approval.

Read more: Clinton not warned of Egyptian president's power grab

As the constitutional debate unfolded, fresh clashes broke out Thursday between rowdy protesters and police in central Cairo.

The mayhem prompted the closure of the U.S. Embassy near Tahrir Square, the epicenter of the current protests and those in 2011.

Opinion: Don't blame Muslim Brotherhood for Morsy power grab

The Muslim Brotherhood has called for its own demonstration Saturday, in what would be the biggest public show of support for Morsy since he issued his controversial edict.

They will be joined on the streets Friday and probably Saturday by opposition protesters.

CNN's Amir Ahmed and Ben Brumfield contributed to this report.