Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

[EX Q]: Paragraph: "South Florida has a reputation as a place ripe for fraud and crime -- including bilking the government. State Rep. Ron Saunders, the Democratic minority leader from Key West, has slapped a more specific label on a costly problem in South Florida: Medicaid fraud. ""The two worst counties for fraud in the country -- not state -- are Dade and Broward county,"" he told a roomful of reporters on Jan. 19, 2011, during an Associated Press preview of Florida's upcoming legislative session. It's easy to find news articles describing South Florida as a mecca for such fraud -- with labels such as ""ground zero"" or mind-boggling tales of abuse. But the word ""worst"" caught our eye -- are the South Florida counties of Miami-Dade and Broward truly the ""worst"" in the country for Medicaid fraud? Medicaid, a health care program for low-income individuals, is administered by the states and receives some federal funding. The Truth-O-Meter has weighed in multiple times on fact-checks related to the high cost and growth of Medicaid, including a claim by Pam Bondi, now Florida's attorney general, and Bill McCollum, Florida's previous attorney general. For more background, check out this website of the federal Centers for Medicare and Medicaid Services. We spoke to Saunders directly on Jan. 20, who told us that his statement was in response to a question about how to resolve the state's budget crisis. Saunders said it's a ""no-brainer"" to cut back on fraud such as in Medicare and Medicaid rather than make more cuts in areas such as education. But after a lot of calls and research, we can say one thing for certain: Nobody tracks county-by-county Medicaid fraud nationally. Even within Florida, a county breakdown is not available. So we're going to rely on expert opinions and documented trends in this ruling. Mark Hollis, spokesperson for the House Democratic caucus, sent us links to newspaper articles and government reports about Medicaid fraud in South Florida. Among the sources Hollis cited was a March 2009 article in Health News Florida, quoting state Sen. Don Gaetz saying: ""Since we have the worst problem in the nation, we need the most effective solution."" Hollis also sent us a December 2005 article in HomeCare, an industry publication, quoting FBI agent Michael Clemens, who was in charge of the Miami field office at the time, saying: ""South Florida is ground zero for health care fraud."" But neither article provides any documentation to support that ""worst"" label. Hollis also sent us links to a House bill and recent government reports about Medicaid fraud. House Bill 1487 in 2009, which labeled Miami-Dade an area of ""special concern,"" was intended to rein in Medicaid fraud. The Senate version, Senate Bill 2658, was signed into law in June 2009. The staff analysis outlined the rampant growth in home health care agencies in Florida: Of the 431 licensure applications in 2007, 58.5 percent were in Miami-Dade. In that county, the number of licensed agencies grew 414 percent between August 1999 and March 6, 2009. The analysis also stated that ""While Miami-Dade has about 20 percent of Florida’s Medicaid population and about 33 percent of Florida’s residents over the age of 60, 91 percent of the state reimbursement for certain home health services were going to Miami-Dade."" While the bill analysis doesn't provide data ranking all of Florida's counties, it certainly suggests that Miami-Dade has an overwhelmingly disproportionate share of Medicaid dollars -- and fraud. Florida's Agency for Health Care Administration, which administers the Medicaid program, has a report from 2009-10 that also provides some insight. Although the 94-page report does not describe Broward and Miami-Dade as the worst in the nation, it noted:  • ""Home health agencies have been an acknowledged area of health care fraud in recent years. For the four fiscal years ending June 30, 2009, approximately 90 percent of Medicaid expenditures for home health aide visits were made to providers in Miami‐Dade County, while only about 20 percent of Medicaid recipients reside in that area. At the end of the fiscal year, there were 339 home health agencies in Miami‐Dade County actively enrolled in the Medicaid program and only 293 in the other 66 counties combined."" (Page 53)  • Statutes were changed in 2008 and 2009 to address home-health fraud. Forty-seven licensure denials for home health agencies were upheld in FY 2009-10 for fraud-related reasons. Thirty-one of the denials (66 percent) were in Miami-Dade County. (Page 65)  We reached out to several agencies that have a role in Medicaid. Both the Florida Attorney General, which has a Medicaid Fraud Control Unit, and AHCA said they had no nationwide county-by-county information to support or refute Saunders' claim. Don White, spokesman for the Office of Inspector General for the U.S. Department of Health and Human Services, also told us that the federal government has ""no statistics on Medicaid fraud."" As for Saunders' claim that Dade and Broward are the ""worst"" in the country, White said: ""Do we have the numbers? No. Is he probably correct? Yes."" We ran Saunders' claim by Alan Levine, a former secretary at AHCA under Gov. Jeb Bush and an expert on Medicaid. ""I have absolutely no doubt South Florida is among the highest,"" Levine wrote in an e-mail. ""Others that likely run in the same circle are New York and New Jersey. But South Florida, from all the experience I have, clearly leads the way."" Levine sent us a 2009 report, ""Stop Paying the Crooks,"" by the Center for Health Transformation, an organization founded by former House Speaker Newt Gingrich. It stated that the U.S. Department of Justice labeled ""South Florida -- and more specifically, Miami-Dade County --Ground Zero for health care fraud in America."" But no numbers ranking counties nationwide. We sent Saunders' claim to Craig Smith, the attorney who wrote the South Florida chapter, who works at Hogan Lovells law firm in Miami. ""Whatever the exact figure is, there can be no question that the bulk of the fraud, waste and abuse is occurring in Miami-Dade and Broward counties,"" Smith wrote to us in an e-mail Feb. 1. ""Based on the size of Florida's Medicaid program, you can fairly eliminate about 45 states from the comparative discussion."" So let's review: Saunders said that ""The two worst counties for (Medicaid) fraud in the country -- not state -- are Dade and Broward county."" We could not find any government office that could point to numbers ranking counties across the nation in terms of Medicaid fraud. But we found four experts -- one from the federal Department of Health and Human Services Office of Inspector General, one a former secretary of the state's AHCA, a spokesperson from a national organization that provides information on health care fraud and an attorney who specializes in health care law -- who all agree that Saunders is likely right. At PolitiFact Florida, we dig for data to support claims by politicians -- and Saunders and our experts haven't provided hard numbers to prove him right. But the fact that four experts -- including one appointed by a Republican governor -- generally back up the Democratic minority leader or say that the two counties are at least among the worst in the nation carries weight with us." Claim: The two worst counties for (Medicaid) fraud in the country -- not state -- are Dade and Broward county.
[EX A]: Ron Saunders says Miami-Dade, Broward rule the country in Medicaid fraud

[EX Q]: Paragraph: "Residents of some Baltimore neighborhoods are no better off than people living in impoverished North Korea and the violent West Bank, Bernie Sanders said during a campaign rally in Maryland ahead of that state’s primary. ""Poverty in Baltimore, and around this country — poverty is a death sentence,"" Sanders said April 24. He then laid out some rather unflattering and harsh comparisons: ""Fifteen neighborhoods in Baltimore have lower life expectancies than North Korea. Two of them have a higher infant mortality rate than the West Bank in Palestine. Baltimore teenagers between the ages of 15 and 19 face poorer health conditions and a worse economic outlook than those in distressed cities in Nigeria, India, China and South Africa. We are talking about the United States of America in the year 2016 — a country in which the top 1/10th of 1 percent now owns almost as much wealth as the bottom 90 percent."" While it would be wrong to take Sanders’ claim to mean that conditions overall are worse than Baltimore, we found that his specific comparisons are largely accurate. ""The comparisons fairly make the point that there are some parts of this rich country where conditions resemble those in much poorer countries,"" said Alan Berube, an expert on urban poverty at the Brookings Institution. ""This isn't isolated to Baltimore; there are neighborhoods in nearly every big U.S. city and metropolitan area, and many rural communities, that perform just as poorly on these outcomes."" Let’s take Sanders’ claims one by one. Life expectancy in North Korea The Sanders campaign referred us to a Washington Post article noting that 14 Baltimore neighborhoods had shorter life expectancies than North Korea in 2013. (The article originally said 15 but was corrected.) His number is slightly outdated. In 2014, the latest year where there’s data on both places, the average life expectancy in North Korea was 69.81 years, according to the CIA World Factbook. That placed the impoverished dictatorship at No. 155 in longest lifespans out of 224 countries. The United States overall ranked at No. 42 with 79.56 years. Residents in 12 of Baltimore's 56 neighborhoods lived shorter lives, according to data from the Baltimore City Health Department provided to the Baltimore Neighborhood Indicators Alliance. That’s not 15, but it’s close. (For context, just five Baltimore neighborhoods have life expectancies higher than the U.S. national average, and four of them are relatively affluent and white.) Here’s a map from the University of Maryland’s Capital News Service that compares the life expectancies of Baltimore neighborhoods in 2013 to other places in the world:  An important caveat: The city of Baltimore has a total population around 600,000 people while North Korea has a population 40 times that. That means fewer events in Baltimore neighborhood could swing the overall life expectancy of a neighborhood up or down. Infant mortality in the West Bank For this claim, the Sanders campaign referred us to a Vox article that said two neighborhoods in Baltimore — Little Italy and Greenmount East — had a higher rate of infant mortality than the West Bank, Honduras and Venezuela in 2013. But in his speech, Sanders only mentioned the West Bank. In 2014, 13.49 out of 1,000 babies died before their first birthday in the notorious conflict zone, according to the CIA’s World Factbook. The West Bank places in the middle of the pack in infant mortality at No. 117 out of 224 countries. The United States, meanwhile, ranked at No. 169 with a rate of 6.17 deaths per 1,000. In 2014, 11 Baltimore neighborhoods had a higher rate than the West Bank. In Hilltop and Little Italy, at least 20 out of 1,000 infants died before their first birthday. That’s not only higher than the West Bank, Honduras and Venezuela but also war-torn Syria and oppressive Uzbekistan. Teen health in distressed cities in developing countries Sanders claimed that ""Baltimore teenagers between the ages of 15 and 19 face poorer health conditions and a worse economic outlook than those in distressed cities in Nigeria, India, China and South Africa."" The Sanders campaign cited a Washington Post article by Johns Hopkins University researchers. ""Teenagers in Baltimore face poorer health and more negative outlooks than those in urban centers of Nigeria, India and China,"" they write. Contrary to what Sanders said, the work by the Johns Hopkins researchers don’t consider economic outlooks nor do they show Baltimore conditions being worse than South Africa’s. Nonetheless, his broader point is accurate. The researchers published a comprehensive set of studies published in the Journal of Adolescent Health in 2014 that compared the well-being of teens in impoverished areas in Baltimore; Ibadan, Nigeria; Johannesburg, South Africa; New Delhi, India; and Shanghai, China. Baltimore teens reported the highest rates pregnancy and, after Johannesburg, the second highest rates of substance use, sexual and physical violence, and feeling unsafe in their community:  Our ruling Sanders presented a series of comparisons showing that conditions in some parts of Baltimore rivaled that of ""the West Bank in Palestine,"" ""North Korea,"" and ""distressed cities in Nigeria, India, China and South Africa. Some of Sanders’ figures need to be updated, but the gist of his specific comparisons are accurate: 12 Baltimore neighborhoods have a lower life expectancy than North Korea; 11 have a higher infant mortality rate than the West Bank; and research shows health conditions are worse for poor teens than in Baltimore than in Ibadan, New Delhi and Shanghai." Claim: "Bernie Sanders Says an array of statistics show that conditions in some parts of Baltimore rival that of ""the West Bank in Palestine,"" ""North Korea,"" and ""distressed cities in Nigeria, India, China and South Africa."
[EX A]: "Sanders presented a series of comparisons showing that conditions in some parts of Baltimore rivaled that of ""the West Bank in Palestine,"" ""North Korea,"" and ""distressed cities in Nigeria, India, China and South Africa. Some of Sanders’ figures need to be updated, but the gist of his specific comparisons are accurate: 12 Baltimore neighborhoods have a lower life expectancy than North Korea; 11 have a higher infant mortality rate than the West Bank; and research shows health conditions are worse for poor teens than in Baltimore than in Ibadan, New Delhi and Shanghai."

[EX Q]: Paragraph: Both stories we reviewed discussed costs, but the LA Times provided more details. “They can be lifesaving in appropriate patients. The devices cost $20,000 to $30,000, and normal hospitalization expenses can bring the total cost to $40,000 or more.” A bit more information would have provided a more complete picture. While the cost per patient is high, the true economic picture is more complicated. In reality, the cost of ICD in appropriate patients rivals those of the treatment of high blood pressure and elevated cholesterol in terms of life years saved. The story quantifies the potential benefits of following the guidelines for implants in a couple of different ways. “Deaths in the hospital among patients receiving defibrillators outside the guidelines were 0.57%, compared with 0.18% among those who received them within the guidelines. About 3.23% of those receiving the devices outside guidelines had complications, compared with 2.41% of those within guidelines. The median length of a hospital stay was three days for those outside the guidelines, compared with one day for those within them.” High in the story, the LA Times explains that unnecessary defibrillators increased the risk of harm, but it also put in some important context. “Although the absolute risk of dying is still low — less than 1% — such patients also endure longer hospitalizations and other complications and add substantially to the nation’s healthcare costs, researchers from the Duke Clinical Research Institute in Durham, N.C., reported in the Journal of the American Medical Assn.” The story also quantifies harms later in the piece. The story does a good job examining the evidence with the help of some outside experts. One of the best parts of the story, in comparison with the Wall Street Journal blog, is how this story explains why certain patients didn’t meet the guidelines for the implants. The story does so in clear terms, unlike the Journal. “The team found that 25,145 of the implants were for causes that were not covered by the guidelines. Of those, 9,257 were in patients who had had a heart attack within 40 days and 15,604 were in patients with newly diagnosed heart failure. These problems fall outside the guidelines because they have not been studied in clinical trials of the devices or because clinical trials have shown that the devices are not effective in treating them.” We wish the story had taken advantage of the accompanying editorial. In reality, only one of the criteria (severe heart failure) is an absolute and only includes about 2.5% of the ICD implanted patients. The other patients who did not meet criteria did so because of the timing of the implant. Not all patients who have a heart attack or who undergo coronary artery surgery will eventually need an ICD. Many however are left with a sufficiently damaged heart to meet criteria. So, while the story does a good job reporting on the study, it really does not go as far as we would have liked in its interpretation. The story does not engage in disease-mongering, far from it. The story provides good insights and context from outside sources, including Dr. Shephal Doshi and Dr. Robert Ruelaz. We wish the story had pointed out, as the Wall Street Journal blog did, that the study was funded by Medtronic, which makes one of these devices. That is important context for readers. Without it, we feel this story does not meet this criteria. And, as already noted above, we often wonder, as we did in this case, why the accompanying journal editorial wasn’t cited. The story does not offer a comparison of the implants to other treatments. Even a line about other approaches may have satisfied this criterion. Unlike the WSJ blog post we reviewed, this story pointed out the massive scope of this study and, thus, the widespread use of these implants. “The researchers examined a registry of implants maintained by the American College of Cardiology that covers an estimated 95% of all U.S. implants. The team studied 111,707 implants for what is called primary prevention, performed between January 2006 and June 2009. Primary prevention is for patients who had not had a recent heart attack or a problem with the bottom chambers of the heart.” This story points out, as the WSJ blog story failed to do, that this same team of researchers had previously studied the underuse of these implants. “In previous studies, Al-Khatib and her colleagues have examined underuse of the devices and found that many patients who could benefit from the defibrillators did not get them. This time, she said, “we decided to look at the flip side.”” This speaks to the novelty and the importance of the devices in the population of patients who meet the guidelines. The story does not rely on a news release. Claim: Study finds overuse of implanted defibrillators
[EX A]:
This story about a study on the overuse of implanted defibrillators packs in more information than many competing stories and hits nearly all of our marks, giving readers good context and a clear understanding of the study and its implications. We would have liked to have seen a bit more background information on the registry and on the guidelines. We are mystified by the lack of attention to the accompanying editorial in the journal that places the study into an important frame of reference and provides a good counter balance. The study in question examined data collected from a national registry on over 100,000 patients and concluded that 1/5 of the implants were outside existing guidelines. This number is troubling at face value but the story appears to be a bit more complicated. The accompanying editorial places the results in a slightly different perspective. Of the four criteria examined, only one (placement of the ICD in patients with severe heart failure) is an absolute. The other three criteria are related purely to timing and not to whether the device is of value. This nuance was not clarified in the story.