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Rose McGowan

Health Insurance Giants To Unveil Price Information In 2015 - 1 views

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    A nonprofit organization the three work with known as Health Care Cost Institute, a nonpartisan research organization, said the insurance companies will develop and provide consumers "free access to an online tool that will offer consumers the most comprehensive information about the price and quality of health care services." Additional health plans could soon join Aetna, Humana and UnitedHealth in the effort. The move by the insurance companies comes as more Americans gain health care coverage under the Affordable Care Act. Meanwhile, these newly insured Americans and those already with coverage are demanding more information about the cost of care as deductibles and co-payments rise and they pay more out of their own pockets for medical services and treatments. "This unprecedented initiative is testament to our belief that educated consumers benefit the entire health care system," UnitedHealth Group said in a statement to Forbes. The information on prices will also include information about quality and other information in an effort to help health care become more transparent. "Consumers, employers and regulatory agencies will now have a single source of consistent, transparent health care information based on the most reliable data available, including actual costs, which only insurers currently have," David Newman, the Health Care Cost Institute's executive director said in a statement issued this morning. There will be three tiers of information provided. In one tier, any consumer will get average price information for an "episode of care" such as a knee replacement or heart surgery based on complex coding and claims data submitted to and analyzed by the Institute. In another tier, consumers with coverage from Aetna, Humana or UnitedHealth Group will get more detailed price information given the health plan subscribers in their plans already have a relationship with the companies and therefore more specific information on their networ
Rose McGowan

READER'S VIEWS: Enabling or blocking health insurance fraud - Westhill Consulting Insur... - 1 views

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    When the subject of health insurance is discussed someone raises the argument that because Medicare or Medicaid are government programs, they are subject to fraud. This is usually an objection from politicians who support Free Enterprise and fear Big Government. Let's be honest with ourselves, any human event that involves something of value attracts fraudsters. A bank robber, a hacker, a big company submitting false claims; all fall into the category of fraud. Any googling of Medicare fraud brings up some infuriating examples. For example, health care industry giant HCA (which the New York Times notes was bought by Bain Capital in 2006) eventually settled a Medicare fraud scandal (overcharging) for more than $1.7 billion. Or, last May the feds arrested 107 health care providers, including doctors and nurses, in several cities and charged them with cheating Medicare out of $452 million. In 2010, 94 people were charged with submitting $251 million in phony claims. Fraud isn't the product of scheming low-income beneficiaries - Mitt Romney's 47 percent - it is most often committed by big companies and rich doctors, not a patient seeking a second colonoscopy. We should admit that fraud is endemic to the insurance business, whether public or private. The Coalition Against Insurance Fraud estimates that in 2006 a total of about $80 billion was lost in the United States due to insurance fraud. According to estimates by the Insurance Information Institute, insurance fraud accounts for about 10 percent of the property/casualty insurance industry's incurred losses and loss adjustment expenses. So, how to tackle any fraud. Putting more police on the streets is an acceptable way of reducing crime. Private industry is free to hire as many investigators and accountants as it takes to catch fraudsters.
Rose McGowan

'Fraud' and 'cover-up' exposed in failing semi-privatised Irish healthcare - Westhill C... - 1 views

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      Image: Pharmaceuticals. Flickr/Waleed Alzuhair. Some rights reserved.   Commerce has corrupted healthcare in the Irish semi-privatized insurance-based system.   Late last year Senator John Crown revealed under parliamentary privilege in Ireland's Senead that his own hospital, St. Vincent's University Hospital in Dublin, had in 2002 billed the country's largest private health insurer €1 million for the drug trastuzumab (Herceptin). But the drug had in fact been supplied to the hospital free by pharmaceutical giant Roche, as part of clinical trials for women with breast cancer.   This was not an inadvertent error as the hospital claimed, said Senator Crown, but deliberate financial fraud, which the hospital board had spent perhaps tens of thousands trying to cover up, employing 'substantial intimidation' to bury the matter.   Senator Crown is also Professor Crown, arguably Ireland's most distinguished oncologist. He had been told of the fraud in 2002 and at once notified all relevant health authorities.   An investigation started, and then stopped in its tracks. The hospital argued it had not known about this major research program me taking place on its premises.   The debacle had ended with the suspension of the drugs trial for a year, jeopardising the lives of women with breast cancer who might otherwise have participated in this important trial
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