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Special Fraud Alert: Laboratory Payments to Referring Physicians - 1 views

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    I. The Anti-Kickback Statute One purpose of the anti-kickback statute is to protect patients from inappropriate medical referrals or recommendations by health care professionals who may be unduly influenced by financial incentives. Section 1128B(b) of the Social Security Act (the Act) makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce, or in return for, referrals of items or services reimbursable by a Federal health care program. When remuneration is paid purposefully to induce or reward referrals of items or services payable by a Federal health care program, the anti-kickback statute is violated. By its terms, the statute a scribes criminal liability to parties on both sides of an impermissible "kickback" transaction. Violation of the statute constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to 5 years, or both. Conviction will also lead to exclusion from Federal health care programs, including Medicare and Medicaid. OIG may also initiate administrative proceedings to exclude persons from the Federal health care programs or to impose civil money penalties for fraud, kickbacks, and other prohibited activities under sections 1128(b)(7) and 1128A(a)(7) of the Act. II. Remuneration From Laboratories to Referring Physicians Arrangements between referring physicians and laboratories historically have been subject to abuse and were the topic of one of the OIG's earliest Special Fraud Alerts. 1 In that Special Fraud Alert, we stated that, "[w]henever a laboratory offers or gives to a source of referrals anything of value not paid for at fair market value, the inference may be made that the thing of value is offered to induce the referral of business.
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The 5 Best Money Lessons We Learned Last Year - 1 views

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    1. It's Smart to Prepare for a Breach How many data breaches from 2014 can you name? The freshest one in your mind is probably the Sony hack, but there were also attacks on Home Depot, Staples, Dairy Queen, P.F. Chang's the list goes on. Credit.com Co-Founder and Chairman Adam Levin recently wrote about the most important lessons you can learn from the Sony hack, encouraging consumers and companies to prioritize data security and behave with the knowledge that your personal information and correspondence could be exposed at any time. Prepare for the possibility of fraud by monitoring your credit, regularly reviewing account activity and knowing what to do if your personal information has been stolen. Do what you can to strengthen your data security, but know that so much of it is beyond your control, so the best thing you can do is know how to react to a breach. 2. Communication Is Crucial to Getting Debt-Free as a Couple We published several success stories about getting out of debt, but some of the most memorable involved couples working together to conquer their finances. The stories had similar themes: Ellie Kay married her husband without knowing about his $40,000 of consumer debt, and Ja'Net Adams was unaware her husband took out student loans to pay for college. Both families eventually hit breaking points where they realized debt was holding them back, and they needed to make drastic changes to get rid of it. Getting out of debt is never easy, and the more people who are involved, the more complicated it can be. At the same time, having someone to work through the challenges with you can be extremely helpful. Adams' and Kay's stories highlight two crucial elements of getting debt free: staying committed to a plan and remaining open and honest about the process' progress and challenges. Those lessons apply to any personal finance goal, whether you're planning with a family or on your own.
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Westhill Consulting - Healthcare | Home - 3 views

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    Westhill Consulting: Healthcare & Insurance - Individuals, families and the self employed Health Insurance It is hard to find a health insurance in the current situation of our marketplace. It seems impossible to get one of those as per this individual health insurance can offer you a confusing array of options more especially if you're one of the millions of Americans who buys their own health coverage. This health coverage are sometimes good but not always and worse few are expensive. Agents though are everywhere, and they are easy to find and readily available. They offer you cheap health insurance but you got to remember this: health coverage isn't cheap if it doesn't adequately cover your expenses when you need it most. Health reform legislation is recently passed and thanks to this the landscape is changing for consumers. Soon, millions of uninsured will have an access for a quality but low-cost insurance. The chief challenge could be determining options to choose the right coverage. There is nothing to worry about! Because Westhill Healthcare Consulting has everything that one has to know, all the information you needed. Learn. Compare. Save. We have library of articles and we are sure every article is fruitful. Learn how to cut your health care costs, get coverage if you're self-employed. Go trough most frequently asked questions about health coverage and be familiar with health insurance terms. Discover how health reform will affect your benefits and your budget. Otherwise find out how it stands to help populations that historically have faced barriers to affordable health coverage. It would be useful and practical if you use free, no-obligation health insurance quotes to compare private health insurance in your area, plan benefits and coverage costs. Every plan id different in every state so the first thing to do is to go trough our state guide in order to evaluate coverage options, including whether yo
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Elderly Population Will Double By 2050, Taxing U.S. Healthcare System - 1 views

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    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.
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Medicare Overbilling Probes Run Into Political Pressure - 1 views

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    When investigators suspected that Houston's Riverside General Hospital had filed Medicare claims for patients who weren't treated, they moved to block all payments to the facility. Then politics intervened. Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official who oversees Medicare, Marilyn Tavenner, asking her to back down, according to documents reviewed by The Wall Street Journal. In a June 2012 letter to Ms. Tavenner, Rep. Jackson Lee said blocking payments had put the hospital at financial risk and "jeopardized" patients needing Medicare. Weeks later, Ms. Tavenner, administrator of the Centers for Medicare and Medicaid Services, instructed deputies to restore most payments to the hospital even as the agency was cooperating in a criminal investigation of the facility, according to former investigators and documents. "These changes are at the direction of the Administrator and have the highest priority," a Medicare official wrote to investigators. About two months after that order, Riverside's top executive was indicted in a $158 million fraud scheme. The hospital was barred from Medicare this May, and the CEO was convicted in October. What happened at Riverside General Hospital shows how political pressure from medical providers and elected officials can collide with efforts to rein in waste and abuse in the nearly $600 billion, taxpayer-funded Medicare system. More than a dozen former investigators and CMS officials said in interviews that they faced questions from members of Congress about policy changes or punitive action affecting providers or individual doctors.
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Fraud watchdog: Health law sign-ups dogged by data discrepancies - 1 views

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    WASHINGTON - The Obama administration has been struggling to clear up data discrepancies that could potentially jeopardize coverage for millions under the health overhaul, the government's health care fraud watchdog reported Tuesday. The Health and Human Services inspector general said the administration was not able to resolve 2.6 million so-called "inconsistencies" out of a total of 2.9 million such problems in the federal insurance exchange from October through December 2013. Of the roughly 330,000 cases that could be straightened out, the administration had only actually resolved about 10,000 during the period of the inspector general's audit. That worked out to less than 1 percent of the total. Several states running their own insurance markets also were having problems clearing up data discrepancies. Most of the issues dealt with citizenship and income information supplied by consumers that conflicted with what the federal government has on record, the report said. It marked the first independent look at a festering behind-the-scenes issue that could turn into another health law headache for the White House. President Barack Obama celebrated 8 million sign-ups as proof that technical problems which initially kept many consumers from enrolling had finally been overcome. It now turns out that some of those problems continued out of sight. The inspector general said the efforts of the administration and states to clear up the discrepancies were complicated by lingering computer issues.
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Austin Company Leads Medicaid Fraud Crackdown - 1 views

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    Texas pays out $28 billion a year to some 4.8 million people, according to Kaiser. The state picks up one-fourth of the tab, and the feds pay the rest.  The FBI estimates that 10% of Medicaid claims are fraudulent, which comes out to $2.8 billion a year in Texas alone. On Monday, Austin company 21CT launches a new computer system called "Torch" to help the state bring scammers to justice. Torch will collate state data around the clock. The system will monitor frequency of claims, the size of claims and any funny patterns or anomalies. 21CT has grown to over 100 employees, most of them devoted to the crackdown. Company officials say what they are finding is eye opening. "You know it's there," said Kyle Flaherty, Vice President of Marketing for 21CT. "What's so surprising is how complex and entrepreneurial the fraudsters can be. This is a business for them and we need to disrupt the business they are creating." Torch will eyeball providers: businesses, medical supply companies, doctors, therapists, dentists, ambulance firms, hospitals and more. The system will make it easier to sort out.
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Medicare fraud: Meet the ZPICs - Westhill Consulting Insurance - 1 views

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    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.
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Senate Dems Try to Pull Focus From Health Law - 1 views

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    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.
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Insurers, providers may need to work harder to educate ACA's newly covered - 1 views

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    Millions of Americans gained health insurance coverage under the Patient Protection and Affordable Care Act this year, but the influx apparently has not yet translated into patients packing doctors' offices. That may reflect a lack of understanding about how and where to seek care-and a lack of outreach by their new plans and providers. "If coverage expansion is allowing patients to establish new relationships with physicians, we would expect to see physicians devote a greater share of their calendars and work effort to caring for new patients," wrote the authors of a report released this week by the Robert Wood Johnson Foundation and Athenahealth, a company that sells cloud-based health information and practice management technology. But that is not what they found. Though it may seem counterintuitive, the organizations discovered that during the first five months of 2014, all specialties-with the exception of pediatrics-experienced lower rates of new-patient visits than they had in the year-ago period. This was based on data taken from more than 14,000 providers across specialties. for example, the proportion of visits from new patients to primary-care physicians in the sample from January to May 2014 was 18.8% compared with 19.3% during that same five-month period in 2013. The study did not analyze what caused this decline, but the authors suggest that one reason is that the newly insured are continuing to go to emergency departments instead of physician offices. That explanation seems consistent with studies that showed increased emergency department use after pre-ACA expansions of health insurance in Massachusetts and Medicaid in Oregon.
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Westhill Consulting Insurance - Experimental Melanoma Vaccine Responds Positively - Wes... - 0 views

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    Westhill Consulting - Experimental Melanoma Vaccine Responds Positively Experimental Melanoma Vaccine Responds Positively One day late-stage skin cancer may be treated by 'Personalized immunotherapy' Researchers report a finding shows promise for personalized skin cancer treatment since six of seven advanced melanoma patients had a positive response to an experimental vaccine According to the investigators at the Washington University School of Medicine in St.
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Westhill Consulting Insurance - Important Tips From a Health Insurance - 1 views

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    Never take medical health insurance advice from someone that is absolutely unqualified to give you with these tips!! Don't take medical health insurance advice from someone unqualified to provide these tips. Seek any adverse health insurance specialist, they've analyzed and therefore are licensed to provide these tips and they are liberated to you. Rely On Them!! All of us have our own opinion of what health plan we want. And not because someone is your relative, someone you know or someone he knows are associated with some section of healthcare totally not connected to insurance, does not necessarily mean they are completely knowledgeable of the solutions for your individual needs and questions. And even before problems show up, insurance specialists are always readily available. Most insurance specialists get compensated through insurance service providers, so their professional services can you. Rely On Them!!
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Wearable Technology: The Coming Revolution in Healthcare - 2 views

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    Wearable Technology: The Coming Revolution in  Healthcare The year 2014 may well go down as the year of wearable technology. The impact of wearables is already being felt in education, communication, navigating, and entertainment; but perhaps the greatest potential lies in healthcare. Wearable technology has started to revolutionize healthcare by assisting doctors in the operating room and providing real time access to electronic health records. The full potential of wearable technology in healthcare, though, goes well beyond directly assisting doctors. Patients can now continuously monitor their own health. At the 2014 Consumer Electronics Show in Las Vegas, Sony, LG and Garmin introduced devices that track everything from heart rate and blood pressure to a patient's O2 saturation. By 2018, the overall number of wearable devices shipped to consumers is expected to reach 130 million. With such acceptance on the part of the public, wearables are perhaps the perfect application for healthcare.
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Stateline Health Insurance Death Rates - 1 views

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    Does health insurance increase your lifespan? Felue Chang, who is newly insured under an insurance plan through the Affordable Care Act, receives a checkup from Dr. Peria Del Pino-White at the South Broward Community Health Services clinic on April 15 in Hollywood, Fla. The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act. In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that "health reform in Massachusetts was associated with a significant decrease in all-cause mortality." The authors caution that their conclusions, published in Annals of Internal Medicine, may not apply to all states, and other studies have shown little correlation between having insurance and living longer. Nevertheless, the Harvard study adds to a growing body of evidence that having health insurance increases a person's life expectancy.
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Woman found dead in shooting at Sanford insurance offices - 2 views

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    According to her friends, Cynthia McGee Bryant was a religious woman who owned her own insurance agency, worked hard and didn't have enemies. But on Monday, someone shot McGee Bryant, 53, to death inside her office at 400 W. 25th St., police said. Few details were released by the investigators however they did not mention if the motive was robbery. Officers received a 911 call about 12:15 p.m. and found Bryant's body a couple of minutes later at McGee Insurance and Financial Services, Police Department spokeswoman Shannon Cordingly said. Detectives were hesitant in revealing where in the office Bryant's body was found or what part of the body she was shot in and whether anyone witnessed the crime. They would not even say who was responsible in calling 911. McGee Bryant's former husband, Reginald Bryant, said his ex-wife was focused on her job and on evangelical work. She was a longtime member of Livingston Street Church of God in Orlando. "She was a God-fearing woman," Bryant said. McGee Bryant, who lived near Lake Mary, was from a small town in Georgia and also lived in upstate New York before moving to Central Florida to be near extended family, her ex-husband said. She was named Allstate agent of the year in her territory in 2005 and started her own Allstate agency in Sanford in 2007, according to her website. She started her current business in 2009. Her business is selling personal and business insurance. Her motto was "Integrity. Commitment. Dedication. Loyalty. Respect. Responsive." Bishop Antonio Richardson, whom Bryant recruited a few months ago to be spiritual leader at Livingston Street Church of God, described McGee Bryant as "a very soft-spoken, giving person" who sometimes paid clients' premiums when they could not afford to, ministered to the homeless and handed out money on the street if she saw a needy person. She as well was a licensed minister who was about to become outreach director for her congregation. "It's a shock," Richa
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Insurance fraud cases reduce by half, says IRA - 1 views

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    BY PETER KIRAGU Kenya: The number of insurance fraud cases reduced by more than half last year thanks to tighter supervision by the Insurance Regulatory Authority ( IRA)'s Insurance Fraud Investigation Unit. According to the just released industry report for the year ended December 31, 2013, the unit received reports and detected cases of insurance fraud totaling 57 during the period compared to 133 similar cases in 2012. The report shows that fraud remains highest in motor insurance category with 21 cases reported in the year, down from 35 the previous year. Out of this, four fraudulent accident and 14 theft claims were made. Another three fraudulent cases of forged certificates were also reported. There were three fraudulent claims in the medical insurance category down from six the previous year with two fraudulent funeral claims made in the year down from nine in 2012. Fraud related to insurance agents also dropped with only six cases reported down from 38 the previous year. All the six reported cases were theft by insurance agents. The level of fraud related to insurance companies especially theft by employees remained the same with 10 cases reported. See Also: Australia agency opens
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