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Westhill Consulting Insurance - How to Avoid Health Care Fraud Mail-order medications Patients who buy drugs through mail-order companies could be rolling the dice with their health says Dr. Deborah C. Peel, a physician and founder of the nonprofit Patient Privacy Rights. There's a high probability in many cases that these drugs are counterfeit Peel added. "And you don't ever know because the fraudulent tablets look just like the real ones," says Peel. She says ordering from companies that specialize in mail-order sales that are not affiliated with a legitimate insurance company, especially from foreign countries, can be very risky. Not only could the quality be questionable, it could also be illegal. "But people are desperate because we're being so grossly overcharged for medication," she says. Peel says you can lessen costs by buying generic. You can spot it by: the best thing to do is to keep away from buying drugs from foreign or obscure pharmacies. And if you decide to go with the mail-order route, just stay with U.S.-based companies because if it's a U.S. company, you can report the health care fraud to the Food and Drug Administration while if it's a foreign company, there's little that can or will be done. False product claims According to the Federal Trade Commission, millions fall victim each year to false miracle cures. Especially vulnerable are victims of debilitating and potentially deadly illnesses such as cancer, multiple sclerosis, HIV and AIDS. The FTC website says scammers take advantage of people with a grim diagnosis such as cancer and "promote unproven - and potentially dangerous - substances like black salve, essiac tea, or laetrile with claims that the products are both 'natural' and effective." But, say physicians and other experts, simply because something is advertised as "natural" doesn't mean it works. And while a patient is experimenting with bogus treatments, he or she can squander the opportu

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.

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,

National Insurance Crime Bureau (NICB) says a bill introduced in the Senate yesterday provides much needed support for fighting healthcare fraud. The Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act, was introduced by Sen. Bill Nelson (D-FL), and is co-sponsored by Sens. Susan Collins (R-ME), Tom Carper (D-DE) and Chuck Grassley (R-IA).] The bill contains important provisions to strengthen the Healthcare Fraud Prevention Partnership (HFPP). The Partnership was established last year to focus on joint efforts to fight fraud by both the public and private sectors. "NICB is particularly focused on the bill's carefully crafted provisions relating to the sharing of fraud-related information and investigative activities among the HFPP's partners," said NICB President and CEO Joe Wehrle. This language is consistent with the HFPP's anti-fraud program and with laws already in effect in many states governing anti-fraud insurance investigations. "The same fraudsters who prey on government healthcare programs and private health insurance also target the medical component of auto and workers' compensation insurance," said Wehrle. "The HFPP is the most comprehensive effort ever undertaken to bring the nation's public and private resources together to protect the integrity of medical care and insurance. The Stop SCAMS Act's support for the HFPP will strengthen it and the anti-fraud program overall." About the National Insurance Crime Bureau: headquartered in Des Plaines, Ill., the NICB is the nation's leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy and public awareness. The NICB is supported by more than 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote $371 billion in insurance premiums in 2013, or more than 78 percent of the nation's property/cas

SACRAMENTO, California - Aetna Inc. discontinue selling individual health insurance policies in California, just weeks after opting out of the exchange that is being established as part of the national health care reforms, a state regulator said last month. California Insurance Commissioner Dave Jones said he was disappointed in Aetna's decision because consumers need more choices. The decision does not affect people who have Aetna insurance through their employer. "This is not good news for California consumers," Jones said in a statement. "A competitive market with more choices for consumers is important, as we implement the Affordable Care Act and health insurance coverage is a requirement." In California's individual health insurance market, Aetna is a quite small player. According to 2011 figures compiled by the California HealthCare Foundation, Aetna has about 5 percent of the state's individual health market. By comparison, Anthem Blue Cross, Blue Shield and Kaiser share 87 percent. Aetna says it has about 58,000 individual enrollees in the state and expects to have about 49,000 by the end of the year. It plans to withdraw from the state at the end of the year but will continue to offer small and large group plans, as well as Medicare, dental and life insurance products. Those in search of to buying their own health insurance will be directed to Covered California, the state's new health insurance exchange starting Oct. 1. Aetna was not among 13 insurance carriers that will sell individual coverage to millions of Californians through the exchange. According to Jones' office Under state law, Aetna will not be allowed to sell individual policies in California for five years once it leaves that market. http://www.westhillinsuranceconsulting.com/blog/ http://www.westhillinsuranceconsulting.com/

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 trough 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. http://www.westhillinsuranceconsulting.com/blog/

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.

A 27-year-old in Jackson pays $336 a month for the second-cheapest silver health plan on Mississippi's s federally run insurance marketplace. That is more than twice as much as the $154 a 27-year-old in Nashville would pay for the same type of policy, and the $138 for a similar person in Tucson. Across all 34 insurance marketplaces run by the federal government, the average is $287, about 25 percent cheaper. The reason for the higher prices in some markets? Paltry competition, say Leemore Dafny and Christopher Ody from Northwestern University, and Jonathan Gruber of the Massachusetts Institute of Technology. Jackson has only two insurers on the marketplace: Humana and Centene. By contrast, four insurance companies slug it out on Nashville's exchange. In Tucson, there are eight. Jackson's over-the-top premiums underscore one of the least-heralded shortcomings of the rollout of the Affordable Care Act: the scarcity of insurers on health plan exchanges, which is driving up the price of policies across the country. The research by Ms. Dafny, Mr. Gruber and Mr. Ody, to be published by the National Bureau of Economic Research next week, concludes that premiums on the exchanges are 11 percent higher than they would be if all the health insurance companies that sell policies in each state had participated in the new markets for health plans. More competition not only would lower premiums, but would also save the federal government money. It would spend $1.7 billion less in subsidies to low- and middle-income Americans buying policies on the health care insurance exchanges. "Half of the population in the states with health exchanges facilitated by the federal government is served by three insurers or fewer," Ms. Dafny said. "To have competition on the exchanges you need competitors." The findings are somewhat perplexing, though. By law, 80 to 85 percent of premiums must be devoted to medical spending. Insurers don't have particularly large profit margin

A pair of editorials last week took up the issue of Medicare and Medicaid fraud, waste and abuse, signifying these problems are becoming a greater focus of public attention and debate "Area ambulance companies are facing deserved scrutiny for their disproportionate share of the nation's outsize[d] healthcare costs," The Inquirer wrote. Ground ambulance providers around Philadelphia collected 64 percent more Medicare dollars than the national average in 2012, with 33 area companies raking in 10 times the norm, the article noted. "No wonder Medicare has stopped taking new company enrollments while it sorts out the fraud," the article stated. The Inquirer referenced charges against eight local ambulance providers since 2011, including one's five-year prison sentence for executing a $3.6 million scam involving kickbacks for unnecessary transport. "Medicare is still not as open [as] it should be," the editorial said. "It has spurned numerous attempts by The Inquirer to get additional information on the ambulance companies that are costing the government the most." The paper wants to know if aberrant providers still collect federal money and if Medicare demanded overpayment refunds. Meanwhile, a Farmington Daily Times editorial highlighted the case of Agave Health, Inc., an Arizona mental health services company that in six months received more than $172,000 from Medicaid. Half this money was disbursed before the completion of a state audit led to a funding freeze for 15 nonprofit healthcare providers. "The question is whether those payments suggest state officials prejudged the conclusion of the audit before it was completed," the editorial stated. That audit exposed $36 million in Medicaid overpayments, the Times reported, which led New Mexico to halt Medicaid funding to in-state providers and shift business to Arizona companies like Agave. But New Mexico paid Agave more than it paid in-state providers.

When the Bergen County couple filing for unemployment certified they were "able and looking for work," they did so the same way thousands of others do from home every week - by logging into the state Department of Labor website. The online world, however, is not quite as anonymous as many believe. Every computer carries a unique electronic address so it can be found on the internet, and what alerted state investigators to this particular claim was the location of the network being used. It was not in New Jersey. It was registered to Royal Caribbean Cruises in Miami, and no one was under any illusion that the couple was looking for work at sea. Unemployment fraud is a multimillion-dollar business in New Jersey, say officials, with 1,600 to 2,000 attempts to bilk the system each week - from the couple on vacation certifying they were able to work while cruising to the Bahamas, to hackers from all over the world trying to game the system, to people still trying to collect unemployment benefits even after finding new jobs. "No one likes to be ripped off, but the volume of money we put out is staggering," said Harold Wirths, the commissioner of the Department of Labor and Workforce Development. New Jersey's Unemployment Trust Fund went broke in 2009, not only under the strain of the severe recession that led to high unemployment levels, but from years of fraud that went on through decades of neglect. Wirths said the fund is now solvent again, due in part to anti-fraud measures being put into play that he said have saved the state $448.7 million the past three years. "We're fighting fraud on every front," the commissioner said. It is a national issue, according to Douglas Holmes, president of UWC Strategic Services, a Washington, D.C., group that represents businesses on unemployment issues.

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.

Consumer Alert: The Impact of Health Care Fraud on You! In 2011, $2.27 trillion was spent on health care and more than four billion health insurance claims were processed in the United States. It is an undisputed reality that some of these health insurance claims are fraudulent. Although they constitute only a small fraction, those fraudulent claims carry a very high price tag. The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year. Whether you have employer-sponsored health insurance or you purchase your own insurance policy, health care fraud inevitably translates into higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits or coverage. For employers-private and government alike-health care fraud increases the cost of providing insurance benefits to employees and, in turn, increases the overall cost of doing business. For many Americans, the increased expense resulting from fraud could mean the difference between making health insurance a reality or not. However, financial losses caused by health care fraud are only part of the story. Health care fraud has a human face too. Individual victims of health care fraud are sadly easy to find. These are people who are exploited and subjected to unnecessary or unsafe medical procedures. Or whose medical records are compromised or whose legitimate insurance information is used to submit falsified claims. Don't be fooled into thinking that health care fraud is a victimless crime. There is no doubt that health care fraud can have devastating effects. What Does Health Care Fraud Look Like? The majority of health care fraud is committed by a very small minority of dishonest health care providers. Sadly, the actions of these deceitful few ultimately serve to sully the reputation of perhaps the most trusted and respected members of our society-

With the widespread of insurance nowadays, people are confused which one is legit and which one is a fraud; which can offer better and which one cost less. Choosing the right health coverage has never been easy, and the health reform law has made things more complicated. Besides sorting through differences in premiums, deductibles, and copayments, you need to consider new provisions in the law that have recently kicked in and could impact your coverage for the coming year. Westhill Insurance Consulting can help you clear away any confusion, doubts and complaints. Health insurance should cover any medical need you may have, now or in the future. Buying insurance on your own used to be riskier because many plans didn't cover important things such as prescription drugs or mental health care. Every kind of health insurance must now cover preventive care, with no deductibles, co-pays, or other types of out-of-pocket expenses. That includes Pap and cholesterol tests, mammograms, immunizations, and colonoscopies when age- and condition-appropriate. But even though you no longer have to worry about your basic health care needs being covered, you'll still have to navigate lots of other confusing choices. That's true even if you get coverage through a job, because more than half of workers have a choice of two or more types of health plans. 1. Do you want to pay for care now or later? All health plans have to come up with enough money to pay for the medical expenses of their members. You can choose to collect most of the money up front in the form of premiums. If you have a high premium, you'll pay a smaller share out of your own pocket, in the form of deductibles, co-insurance, and co-pays. Or plans can go the other way, charging smaller premiums but asking you to pay a bigger share on your own. 2. Are you OK with a small network of docs? Doctors and hospitals accept lower fees from insurers if they know they'll be part of a small, o

How to spot and stop health insurance scams Medical and health insurance scams are rampant. Both government and private initiatives have renewed their focus on preventing health insurance fraud and abuse. Michael Williams, director of communications and membership of the National Health Care Anti-Fraud Association, says new and better technology, improved awareness, and more widely available information combine to combat fraud. Williams adds that while the majority of physicians run honest practices, consumers must also step up to the plate to prevent fraud. "Pay attention, do your research, read your EOBs (explanations of benefits) and beware of free offers," he says. Read on to discover some of the most common health insurance scams making the rounds and ways experts like Williams say you can guard against becoming another victim. Fake insurance policies Like counterfeit money, bogus health insurance is not only circulating, but it's becoming increasingly common. James Quiggle, communications director of the Coalition Against Insurance Fraud, says fake policies are particularly virulent. "These crooks come out of the woodwork and promise affordable premiums, no medical exams and guaranteed acceptance," Quiggle says, adding that the criminals who offer worthless policies often operate through sophisticated networks with strong marketing arms and money-laundering components. Many times they can be tied to organized crime. Often, these con artists target small businesses, unions and associations. It's only when a policyholder needs the insurance that the game's up.