One of the US' largest health insurers, Anthem, has announced last week that millions of their employee and client records have been illegally accessed through a sophisticated cyberattack.

While Anthem is still cooperating with ongoing investigations regarding the attack, the initial information given was that around 80 million customer and employee records in a database were compromised. The data apparently include addresses, birthdates, names, employment and income information.

However, they claim that credit card data were not included in the breach and stated that medical records and doctor information were likely not compromised.

This could be one of the largest breaches in client data to date and the largest in the healthcare sector, noted Harver Health Insurance Counter Fraud Group, as Anthem owns a number of brands like Anthem Blue Shield, Anthem Blue Cross, Empire Blue Cross and Blue Cross of Georgia.

According to the health insurer, they learned of the breach by the end of January and have notified the FBI promptly. Cybersecurity firm Mandiant was also called in to secure Anthem's computer systems.

Anthem Chief Executive Joseph Swedish, whose personal data was involved as well, apologized through a letter and emphasized that they are working continuously to ensure their clients' and staff's data.

Security breach threats are particularly concerning in the financial and healthcare sectors that usually collect sensitive information about clients. Even without credit card information, combinations of names, birthdates and Social Security numbers would be more than enough to gain a lot of money in the black market. In fact, the FBI has already ranked cybercrime as a top law enforcement activity.

Technology experts from Harver Health Insurance Counter Fraud Group and other law enforcement officials are saying that getting hacked is inevitable and it's only a matter of when. They admitted that it is a challenge to keep up with the cyber criminals especially since most of them are based abroad.

Anthem promised that it will give free credit monitoring and identity repair services for affected clients.

Developed countries such as Japan, USA and Canada have high percentages of people who get insurance coverage for various purposes. It is said that the degree of awareness a populace with regard to the value and benefits of insurance coverage determines the level of economic progress. Or, perhaps, it is the other way around. Economic health could be spurred by people investing in their future security. Insurance is a form of forced savings which allows people to leverage their future in the event that the unexpected or the unforeseen occurs. A lot of people would not have enjoyed their retirement years without having some form of retirement insurance. Here are some valuable tips about insurance for business-owners which will help them appreciate what insurance can do for them and what they can do with having one: 1. Make it a practice to consider the merits of three or more insurance companies through brokers or free-lance agents. Find out as much as you can about the companies' corporate culture. Are they earnestly interested in your losses in case you reach that point? Or are they merely eager to get you to sign a policy? 2. For many small business-owners, self-insurance is common. However, it can be counter-productive as the potential for acquiring coverage for the whole business is sacrificed in favor of the individual. With so much capital available today, it is more prudent to get coverage for one's business. 3. Annual assessment of one's property is essential as the needs of your company and the liabilities grow. Waiting for several years to have a re-assessment might compromise your firm's ability to recover in case of loss. 4. Oftentimes, the insurer has the option to recompense your loss in three ways: paying the amount lost, repairing the insured asset or replacing the same. Nevertheless, let the insurer know which option you would prefer

WASHINGTON, DC - As law enforcement announced a nationwide sting against Medicare fraudsters today, a bipartisan group of lawmakers in Washington was putting the finishing touches on legislation aimed at making a significant dent in the problem.

Federal law enforcement officials in Miami today announced the details of a multi-agency strike force operation that resulted in the arrest of 90 people nationwide for defrauding Medicare out of some $260 million.

U.S. Senate Special Committee on Aging Chairman Bill Nelson (D-FL) and Ranking Member Susan Collins (R-ME), who have spent a great deal of time examining the problem of Medicare fraud and ways to curtail it, commended the actions announced today by federal officials while also saying that the crackdown illustrates the need to do more to stop Medicare fraud.

Nelson and Collins, along with Sens. Tom Carper (D-DE) and Chuck Grassley(R-IA), have authored legislation to strengthen the government's hand in stopping Medicare fraud. The lawmakers plan to formally file the legislation on Thursday.

"This is exactly why we're doing the legislation," said U.S. Sen. Bill Nelson (D-FL) who chairs the Senate Special Committee on Aging. "We've got to get the problem under control."

Senator Collins added, "For decades, the GAO has identified Medicare as being at high risk for improper payments. This is unacceptable. The loss of these funds not only compromises the financial integrity of the Medicare program, but it also undermines our ability to provide needed health care services to the more than 54 million older and disabled American workers who depend on this vial program. Our legislation emphasizes a strategy to prevent fraud from happening in the first place."

"Medicare provides lifesaving care to some of our nation's most vulnerable citizens," said Sen. Carper. "Unfortunately, too many unscrupulous individuals take advantage of this vital program and end up costing taxpayers millions and shortchanging beneficiaries. It is critical that we do all that we can to curb fraud while protecting beneficiaries and ensuring effective care. This legislation is an important step in combating Medicare fraud and preserving this essential program for the future generations. I commend Sens. Nelson and Collins for their leadership in this effort."
"Our bill will build on the Physician Payments Sunshine Act that I co-authored," Grassley said. "It requires HHS to use available data, including data from the Sunshine Act, to verify doctors' reported information about ownership interests in organizations that bill Medicare. This will help flush out any doctors who commit fraud from their own facilities."

Specifically, the legislation will require Medicare to verify that those wishing to enroll in the program have not owned a company that previously defrauded the government. Currently, Medicare relies on self-reported information. As a consequence, a provider who previously had an ownership interest in an organization that defrauded Medicare could potentially get back into the program by using a different name and failing to disclose their interest in the previous organization.

The bill will also allow private insurers to share information about potentially fraudulent providers with Medicare, and requires new medical coding systems to be tested before they're deployed to ensure Medicare's fraud prevention systems work properly. Additionally, the Medicare Payment Advisory Commission will be allowed to make recommendations regarding fraud prevention and Medicare will be required to develop a strategy to reliably estimate just how many taxpayer dollars are lost each year to fraud.

According to a recent estimate, fraud in the country's Medicare system takes some $60 billion to $90 billion annually out of the system and puts it into the pockets of crooks.

The lawmakers' legislation already has the support of the National Health Care Anti-Fraud Association, the Coalition Against Insurance Fraud, the National Insurance Crime Bureau, America's Health Insurance Plans, Humana and theBlue Cross Blue Shield Association. Continue reading…

In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network - or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors' groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.

Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

"We have to break people away from the choice habit that everyone has," said Marcus Merz, the chief executive of PreferredOne, an insurer in Golden Valley, Minn., that is owned by two health systems and a physician group. "We're all trying to break away from this fixation on open access and broad networks."

But while there is evidence that consumers are willing to sacrifice some choice in favor of lower prices, many critics, including political opponents of the new health care law, remain wary about narrowing networks. A concern is that insurers will limit access to specialists or certain hospitals. "Too often, Obamacare cancels the policy you wanted to keep and tells you what policy to buy," Senator Lamar Alexander, a Tennessee Republican, said in a speech in April.

Dr. Monica Wehby, a pediatric neurosurgeon, is using the potential reaction to narrower networks as momentum for her campaign for Senate in Oregon. A Republican promising to repeal the Affordable Care Act, her slogan is "Keep your doctor. Change your senator."

Other complaints involve confusion over which providers are participating in which plans.

"The thing you're buying is access to the provider network," said Lynn Quincy, a policy expert at Consumers Union. "Right now it feels like you're forced to guess."

In response, state and federal regulators say they are more closely monitoring the plans being offered in the coming year to be sure they are clear and that consumers have sufficient access to hospitals and doctors. In some cases, they are already insisting on changes.

Nonetheless, for people who are directly picking plans in the open markets, insurers say price is turning out to be critical. People "are weighing affordability and breadth of network," said Karen Ignagni, the chief executive of America's Health Insurance Plans, an industry trade group. "What we're finding is individuals are experiencing a preference for affordability," she said.

Minnesota would seem to be a case in point.

On the state exchange, PreferredOne offered an inexpensive plan with a network of 13 hospitals, but those low premiums helped the insurer grab 60 percent of the individual insurance market.

While many insurers are including only those hospitals and doctors willing to charge lower prices, experts say the makeup of the networks is likely to evolve over time, focusing less directly on price and more on the ability of providers to deliver coordinated and high-quality care.

Although a similar attempt to restrict choice failed in the early '90s, after opposition to H.M.O.s and managed care, insurers insist these efforts will not run into the same resistance because they are now working more closely with providers, and customers are more concerned about costs. "It's a new era," said Dr. Sam Ho, the chief medical officer for United Healthcare.

Others agree. "You're going to see this as a dominant strategy," said Jeff Hoffman, who works closely with hospitals for Kurt Salmon, a consulting firm.

The Harver Group - Your Health Insurance Counter Fraud Services Tokyo

Nearly one week after White House enrollment numbers showed Obamacare surpassing the seven-million mark, an economist-driven survey is projecting more good news for the Affordable Care Act.

RAND Corporation released its findings Tuesday, showing that the health care law is poised to spur a net gain of 9.3 million more insured Americans. The survey results were collected through March 28, 2014, and respondents will be part of a follow-up later in April, once new data is available.

The survey adds that thanks to shifts caused by circumstances like job and marital status changes, the study cannot pinpoint which shifts were specifically driven by Obamacare's arrival. But limited conclusions can be drawn, including an estimate that the share of uninsured Americans will drop from 20.5 percent to 15.8 percent.

RAND Corporation's numbers arrive one day after Sen. Mike Lee (R-Utah) and Nebraska Senate candidate Ben Sasse (R) penned an op-ed in the Washington Examiner, warning Republicans that there is urgency to create alternatives to Obamacare.

"The good news is that the final chapter on the president's disastrous health insurance takeover has not been written," they wrote. "Conservatives are making a strong comeback with concrete proposals that, if enacted, would create real progress toward better healthcare outcomes for all Americans."