Group items tagged

CMS created the Zone Program Integrity Contractor (ZPIC) program to investigate allegations of Medicare claim fraud in the country's seven traditional Medicare program claim processing zones. Kathleen King, a GAO director, testified that the ZPICs say they helped Medicare save about $250 million in 2012. CMS does not know how quickly ZPICs are conducting investigations, King said. The GAO is looking into the possibility that the ZPICs could save Medicare more money by acting more quickly, according to King. Hearing witnesses also talked about another Medicare fraud prevention program -- an automated Fraud Prevention System that came to life in 2011. The system is supposed to use "predictive modeling" -- data sifting tools -- to identify suspects for the ZPICs to investigate. During the first year of operation, the system generated only about 5 percent of the ZPICs' leads, King said. CMS says the system is now the primary source of the ZPICs' leads, but details are scarce, she added. Dr. Shantanu Agrawal, director of the CMS Center for Program Integrity, said the Fraud Prevention System stopped, prevented or identified $115.4 million in improper payments during the first two full years of operation. Savings increased in the second year, Agrawal said. King said one problem is that the Fraud Prevention System does not give CMS any way to suspend paying questionable Medicare claims while investigations are still under way.

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

Tulsa - October marks the start of when many health insurance plans open enrollment.Medicare and Obamacare will also soon begin enrolling for next year's coverage. 2NEWSProblem Solver Jamil Donith has a word of caution before you shop for health insurance online. According to the Federal Trade Commission, health insurance scams are preying on consumers shopping for or comparing health plans online. Scammers use websites or phony non-profit sites that seem to offer discount medical plans. In reality, the sites are set up to get your personal information. Things like your age, occupation, contact information, marital status and whether you have pre-existing medical conditions. The FTC advises: Be stingy with your personal information when you're on the web. When a site asks for your personal information know that data could end up in the wrong hands. A health insurance website might look like the real deal, but many are fronts for criminals wanting to steal your money and personal information. Research a company before giving it your business. Enter the company's name and the "complaints" into an online search engine to see what comes up. And, before giving any personal information ask the company for the details in writing about what you want to buy. If it can't provide the fine prince, that's a big red flag. Finally, check to find out if the plan you want to buy is really insurance. The State Insurance Department can tell you whether the plan is legitimate and whether an insurance provider is licensed to do business in Oklahoma. The Oklahoma Insurance Department website link is www.oid.ok.gov

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

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.

Study: More exercise, less sitting reduces heart failure risk for men More exercise, less sitting reduces heart failure risk for men By American Heart Association DALLAS - sitting for long period's increases heart failure risk in men, even for those who exercise regularly, according to new research published in the American Heart Association journal Circulation: Heart Failure. Preventing heart failure, researchers found, requires a two-part behavioral approach: high levels of physical activity plus low levels of sedentary time. The study is the first to examine the link between heart failure risk and sedentary time, said Deborah Rohm Young, Ph.D., lead researcher and a senior scientist at Kaiser Permanente in Pasadena, Calif. "Be more active and sit less. That's the message here," Young said. Researchers followed a racially diverse group of 84,170 men ages 45 to 69 without heart failure. Exercise levels were calculated in METs, or metabolic equivalent of task, a measure of the body's energy use. Sedentary levels were measured in hours. After an average of nearly eight years of follow-up, researchers found: Men with low levels of physical activity were 52 percent more likely to develop heart failure than men with high physical activity levels, even after adjusting for differences in sedentary time. Outside of work, men who spent five or more hours a day sitting were 34 percent more likely to develop heart failure than men who spent no more than two hours a day sitting, regardless of how much they exercised. Heart failure risk more than doubled in men who sat for at least five hours a day and got little exercise compared to men who were very physically active and sat for two hours or less a day. Study limitations included: Since

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

Health insurance protects you from any unexpected and costly medical emergencies. However, the situation today is different than 20 years ago where healthcare is now rather cheap and affordable for all Americans. Choosing a reliable insurance company can be complicated, as you will have to deal with several insurers and their various healthcare policies. Individuals who want to enroll themselves to a good health insurance policy must take their time in choosing a good company that offers the right coverage at an affordable cost. Saving money on health insurance is not an easy goal to achieve but with some thorough research, you'll have an understanding of each of the policies available. First and foremost, you should check out the company's credentials and past achievements before you consider it as the one to get your policy from. Don't get confused by the different policies they offer; just choose the one that suits your budget with the coverage you need. Having good customer service that will answer your concerns in case the situation gets complicated is also a must for all health insurance companies. Comparing health insurance quotes is another good thing to consider, as it will give you the opportunity to choose the right policy that fits your needs. A cheap insurance policy is always an attractive deal for anyone to consider, but you must also check for the benefits it provides. It does appear like you save money in choosing an inexpensive plan, but with limited medical coverage you will end up spending more. Going through the terms and conditions before signing up with any plan is one way to find out if your insurance policy will take care of you until its validity ends. Joining various discount clubs for a lesser monthly payment is also a good idea. Some companies even provide up to 60 percent discount as long as you show them your discount cards. However, it will help you choose the right club to join if you check each plan's coverage as some re