/**
 * Canonical API to handle WordPress Redirecting
 *
 * Based on "Permalink Redirect" from Scott Yang and "Enforce www. Preference"
 * by Mark Jaquith
 *
 * @package WordPress
 * @since 2.3.0
 */

/**
 * Redirects incoming links to the proper URL based on the site url.
 *
 * Search engines consider www.somedomain.com and somedomain.com to be two
 * different URLs when they both go to the same location. This SEO enhancement
 * prevents penalty for duplicate content by redirecting all incoming links to
 * one or the other.
 *
 * Prevents redirection for feeds, trackbacks, searches, and
 * admin URLs. Does not redirect on non-pretty-permalink-supporting IIS 7+,
 * page/post previews, WP admin, Trackbacks, robots.txt, searches, or on POST
 * requests.
 *
 * Will also attempt to find the correct link when a user enters a URL that does
 * not exist based on exact WordPress query. Will instead try to parse the URL
 * or query in an attempt to figure the correct page to go to.
 *
 * @since 2.3.0
 *
 * @global WP_Rewrite $wp_rewrite
 * @global bool $is_IIS
 * @global WP_Query $wp_query
 * @global wpdb $wpdb WordPress database abstraction object.
 * @global WP $wp Current WordPress environment instance. 
 *
 * @param string $requested_url Optional. The URL that was requested, used to
 *		figure if redirect is needed.
 * @param bool $do_redirect Optional. Redirect to the new URL.
 * @return string|void The string of the URL, if redirect needed.
 */
function redirect_canonical( $requested_url = null, $do_redirect = true ) {
	global $wp_rewrite, $is_IIS, $wp_query, $wpdb, $wp;

	if ( isset( $_SERVER['REQUEST_METHOD'] ) && ! in_array( strtoupper( $_SERVER['REQUEST_METHOD'] ), array( 'GET', 'HEAD' ) ) ) {
		return;
	}

	// If we're not in wp-admin and the post has been published and preview nonce
	// is non-existent or invalid then no need for preview in query
	if ( is_preview() && get_query_var( 'p' ) && 'publish' == get_post_status( get_query_var( 'p' ) ) ) {
		if ( ! isset( $_GET['preview_id'] )
			|| ! isset( $_GET['preview_nonce'] )
			|| ! wp_verify_nonce( $_GET['preview_nonce'], 'post_preview_' . (int) $_GET['preview_id'] ) ) {
			$wp_query->is_preview = false;
		}
	}

	if ( is_trackback() || is_search() || is_admin() || is_preview() || is_robots() || ( $is_IIS && !iis7_supports_permalinks() ) ) {
		return;
	}

	if ( ! $requested_url && isset( $_SERVER['HTTP_HOST'] ) ) {
		// build the URL in the address bar
		$requested_url  = is_ssl() ? 'https://' : 'http://';
		$requested_url .= $_SERVER['HTTP_HOST'];
		$requested_url .= $_SERVER['REQUEST_URI'];
	}

	$original = @parse_url($requested_url);
	if ( false === $original ) {
		return;
	}

	$redirect = $original;
	$redirect_url = false;

	// Notice fixing
	if ( !isset($redirect['path']) )
		$redirect['path'] = '';
	if ( !isset($redirect['query']) )
		$redirect['query'] = '';

	// If the original URL ended with non-breaking spaces, they were almost
	// certainly inserted by accident. Let's remove them, so the reader doesn't
	// see a 404 error with no obvious cause.
	$redirect['path'] = preg_replace( '|(%C2%A0)+$|i', '', $redirect['path'] );

	// It's not a preview, so remove it from URL
	if ( get_query_var( 'preview' ) ) {
		$redirect['query'] = remove_query_arg( 'preview', $redirect['query'] );
	}

	if ( is_feed() && ( $id = get_query_var( 'p' ) ) ) {
		if ( $redirect_url = get_post_comments_feed_link( $id, get_query_var( 'feed' ) ) ) {
			$redirect['query'] = _remove_qs_args_if_not_in_url( $redirect['query'], array( 'p', 'page_id', 'attachment_id', 'pagename', 'name', 'post_type', 'feed'), $redirect_url );
			$redirect['path'] = parse_url( $redirect_url, PHP_URL_PATH );
		}
	}

	if ( is_singular() && 1 > $wp_query->post_count && ($id = get_query_var('p')) ) {

		$vars = $wpdb->get_results( $wpdb->prepare("SELECT post_type, post_parent FROM $wpdb->posts WHERE ID = %d", $id) );

		if ( isset($vars[0]) && $vars = $vars[0] ) {
			if ( 'revision' == $vars->post_type && $vars->post_parent > 0 )
				$id = $vars->post_parent;

			if ( $redirect_url = get_permalink($id) )
				$redirect['query'] = _remove_qs_args_if_not_in_url( $redirect['query'], array( 'p', 'page_id', 'attachment_id', 'pagename', 'name', 'post_type' ), $redirect_url );
		}
	}

	// These tests give us a WP-generated permalink
	if ( is_404() ) {

		// Redirect ?page_id, ?p=, ?attachment_id= to their respective url's
		$id = max( get_query_var('p'), get_query_var('page_id'), get_query_var('attachment_id') );
		if ( $id && $redirect_post = get_post($id) ) {
			$post_type_obj = get_post_type_object($redirect_post->post_type);
			if ( $post_type_obj->public && 'auto-draft' != $redirect_post->post_status ) {
				$redirect_url = get_permalink($redirect_post);
				$redirect['query'] = _remove_qs_args_if_not_in_url( $redirect['query'], array( 'p', 'page_id', 'attachment_id', 'pagename', 'name', 'post_type' ), $redirect_url );
			}
		}

		if ( get_query_var( 'day' ) && get_query_var( 'monthnum' ) && get_query_var( 'year' ) ) {
			$year  = get_query_var( 'year' );
			$month = get_query_var( 'monthnum' );
			$day   = get_query_var( 'day' );
			$date  = sprintf( '%04d-%02d-%02d', $year, $month, $day );
			if ( ! wp_checkdate( $month, $day, $year, $date ) ) {
				$redirect_url = get_month_link( $year, $month );
				$redirect['query'] = _remove_qs_args_if_not_in_url( $redirect['query'], array( 'year', 'monthnum', 'day' ), $redirect_url );
			}
		} elseif ( get_query_var( 'monthnum' ) && get_query_var( 'year' ) && 12 < get_query_var( 'monthnum' ) ) {
			$redirect_url = get_year_link( get_query_var( 'year' ) );
			$redirect['query'] = _remove_qs_args_if_not_in_url( $redirect['query'], array( 'year', 'monthnum' ), $redirect_url );
		}

		if ( ! $redirect_url ) {
			if ( $redirect_url = redirect_guess_404_permalink() ) {
				$redirect['query'] = _remove_qs_args_if_not_in_url( $redirect['query'], array( 'page', 'feed', 'p', 'page_id', 'attachment_id', 'pagename', 'name', 'post_type' ), $redirect_url );
			}
		}

		if ( get_query_var( 'page' ) && $wp_query->post &&
			false !== strpos( $wp_query->post->post_content, '<!--nextpage-->' ) ) {
			$redirect['path'] = rtrim( $redirect['path'], (int) get_query_var( 'page' ) . '/' );
			$redirect['query'] = remove_query_arg( 'page', $redirect['query'] );
			$redirect_url = get_permalink( $wp_query->post->ID );
		}

	} elseif ( is_object($wp_rewrite) && $wp_rewrite->using_permalinks() ) {
		// rewriting of old ?p=X, ?m=2004, ?m=200401, ?m=20040101
		if ( is_attachment() &&
			! array_diff( array_keys( $wp->query_vars ), array( 'attachment', 'attachment_id' ) ) &&
			! $redirect_url ) {
			if ( ! empty( $_GET['attachment_id'] ) ) {
				$redirect_url = get_attachment_link( get_query_var( 'attachment_id' ) );
				if ( $redirect_url ) {
					$redirect['query'] = remove_query_arg( 'attachment_id', $redirect['query'] );
				}
			} else {
				$redirect_url = get_attachment_link();
			}
		} elseif ( is_single() && !empty($_GET['p']) && ! $redirect_url ) {
			if ( $redirect_url = get_permalink(get_query_var('p')) )
				$redirect['query'] = remove_query_arg(array('p', 'post_type'), $redirect['query']);
		} elseif ( is_single() && !empty($_GET['name'])  && ! $redirect_url ) {
			if ( $redirect_url = get_permalink( $wp_query->get_queried_object_id() ) )
				$redirect['query'] = remove_query_arg('name', $redirect['query']);
		} elseif ( is_page() && !empty($_GET['page_id']) && ! $redirect_url ) {
			if ( $redirect_url = get_permalink(get_query_var('page_id')) )
				$redirect['query'] = remove_query_arg('page_id', $redirect['query']);
		} elseif ( is_page() && !is_feed() && 'page' == get_option('show_on_front') && get_queried_object_id() == get_option('page_on_front')  && ! $redirect_url ) {
			$redirect_url = home_url('/');
		} elseif ( is_home() && !empty($_GET['page_id']) && 'page' == get_option('show_on_front') && get_query_var('page_id') == get_option('page_for_posts')  && ! $redirect_url ) {
			if ( $redirect_url = get_permalink(get_option('page_for_posts')) )
				$redirect['query'] = remove_query_arg('page_id', $redirect['query']);
		} elseif ( !empty($_GET['m']) && ( is_year() || is_month() || is_day() ) ) {
			$m = get_query_var('m');
			switch ( strlen($m) ) {
				case 4: // Yearly
					$redirect_url = get_year_link($m);
					break;
				case 6: // Monthly
					$redirect_url = get_month_link( substr($m, 0, 4), substr($m, 4, 2) );
					break;
				case 8: // Daily
					$redirect_url = get_day_link(substr($m, 0, 4), substr($m, 4, 2), substr($m, 6, 2));
					break;
			}
			if ( $redirect_url )
				$redirect['query'] = remove_query_arg('m', $redirect['query']);
		// now moving on to non ?m=X year/month/day links
		} elseif ( is_day() && get_query_var('year') && get_query_var('monthnum') && !empty($_GET['day']) ) {
			if ( $redirect_url = get_day_link(get_query_var('year'), get_query_var('monthnum'), get_query_var('day')) )
				$redirect['query'] = remove_query_arg(array('year', 'monthnum', 'day'), $redirect['query']);
		} elseif ( is_month() && get_query_var('year') && !empty($_GET['monthnum']) ) {
			if ( $redirect_url = get_month_link(get_query_var('year'), get_query_var('monthnum')) )
				$redirect['query'] = remove_query_arg(array('year', 'monthnum'), $redirect['query']);
		} elseif ( is_year() && !empty($_GET['year']) ) {
			if ( $redirect_url = get_year_link(get_query_var('year')) )
				$redirect['query'] = remove_query_arg('year', $redirect['query']);
		} elseif ( is_author() && !empty($_GET['author']) && preg_match( '|^[0-9]+$|', $_GET['author'] ) ) {
			$author = get_userdata(get_query_var('author'));
			if ( ( false !== $author ) && $wpdb->get_var( $wpdb->prepare( "SELECT ID FROM $wpdb->posts WHERE $wpdb->posts.post_author = %d AND $wpdb->posts.post_status = 'publish' LIMIT 1", $author->ID ) ) ) {
				if ( $redirect_url = get_author_posts_url($author->ID, $author->user_nicename) )
					$redirect['query'] = remove_query_arg('author', $redirect['query']);
			}
		} elseif ( is_category() || is_tag() || is_tax() ) { // Terms (Tags/categories)

			$term_count = 0;
			foreach ( $wp_query->tax_query->queried_terms as $tax_query )
				$term_count += count( $tax_query['terms'] );

			$obj = $wp_query->get_queried_object();
			if ( $term_count <= 1 && !empty($obj->term_id) && ( $tax_url = get_term_link((int)$obj->term_id, $obj->taxonomy) ) && !is_wp_error($tax_url) ) {
				if ( !empty($redirect['query']) ) {
					// Strip taxonomy query vars off the url.
					$qv_remove = array( 'term', 'taxonomy');
					if ( is_category() ) {
						$qv_remove[] = 'category_name';
						$qv_remove[] = 'cat';
					} elseif ( is_tag() ) {
						$qv_remove[] = 'tag';
						$qv_remove[] = 'tag_id';
					} else { // Custom taxonomies will have a custom query var, remove those too:
						$tax_obj = get_taxonomy( $obj->taxonomy );
						if ( false !== $tax_obj->query_var )
							$qv_remove[] = $tax_obj->query_var;
					}

					$rewrite_vars = array_diff( array_keys($wp_query->query), array_keys($_GET) );

					if ( !array_diff($rewrite_vars, array_keys($_GET))  ) { // Check to see if all the Query vars are coming from the rewrite, none are set via $_GET
						$redirect['query'] = remove_query_arg($qv_remove, $redirect['query']); //Remove all of the per-tax qv's

						// Create the destination url for this taxonomy
						$tax_url = parse_url($tax_url);
						if ( ! empty($tax_url['query']) ) { // Taxonomy accessible via ?taxonomy=..&term=.. or any custom qv..
							parse_str($tax_url['query'], $query_vars);
							$redirect['query'] = add_query_arg($query_vars, $redirect['query']);
						} else { // Taxonomy is accessible via a "pretty-URL"
							$redirect['path'] = $tax_url['path'];
						}

					} else { // Some query vars are set via $_GET. Unset those from $_GET that exist via the rewrite
						foreach ( $qv_remove as $_qv ) {
							if ( isset($rewrite_vars[$_qv]) )
								$redirect['query'] = remove_query_arg($_qv, $redirect['query']);
						}
					}
				}

			}
		} elseif ( is_single() && strpos($wp_rewrite->permalink_structure, '%category%') !== false && $cat = get_query_var( 'category_name' ) ) {
			$category = get_category_by_path( $cat );
			if ( ( ! $category || is_wp_error( $category ) ) || ! has_term( $category->term_id, 'category', $wp_query->get_queried_object_id() ) ) {
				$redirect_url = get_permalink($wp_query->get_queried_object_id());
			}
		}

		// Post Paging
		if ( is_singular() && get_query_var('page') ) {
			if ( !$redirect_url )
				$redirect_url = get_permalink( get_queried_object_id() );

			$page = get_query_var( 'page' );
			if ( $page > 1 ) {
				if ( is_front_page() ) {
					$redirect_url = trailingslashit( $redirect_url ) . user_trailingslashit( "$wp_rewrite->pagination_base/$page", 'paged' );
				} else {
					$redirect_url = trailingslashit( $redirect_url ) . user_trailingslashit( $page, 'single_paged' );
				}
			}
			$redirect['query'] = remove_query_arg( 'page', $redirect['query'] );
		}

		// paging and feeds
		if ( get_query_var('paged') || is_feed() || get_query_var('cpage') ) {
			while ( preg_match( "#/$wp_rewrite->pagination_base/?[0-9]+?(/+)?$#", $redirect['path'] ) || preg_match( '#/(comments/?)?(feed|rss|rdf|atom|rss2)(/+)?$#', $redirect['path'] ) || preg_match( "#/{$wp_rewrite->comments_pagination_base}-[0-9]+(/+)?$#", $redirect['path'] ) ) {
				// Strip off paging and feed
				$redirect['path'] = preg_replace("#/$wp_rewrite->pagination_base/?[0-9]+?(/+)?$#", '/', $redirect['path']); // strip off any existing paging
				$redirect['path'] = preg_replace('#/(comments/?)?(feed|rss2?|rdf|atom)(/+|$)#', '/', $redirect['path']); // strip off feed endings
				$redirect['path'] = preg_replace("#/{$wp_rewrite->comments_pagination_base}-[0-9]+?(/+)?$#", '/', $redirect['path']); // strip off any existing comment paging
			}

			$addl_path = '';
			if ( is_feed() && in_array( get_query_var('feed'), $wp_rewrite->feeds ) ) {
				$addl_path = !empty( $addl_path ) ? trailingslashit($addl_path) : '';
				if ( !is_singular() && get_query_var( 'withcomments' ) )
					$addl_path .= 'comments/';
				if ( ( 'rss' == get_default_feed() && 'feed' == get_query_var('feed') ) || 'rss' == get_query_var('feed') )
					$addl_path .= user_trailingslashit( 'feed/' . ( ( get_default_feed() == 'rss2' ) ? '' : 'rss2' ), 'feed' );
				else
					$addl_path .= user_trailingslashit( 'feed/' . ( ( get_default_feed() ==  get_query_var('feed') || 'feed' == get_query_var('feed') ) ? '' : get_query_var('feed') ), 'feed' );
				$redirect['query'] = remove_query_arg( 'feed', $redirect['query'] );
			} elseif ( is_feed() && 'old' == get_query_var('feed') ) {
				$old_feed_files = array(
					'wp-atom.php'         => 'atom',
					'wp-commentsrss2.php' => 'comments_rss2',
					'wp-feed.php'         => get_default_feed(),
					'wp-rdf.php'          => 'rdf',
					'wp-rss.php'          => 'rss2',
					'wp-rss2.php'         => 'rss2',
				);
				if ( isset( $old_feed_files[ basename( $redirect['path'] ) ] ) ) {
					$redirect_url = get_feed_link( $old_feed_files[ basename( $redirect['path'] ) ] );
					wp_redirect( $redirect_url, 301 );
					die();
				}
			}

			if ( get_query_var('paged') > 0 ) {
				$paged = get_query_var('paged');
				$redirect['query'] = remove_query_arg( 'paged', $redirect['query'] );
				if ( !is_feed() ) {
					if ( $paged > 1 && !is_single() ) {
						$addl_path = ( !empty( $addl_path ) ? trailingslashit($addl_path) : '' ) . user_trailingslashit("$wp_rewrite->pagination_base/$paged", 'paged');
					} elseif ( !is_single() ) {
						$addl_path = !empty( $addl_path ) ? trailingslashit($addl_path) : '';
					}
				} elseif ( $paged > 1 ) {
					$redirect['query'] = add_query_arg( 'paged', $paged, $redirect['query'] );
				}
			}

			if ( get_option( 'page_comments' ) && (
				( 'newest' == get_option( 'default_comments_page' ) && get_query_var( 'cpage' ) > 0 ) ||
				( 'newest' != get_option( 'default_comments_page' ) && get_query_var( 'cpage' ) > 1 )
			) ) {
				$addl_path = ( !empty( $addl_path ) ? trailingslashit($addl_path) : '' ) . user_trailingslashit( $wp_rewrite->comments_pagination_base . '-' . get_query_var('cpage'), 'commentpaged' );
				$redirect['query'] = remove_query_arg( 'cpage', $redirect['query'] );
			}

			$redirect['path'] = user_trailingslashit( preg_replace('|/' . preg_quote( $wp_rewrite->index, '|' ) . '/?$|', '/', $redirect['path']) ); // strip off trailing /index.php/
			if ( !empty( $addl_path ) && $wp_rewrite->using_index_permalinks() && strpos($redirect['path'], '/' . $wp_rewrite->index . '/') === false )
				$redirect['path'] = trailingslashit($redirect['path']) . $wp_rewrite->index . '/';
			if ( !empty( $addl_path ) )
				$redirect['path'] = trailingslashit($redirect['path']) . $addl_path;
			$redirect_url = $redirect['scheme'] . '://' . $redirect['host'] . $redirect['path'];
		}

		if ( 'wp-register.php' == basename( $redirect['path'] ) ) {
			if ( is_multisite() ) {
				/** This filter is documented in wp-login.php */
				$redirect_url = apply_filters( 'wp_signup_location', network_site_url( 'wp-signup.php' ) );
			} else {
				$redirect_url = wp_registration_url();
			}

			wp_redirect( $redirect_url, 301 );
			die();
		}
	}

	// tack on any additional query vars
	$redirect['query'] = preg_replace( '#^\??&*?#', '', $redirect['query'] );
	if ( $redirect_url && !empty($redirect['query']) ) {
		parse_str( $redirect['query'], $_parsed_query );
		$redirect = @parse_url($redirect_url);

		if ( ! empty( $_parsed_query['name'] ) && ! empty( $redirect['query'] ) ) {
			parse_str( $redirect['query'], $_parsed_redirect_query );

			if ( empty( $_parsed_redirect_query['name'] ) )
				unset( $_parsed_query['name'] );
		}

		$_parsed_query = rawurlencode_deep( $_parsed_query );
		$redirect_url = add_query_arg( $_parsed_query, $redirect_url );
	}

	if ( $redirect_url )
		$redirect = @parse_url($redirect_url);

	// www.example.com vs example.com
	$user_home = @parse_url(home_url());
	if ( !empty($user_home['host']) )
		$redirect['host'] = $user_home['host'];
	if ( empty($user_home['path']) )
		$user_home['path'] = '/';

	// Handle ports
	if ( !empty($user_home['port']) )
		$redirect['port'] = $user_home['port'];
	else
		unset($redirect['port']);

	// trailing /index.php
	$redirect['path'] = preg_replace('|/' . preg_quote( $wp_rewrite->index, '|' ) . '/*?$|', '/', $redirect['path']);

	$punctuation_pattern = implode( '|', array_map( 'preg_quote', array(
		' ', '%20',  // space
		'!', '%21',  // exclamation mark
		'"', '%22',  // double quote
		"'", '%27',  // single quote
		'(', '%28',  // opening bracket
		')', '%29',  // closing bracket
		',', '%2C',  // comma
		'.', '%2E',  // period
		';', '%3B',  // semicolon
		'{', '%7B',  // opening curly bracket
		'}', '%7D',  // closing curly bracket
		'%E2%80%9C', // opening curly quote
		'%E2%80%9D', // closing curly quote
	) ) );

	// Remove trailing spaces and end punctuation from the path.
	$redirect['path'] = preg_replace( "#($punctuation_pattern)+$#", '', $redirect['path'] );

	if ( !empty( $redirect['query'] ) ) {
		// Remove trailing spaces and end punctuation from certain terminating query string args.
		$redirect['query'] = preg_replace( "#((p|page_id|cat|tag)=[^&]*?)($punctuation_pattern)+$#", '$1', $redirect['query'] );

		// Clean up empty query strings
		$redirect['query'] = trim(preg_replace( '#(^|&)(p|page_id|cat|tag)=?(&|$)#', '&', $redirect['query']), '&');

		// Redirect obsolete feeds
		$redirect['query'] = preg_replace( '#(^|&)feed=rss(&|$)#', '$1feed=rss2$2', $redirect['query'] );

		// Remove redundant leading ampersands
		$redirect['query'] = preg_replace( '#^\??&*?#', '', $redirect['query'] );
	}

	// strip /index.php/ when we're not using PATHINFO permalinks
	if ( !$wp_rewrite->using_index_permalinks() )
		$redirect['path'] = str_replace( '/' . $wp_rewrite->index . '/', '/', $redirect['path'] );

	// trailing slashes
	if ( is_object($wp_rewrite) && $wp_rewrite->using_permalinks() && !is_404() && (!is_front_page() || ( is_front_page() && (get_query_var('paged') > 1) ) ) ) {
		$user_ts_type = '';
		if ( get_query_var('paged') > 0 ) {
			$user_ts_type = 'paged';
		} else {
			foreach ( array('single', 'category', 'page', 'day', 'month', 'year', 'home') as $type ) {
				$func = 'is_' . $type;
				if ( call_user_func($func) ) {
					$user_ts_type = $type;
					break;
				}
			}
		}
		$redirect['path'] = user_trailingslashit($redirect['path'], $user_ts_type);
	} elseif ( is_front_page() ) {
		$redirect['path'] = trailingslashit($redirect['path']);
	}

	// Strip multiple slashes out of the URL
	if ( strpos($redirect['path'], '//') > -1 )
		$redirect['path'] = preg_replace('|/+|', '/', $redirect['path']);

	// Always trailing slash the Front Page URL
	if ( trailingslashit( $redirect['path'] ) == trailingslashit( $user_home['path'] ) )
		$redirect['path'] = trailingslashit($redirect['path']);

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<article id="post-94" class="post-94 post type-post status-publish format-standard hentry category-uncategorized tag-administrative-law-judge tag-case-212-cv-00572-ajs tag-federal-rules-of-evidence tag-john-balko-associates tag-mac tag-medicare-appeals-council tag-medicare-audit tag-rule-702 tag-sample-size tag-scientific-standards tag-senior-healthcare-associates tag-statistical-sampling tag-testimony-by-expert-witnesses">
	
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		<h1 class="entry-title"><a href="http://www.barracloughllc.com/dir/john-balko-associates-dba-senior-healthcare-associates-v-kathleen-sebelius-secretary-u-s-department-of-health-and-human-services/" rel="bookmark">John Balko &#038; Associates d/b/a Senior Healthcare Associates v. Kathleen Sebelius Secretary U.S. Department of Health and Human Services</a></h1>
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			<span class="entry-date"><a href="http://www.barracloughllc.com/dir/john-balko-associates-dba-senior-healthcare-associates-v-kathleen-sebelius-secretary-u-s-department-of-health-and-human-services/" rel="bookmark"><time class="entry-date" datetime="2014-04-25T15:41:46+00:00">04/25/2014</time></a></span> <span class="byline"><span class="author vcard"><a class="url fn n" href="http://www.barracloughllc.com/dir/author/admin/" rel="author">admin</a></span></span>			<span class="comments-link"><a href="http://www.barracloughllc.com/dir/john-balko-associates-dba-senior-healthcare-associates-v-kathleen-sebelius-secretary-u-s-department-of-health-and-human-services/#respond">Leave a comment</a></span>
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		<p>John Balko &amp; Associates operates <a href="http://www.seniorhealthcareassociates.com/about.html" target="_blank">Senior Healthcare Associates</a> (SHA)and is located in Hermitage, Pennsylvania.    The company was audited and received a demand letter for approximately $680,000 dollars.  The case went through a number of appeals and eventually the <a href="http://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/MedicareAppealsCouncil.html" target="_blank">Medicare Appeals Council</a> (<a href="http://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/MedicareAppealsCouncil.html" target="_blank">MAC</a>) ruling was appealed for review by a <a href="http://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/FederalCourtReview.html" target="_blank">Federal District Court</a>.</p>
<p>This is a case filed April 30, 2012 in the <a href="https://www.pawd.uscourts.gov/" target="_blank">United States District Court for the Western District of Pennsylvania</a>.  (The <a href="http://www.pacer.gov/" target="_blank">PACER</a> number is <a href="https://ecf.pawd.uscourts.gov/cgi-bin/HistDocQry.pl?862013030927306-L_1_0-1" target="_blank">Case 2:12-cv-00572-AJS</a>)  The case went through several stages prior to being appealed.  (See figure.)</p>
<p><a href="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_CHRONOLOGY.001.png"><img class="aligncenter size-full wp-image-96" alt="BALKO_CHRONOLOGY.001" src="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_CHRONOLOGY.001.png" width="1024" height="768" srcset="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_CHRONOLOGY.001.png 1024w, http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_CHRONOLOGY.001-300x225.png 300w" sizes="(max-width: 1024px) 100vw, 1024px" /></a></p>
<p><em>Source: </em>Memorandum Opinion re: Parties&#8217; Cross-Motions for Summary Judgment, files 12/28/2012, and <a href="http://www.barracloughllc.com" target="_blank">Barraclough</a> analysis.</p>
<p>A number of arguments were made that established clearly that the statistical work was faulty, and from a scientific point of view was completely invalid.</p>
<p style="text-align: left;"><a href="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_1.001.png"><img class="aligncenter size-full wp-image-98" alt="BALKO_ARGUMENTS_1.001" src="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_1.001.png" width="1024" height="768" srcset="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_1.001.png 1024w, http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_1.001-300x225.png 300w" sizes="(max-width: 1024px) 100vw, 1024px" /></a><a href="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_2.001.png"><img class="aligncenter size-full wp-image-99" alt="BALKO_ARGUMENTS_2.001" src="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_2.001.png" width="1024" height="768" srcset="http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_2.001.png 1024w, http://www.barracloughllc.com/dir/wp-content/uploads/2014/04/BALKO_ARGUMENTS_2.001-300x225.png 300w" sizes="(max-width: 1024px) 100vw, 1024px" /></a><a href="http://www.pawd.uscourts.gov/pages/schwab.htm" target="_blank">Arthur J. Schwab</a> the United States District Judge wrote in his opinion <em>&#8220;Balko is not entitled to the best possible statistical sample of claims that it submitted . . . Instead, Balko is only entitled to a statistically valid random sample.&#8221;  </em>(Memorandum Opinion, p. 23.)</p>
<p>Question:  Is a &#8220;statistical valid random sample&#8221; one that is so poor that it lacks any scientific credibility?</p>
<p>What has happened in this case does not bode well for health care providers.   Here, statistical work that is demonstrably faulty and inferior and definitely <em>not</em> scientifically valid has been signed off on by the <a href="http://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/MedicareAppealsCouncil.html" target="_blank">Medicare Appeals Council</a> (<a href="http://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/MedicareAppealsCouncil.html" target="_blank">MAC</a>), and by the Federal Court that reviewed the case.</p>
<p>This type of sloppy scientific work <em>never</em> would be accepted in any other type of case before a Federal Court in which scientific evidence is evaluated in conformity with <a href="http://www.law.cornell.edu/rules/fre/rule_702" target="_blank">Rule 702</a> &#8220;<a href="http://www.law.cornell.edu/rules/fre/rule_702" target="_blank">Testimony by Expert Witnesses</a>&#8221; of the <a href="http://www.law.cornell.edu/rules/fre" target="_blank">Federal Rules of Evidence</a>.   The question is why is this type of poor and inadequate scientific work OK for audits of health care providers but not OK anywhere else?</p>
<p><a href="http://www.barracloughllc.com" target="_blank">Barraclough NY LLC</a> supplies experts for litigation support in Medicare and Medicaid appeals cases.</p>
<p><a href="https://ecf.pawd.uscourts.gov/cgi-bin/HistDocQry.pl?862013030927306-L_1_0-1" target="_blank">Documents reviewed</a>:</p>
<p>John Balko &amp; Associates d/b/a Senior Healthcare Associates, Plaintiff, v. Kathleen Sebelius Secretary U.S. Department of Health and Human Services, defendant. United States District Court for the Western District of Pennsylvania.  Case 2:12-cv-00572-AJS.</p>
<ol>
<li><a href="https://ecf.pawd.uscourts.gov/doc1/15703221289" target="_blank">Complaint</a> (Filed 04/30/12)</li>
<li><a href="https://ecf.pawd.uscourts.gov/doc1/15713379805" target="_blank">Answer to Complaint</a> (Filed 08/20/2012)</li>
<li><a href="https://ecf.pawd.uscourts.gov/doc1/15713503891" target="_blank">Brief in Support of Motion</a> [for Summary Judgment] (Filed 11/15/2012)</li>
<li><a href="https://ecf.pawd.uscourts.gov/doc1/15713525946" target="_blank">Brief in Opposition to Motion</a> (Filed 12/04/12)</li>
<li><a href="https://ecf.pawd.uscourts.gov/doc1/15713504185" target="_blank">Concise Statement of Material Facts</a> (filed 11/16/12)</li>
<li><a href="https://ecf.pawd.uscourts.gov/doc1/15713558683" target="_blank">Memorandum Opinion re: Parties&#8217; Cross-Motions for Summary Judgment</a> (Filed 12/28/2012)</li>
<li><a href="https://ecf.pawd.uscourts.gov/doc1/15713558712" target="_blank">Judgment</a> (Filed 04/08/14)</li>
<li><a href="http://www2.ca3.uscourts.gov/opinarch/131568np.pdf" target="_blank">Opinion of the Court</a> (Filed 02/12/2014)</li>
</ol>
<p>Note: There is <a href="http://www.lexology.com/library/detail.aspx?g=0c3bd2a1-4049-4884-866b-c150404035f3" target="_blank">another write-up of this ruling</a> by <a href="http://www.kslaw.com/people/Paige-Fillingame" target="_blank">Paige Fillingame</a> at <a href="http://www.kslaw.com/" target="_blank">King &amp; Spalding LLP</a> with a <a href="http://www2.ca3.uscourts.gov/opinarch/131568np.pdf" target="_blank">free link to the ruling</a>.</p>
<p>&nbsp;</p>
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