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MEDICAL science is hazy about many things, but doctors agree that if a patient is losing pints of blood all over the carpet, it is a good idea to stanch his wounds. The same is true of a health-care system. If crooks are bleeding it of vast quantities of cash, it is time to tighten the safeguards. In America the scale of medical embezzlement is extraordinary. According to Donald Berwick, the ex-boss of Medicare and Medicaid (the public health schemes for the old and poor), America lost between $82 billion and $272 billion in 2011 to medical fraud and abuse (see article). The higher figure is 10% of medical spending and a whopping 1.7% of GDP-as if robbers had made off with the entire output of Tennessee or nearly twice the budget of Britain's National Health Service (NHS). Crooks love American health care for two reasons. First, as Willie Sutton said of banks, it's where the money is-no other country spends nearly as much on pills and procedures. Second, unlike a bank, it is barely guarded. Some scams are simple. Patients claim benefits to which they are not entitled; suppliers charge Medicaid for non-existent services. One doctor was recently accused of fraudulently billing for 1,000 powered wheelchairs, for example. Fancier schemes involve syndicates of health workers and patients. Scammers scour nursing homes for old people willing, for a few hundred dollars, to let pharmacists supply their pills but bill Medicare for much costlier ones. Criminal gangs are switching from cocaine to prescription drugs-the rewards are as juicy, but with less risk of being shot or arrested. One clinic in New York allegedly wrote bogus prescriptions for more than 5m painkillers, which were then sold on the street for $30-90 each. Identity thieves have realised that medical records are more valuable than credit-card numbers.

When shopping for a plan, start with the basics of what you're looking for and what you're willing to pay for, says Michael McMillan,Executive Director of Market and Network Services at Cleveland Clinic. Then make your selection carefully so you get what you're paying for, he adds. To help you navigate enrollment - either on health insurance exchanges or elsewhere - McMillan offers the following helpful tips: 1. Know what services are covered under a selected plan Start by reviewing what each particular plan offers. For example, what does the network of care providers look like? What services are most important to you based on your particular health needs or conditions, and are they available within a plan's coverage? "This will be a period of great change, and consumers will have a lot of options they haven't had before on the exchanges," McMillan says. "It's important to be clear on what's available and what isn't." 2. Make sure your providers are part of the network When choosing plans, this is a major factor. Look at any given plan to see if your doctors and hospitals you use regularly are listed as network providers. One evolving trend has been for health plans to create narrow networks - smaller versions of their standard network that help them achieve a lower price. The bottom line: Not all providers are included in these limited networks, so it's worth your effort to check first and make sure your new plan includes the doctors and other practitioners you see regularly, McMillan says. 3. Know your out-of-pocket costs These are costs associated with the care received. They include things such as deductibles - the amount you pay before coverage kicks in - as well as copays and coinsurance on services. Out-of-pocket costs vary by the "metal" level of plan you choose on a health insurance exchange. So, for example, you would pay 40 percent of costs of coinsurance in a bronze plan, and 30 percent for silver. In some high

Expatriates may find it hard to avail of health insurance when they are in a foreign place. The system varies from that of your own nation and customs of availing is a far cry especially in developing nations. Luckily, developing countries like Indonesia and Thailand are starting to expand its insurance's scope to a more international level, catering to both local and foreign individuals. Companies operating in Jakarta, Indonesia, for instance, realize the importance of a comprehensive medical plan to cover sickness and accidents that happen to the staff that they hire. Westhill Insurance Consulting is also aware of the struggles faced by expatriates when it comes to getting insurance. What preparations do you do then? 1. Find out before you come The company who hired you and the person you are working for should provide medical insurance for you and your family members just as they do with local folks. Ask for details from your employer to ensure that your policy will adequate cover your family members for sickness, accidents or emergencies, on home leave and when you are visiting other countries for work-related purposes. If you are joining a new company, remember that they may never love you more than when you first join. Do not rely on promises that medical insurance coverage will be sorted out when you arrive. It could be the case that what the company considers ideal coverage may not meet your expectations. Be sure before you arrive that you understand what medical coverage your company provides for regular medical concerns, major medical situations such as surgery or deliveries,

According to healthcare attorney Susan Miller, detailed evidence of HIPAA compliance and going beyond just the black letter HIPAA rules will be important factors when the Office for Civil Rights (OCR) makes its HIPAA audit rounds this fall. Miller said that OCR has been talking about evidence of compliance since 2009, when it first released the HIPAA Omnibus Rule Notice of Proposed Rule Making (NPRM). Evidence of compliance, in my view, goes beyond what the rule asks of an organization, such as where its policies and procedures are. This includes the Notice of Privacy Practices (NPPs), business associate agreements (BAAs), but they've also [made it clear] that organizations must have a breach plan. In no place in the regulation does it say that an organization has to have a breach plan or process. It does makes sense to have a breach plan to know what the organization will do when it has a breach event. I would suggest that organizations have a breach plan that they look at and update yearly. OCR will be looking for specific things in the plans, Miller said, including communication tactics within a breach plan. And Miller tells her clients that they need a detailed training plan, as well as the training materials and sign-in sheet or even some way to know when staff completes computer based training (CBT) modules, depending on how they do training. The important thing is knowing the training was completed. And organizations need something similar to a contingency plan, which is in the Security Rule but the larger organizations name as business continuity and disaster recovery plans. "Think of [the Boston Marathon bombings] - you need something that's going to help you continue to function during these events that are out of the control of the covered entity or business associate (BA)," Miller said.

Welcome to Wonkbook, Wonkblog's morning policy news primer by Puneet Kollipara (@pkollipara). To subscribe by e-mail, click here. Send comments, criticism or ideas to Wonkbook at Washpost dot com. To read more by the Wonkblog team, click here. Follow us on Twitter and Facebook. (Photo by Mike Segar/Reuters) Wonkbook's Number of the Day: 70 percent. That's the latest estimate of the mortality rate in the Ebola outbreak in West Africa, the World Health Organization announced. Wonkbook's Chart of the Day: Oil prices are falling, and fast. Wonkbook's Top 5 Stories: (1) Obamacare October surprises and a lower sales bar; (2) Ebola treatments for U.S. patients; (3) attorney general nomination update; (4) security threats of climate change; and (5) new help for long-term jobless. 1. Top story: With a month to go, why the Obama administration won't oversell Obamacare in year two Team Obama's year-two strategy: Underselling Obamacare. "The Obama administration vastly oversold how well Obamacare was going to work last year. It's not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. The new head of HHS is not on Capitol Hill to promise that HealthCare.gov is on track. And no one is embracing Congressional Budget Office projections of total sign-up numbers.Sobered - and burned - by last fall's meltdown of the federal website, the administration is setting expectations for the second Obamacare open enrollment period as low as possible. Officials say the site won't be perfect but will be improved." Jennifer Haberkorn in Politico. Explainer: 5 things we need to know about Obamacare before enrollment begins. Jason Millman in The Washington Post. Source: Westhill Healthcare Consulting Jakarta fraud prevention review</d

The data breaches of 2014 have yet to fade into memory, and we already have 2015 looming. Experian's 2015 Data Breach Industry Forecast gives us much to anticipate, and I've asked security experts to weigh in with their thoughts for the coming year as well. Experian highlights a number of key factors that will drive or contribute to data breaches in 2015. A few of them aren't surprising: Organizations are focusing too much on external attacks when insiders are a significantly bigger threat, and attackers are likely to go after cloud-based services and data. A few new factors, however, merit your attention. First, there is a looming deadline of October, 2015 for retailers to upgrade to point-of-sale systems capable of processing chip-and-PIN credit cards. As banks and credit card issuers adopt more secure chip-and-PIN cards, and more consumers have them in hand, it will be significantly more difficult to clone cards or perpetrate credit card fraud. That's why Experian expects cybercriminals to increase the volume of attacks early in 2015, to compromise as much as possible while they still can. The third thing that stands out in the Experian report is an increased focus on healthcare breaches. Electronic medical records and the explosion of health or fitness-related wearable devices make sensitive personal health information more vulnerable than ever to being compromised or exposed. The risk of health related data being breached is also a concern voiced by Ken Westin, security analyst with Tripwire. He pointed out that part of the reason that retail breaches have escalated is because cybercriminals have developed the technologies and market for monetizing that data. "The bad news is that other industries can easily become targets once a market develops for the type of data they have. For more info: Westhill Insurance Consulting Data breach trends for 2015: C

The U.S. health care system has changed significantly since the passage of the Affordable Care Act. The federal law introduced many changes to the insurance space and health care market and helped change the way that people shop for health insurance coverage. With the launch of insurance exchanges, new marketplaces were opened up to consumers, but these exchanges also represented a promising opportunity for scammers that are looking to exploit a person's private information. The U.S. Federal Trade Commission recently issued a warning about the growing prevalence of insurance scams, and there are some things that people can do to protect themselves and their information when shopping for insurance coverage. Be Careful About What You Share Online Many insurance scams seek to collect personal information through fraudulent websites. These sites can be designed to look official, but are merely fronts for criminal activity. Many fraudulent sites attempt to show that they represent an insurance or government agency, offering policies at discounted rates, but the policies that these sites offer are not real and exist only to collect information, such as medical records. Beware of Unsolicited Calls Sometimes, scammers prefer to take a more direct approach and will disguise themselves as insurance agents representing a reputable company or exchange. These people often attempt to call consumers and offer inexpensive insurance policies based on the information that they provide. Insurance exchanges do not randomly contact consumers and organizations promoting coverage through exchanges will never ask for personal information to be shared over the phone. Document Everything Keeping records of all salespeople you may come in contact with, as well as the names of their representative companies, could be valuable if your information is ever compromised. Information can be used for or against you, and collecting information from the agents or organizations trying to sell you

How to Find Affordable Family Health Insurance http://www.westhillinsuranceconsulting.com/blog/how-to-find-affordable-family-health-insurance/ Take advantage of free quotes: Who doesn't like free, it a great price! There are many health insurance websites where you can find lot of sites with free family insurance quotes. You must take advantage of these. Not every policy is going to fit for everyone because every family is different. To know the best one for you and your family, use these quoting tools to gather prices and service offerings. And do not think about it as a waste of time, after all it is a free look into the company. It is free yet well worth the time it takes to fill out the questionnaire or quoting application. Know your priorities: You should know and you must be well aware of all your priorities regarding your health care. Are you satisfied with your current doctor or are you open to find new ones? If you are unsure, sit down and take some time listing of your top five most important things when looking for a new policy or health insurance company. This will help you narrow down exactly what you only need and what your looking for. Ask for help if you need it: It is all known to us that understanding the ins and outs of health insurance policies and coverage could sometimes be very frustrating. This is more common to those who are just new to it. Do not hesitate to ask questions if you need to ask questions, ask your questions to the health insurance company representatives. You can even ask your husband, your wife, your dad, your mom, or even your friends. But if you feel that you are not satisfied with the answers you got, don't be frightened to enlist the help of an insurance broker. They can help you find the best rates available, can explain the inner workings of the policy, and know what places are reputab

Westhill Healthcare Consulting has a complete editorial freedom over the content on its pages since it was published. Some information we provide such as view expressed are our editors' and this are not to be shared by other sites we link to or partner with. About Westhill Healthcare Consulting Westhill Healthcare Consulting is one of the internet's oldest sites that offer consumer information on reasonably priced health and medical coverage since it was published during early 90's. It is the most-trusted independent site, respect and loyalty was earned through the years of hard work. All the information on this site is projected to the general consumer audience. Westhill Healthcare Consulting is not selling insurance and is not an insurance agency Your concern is our business, as service to our visitors, we provide health insurance quotes from carefully chosen partners who are in the business of selling health insurance, and who meet Westhill Healthcare Consulting strict standards. It is the referrals that pay us and in turn this is what we use to pay the cost of publishing this site. Editorial policy Westhill Healthcare Consulting has a complete editorial freedom over the content on its pages since it was published. Some information we provide such as view expressed are our editors' and this are not to be shared by other sites we link to or partner with. On behalf universal health insurance access, advocacy efforts are issue-specific. Also, they are not supposed to be considered an endorsement of any particular elected official, political party or ideology. Personal advice We are qualified to give advice on individual situations or legal issues. Aside from our individual state pages that offers links to all state departments of insurance, Westhill Healthcare Consulting, also offers personal consulting. If you have questions about your

WEDNESDAY, May 7, 2014 (Health Day News) - there will be almost twice as many elderly Americans in 2050 as there are now, posing serious issues for the nation's health care system, according to two U.S. Census Bureau reports released Tuesday. "The United States is projected to age significantly over this period, with 20 percent of its population age 65 and over by 2030," Jennifer Ortman, chief of the Population Projections Branch at the census bureau, said in an agency news release. The number of people aged 65 and older is projected to reach 83.7 million by 2050, compared with 43.1 million in 2012, the bureau reported. This sharp rise is due to aging baby boomers, which were born between 1946 and 1964 and began turning 65 in 2011. An aging population "will have implications for health care services and providers, national and local policymakers," Ortman added. She said businesses will also have to adapt to meet new demands as a rising number of elderly influences both the "family structure and the American landscape." Baby boomer-influenced growth in health-care related industries began a few years ago, the agency said. According to the census bureau, there were about 819,000 health and social assistance-related facilities and businesses in 2011 - a 20 percent jump from 2007.

The Anti-Fraud Division of the Kansas Insurance Department (KID) worked nearly 850 cases of suspected insurance fraud in Kansas during 2013. That's a pretty hefty number for our four-person division, but that figure is an average one for us, unfortunately. How to spot the scam: Use common sense, says Quiggle. Check with your state's department of insurance to see if the company is properly licensed. And remember, if it seems too good to be true, it most likely is. What to do: If your policy is through an organization, report fraud to someone within the organization. Also, report the fraud to the Federal Trade Commission at FTC.gov and your state's department of insurance. On a national level, if insurance fraud was a business, it would be a Fortune 500 company, according to national reports. It is, by all accounts, the second largest economic crime in America; only tax evasion exceeds it. This type of fraud is the intentional misrepresentation of facts and circumstances to an insurance company in order to obtain payment that would not otherwise be made. Insurance fraud costs upwards of $80-120 billion annually, but most importantly, it adds hundreds of dollars to your annual insurance premiums, as companies have to include that cost of doing business in the premiums you pay. The fraudulent activity comes in all shapes and sizes, from accident insurance and annuities through health insurance and homeowners claims to renters insurance and travel insurance. It also includes application or policy fraud, where the applicant-or an unscrupulous agent - provides false information or forged documents. The reasons for committing fraud are as numerous as the people who commit it-the need for money for some legitimate (in their minds) or illegitimate activity, or maybe just plain old greed.

As we grow older, our responsibilities add up. Having a health insurance should be one of the priorities that we should think of. By the time you are old enough to fend for yourself, you are then required to get an insurance. However, many young adults are still confused on its importance. 1. It may be Illegal When you are living in the United States, Affordable Care Act (ACA) compels you to purchase insurance. Going without insurance for three months would force you to pay a penalty of $325 or 2% of your monthly income, whichever is higher. In developing countries, uninsured individuals have the option to purchase from private companies but laws are already drafted for completion. In cities like Jakarta, Indonesia and Bangkok, Thailand, more than half of their unemployed population goes uninsured. 2. If you are a full-time employee, your employer should provide you with insurance Most companies require employees work for set period before benefits can be provided. It usually takes 3-6 months in a probationary period before regularization, by which insurance is given. It is in any law in any states and government to mandate to every employer to provide employee benefits. 3. Your parents may still be able to cover you Individuals under the age of 26 can still be listed under their parents' coverage. They can still cover even a modest premium cost. 4. You can do it alone If you are not insured under your parents' plan or purchasing insurance under your employer is not an option, you have the choice to purchase your own insurance from trusted private companies. If you are buying online, just make sure you

The clock on insurance deductibles reset on Jan. 1, and that means big medical bills are in store for some. Patients may be required to pay thousands of dollars before their health care coverage kicks in. Insurers typically begin or renew policies in January, and that means customers could face some daunting cost-sharing requirements in the first few months of the year. That's especially true if they need surgery or have a particularly expensive prescription. Deductibles topping $3,000 are common among plans sold on the health care overhaul's public insurance exchanges, which provide coverage for millions. Companies also have been raising deductibles for years on employer-sponsored health plans, the most common form of coverage in the United States. Plus cost-sharing requirements for Medicare prescription drug coverage renew every year. All this adds up to a business boon for organizations like the Patient Access Network Foundation, which offers grants to help cover prescription costs for dozens of life-threatening, chronic or rare diseases. The nonprofit had to hire about 80 temporary employees to help handle the heavy workload it receives at the start of the year. It fielded 4,000 calls a day last month, double its normal total. "Everybody who works doing what we do has the same challenge," CEO Daniel Klein said. Klein's foundation is one option patients can turn to if too many expenses hit at the start of the year. Here are some other tips. Understand your coverage: You can't prepare for medical expenses until you know how big the bills might be. Your insurance should come with a plan summary that lays out important numbers. Start by understanding your plan's deductibles, which can differ significantly depending on whether care is received inside or outside the insurer's network of providers. If you take prescriptions, double check how much they will cost. Drug coverage is commonly divided in

According to the Centers for Medicare and Medicaid Services, healthcare costs are expected to rise by 5.8% each year until 2022, which is going to make for a pretty serious hike in your expenses. Instead of getting frustrated and giving in, though, put your thinking cap on. If you're willing to roll your sleeves up and do a little research, you can find plenty of ways to reduce your medical costs. Here are six of them. 1. Use Urgent Care Facilities Instead of the Emergency Room It's a pretty decent bet that there's an urgent care facility near where you live that you can use in lieu of the emergency room. It won't cost you as much, and many such facilities offer extended hours. Don't wait for the next time an emergency occurs - do an Internet search now to find suitable locations and note their hours of operation. 2. Improve Your Health One of the simplest ways to decrease your medical costs is to improve your health. If you're overweight, join a gym or create a home workout program and adjust your diet to include more fresh fruits and vegetables. Still smoking cigarettes? Buy a patch or join a support group and quit. Got friends who encourage you to party it up on the weekends? Find yourself some new ones or convince them to participate in healthier activities. Concrete steps like these can get you more fit and less likely to need medical attention. 3. Get Generic Prescription Medication Whenever your doctor prescribes any medication, be sure to ask for a generic option. You can save as much as 85%, according to the Food and Drug Administration, which also points out that you don't sacrifice anything in quality by avoiding brand name meds. 4. Pay Your Bill Upfront If you have the means to do so, offer to pay your medical bill upfront for a negotiated discount. This is a shrewd and under-used method to reduce your medical costs. See the billing department at the hospital or your doctor's office for details. 5. Use Your Smartphone A variety of mo

Thom Tillis is stuck at the state capitol trying to resolve a budget quarrel as speaker of the North Carolina House. It's a spot that helps Hagan emphasize Tillis' role leading a Republican-controlled state government that Democrats contend has gone overboard with conservative zeal by restricting access to abortion and the voting booth while cutting corporate taxes and slashing spending on schools. (Hagan, the daughter of Joe P. Ruthven, grew up in Lakeland.) If Tillis is worried by Hagan's portrayal, he doesn't show it. Drinking coffee last week from a hand-grenade-shaped mug in his no-frills legislative office, he's got his own message in his campaign to take Hagan's Senate seat. "Obamacare," he said, "continues to be a big problem." Similar themes are playing out in other crucial Senate races, as voters have four months to decide which party will control the chamber in the final two years of Barack Obama's presidency. For Republicans, it's all about tying Democrats to Obama - especially to a health care law that remains unpopular with many Americans. And for Democrats, the election is about just about anything else, especially if they can steer attention away from Washington and federal matters. It's a political strategy that sometimes gives the campaigns an inside-out feel, with veteran senators running as if they were first-timers without a Washington resume to defend or tout.