Huge Medicare Bust

Several arrests  from five different states on Medicare Fraud occurred recently.  States involved in this fraud including:  New York, Michigan, Louisiana, Texas, and Florida.

More than 30 people were arrested in conjunction with this recent . Among the suspected were nurses, doctors, and others.

The total amount that has been allegedly scams sits currently at $251 million.

Some of the breakdown of the scams include:

1.) Unnecessary equipment
2.) False patients
3.) Physical Therapy that was never received
4.) HIV treatment that were never received

One such incident in New York found that a fraud was discovered that brought in $70 million dollars alone for physical therapy. The clinic apparently would pay off patients for their Medicare numbers and would provide bonuses for each additional patients. Undercover agents were sent in and they were paid off as well, as part of the sting operation.

Medicare and Medicaid are a serious industries and a potentially lucrative areas for scams and frauds. Recent health care changes by Obama and overalls to the health care industry may be afforded as the government begins cracking down on fraud that may be costing this country over 60 billion dollars a year.

Health Care Spending is an interesting and concerning area our national budget. Many changes may need to be put into place.

Fraud of the medicare systems is happening all the time and from very small scams to quite extensive and elaborate plans.

Federal authorities have been cracking down on many frauds over the past few years. In this most recent raid, over 360 agents were used across the five states. Federal officials have promised more time, money, resources, and manpower to fight fraud. In addition, they have set up strike forces in several cities. It is believed that Miami is the central base for many fraudulent scams over the past few years. This most recent raid found that almost $150 million dollars was from various scams and frauds in that city.

One must ask, is fraud worsening?

The answer is an alarming yes. Criminals are finding easier ways to attempt fraudulent activity. Medicare Scams are often an easy, yet profitable way to bring in large amount of money. One woman’s medicare number had over 3,500 claims on it.

What can you do to keep safe?

1.) Understand the Medicare program

2.) Be familiar with your number

3.) Keep your Medicare number safe

4.) Call your Medicare claim service to see if your number is being falsely used.

Medicare is not the only affected medical area. Medicaid has also been affected. Take a look at the following blog article about Medicaid in Utah

The Day After World AIDS Day

Yesterday we finished off World AIDS Day. I recently gave blood and was tested for HIV.   I hope many were able to go and get checked themselves.   I was able to write a blog about the importance of World AIDS Day.  But throughout the day I  was concerned about more than just about awareness but rather things that need to be done.  Below I have listed a few main points of my thoughts.  Treatment and Prevention are certainly keys.  Take a look and tell me what you think!!!

Future success of preventing and treating HIV is dependant on several things:

1.)   Improved Communication Regarding Risk factors
2.)   Increased Testing
3.)   Improved Access to Testing
4.)   Awareness of Disease
5.)   Improved Cultural Awareness and Sensitivity regarding Risk Factors
6.)   Decrease of Gender and Age Inequalities
7.)   Understand Concern for Racial Risks
8.)   Improved access to Care
9.)   Increase Research
10.)   New Medications
 

Also, Take a look at the following AIDS/HIV complications:

  -    Kaposi’s Sarcoma
  -    AIDS Dementia Complex
  -    Pneumocystis Pneumonia
  -    Tuberculosis
  -    and many others

World AIDS Day – Go get tested

Testing for HIV/AIDS is a large component to World AIDS Day 2009. Many hospitals and clinics offer free testing is today. The expense is often too great from some of the homeless, sick, uninsured, and otherwise concerned individuals. That is what makes December 1st so important.

15 minutes duration from the needle stick to results can be found in The Johnson County Health Department in Kansas allows for quick response. A second appointment to find results often isn’t necessary. A spokesperson for the JCHD said, “One of our overall goals is to help stop the spread of HIV by educating the public.”

The World recognition of AIDS day is today, Tuesday December 1st 2009. Every year memorials, testing, and other disease related issues come to a forefront. 40,000+ individuals in the united states are affected with AIDS each year. One of the larger concern is that it is estimated that 1 in 5 infected with HIV virus are unaware of their infection.

Symptoms for AIDS can take 1 years to manifest.  AIDS is caused by a virus called “Human immunodeficiency virus” (HIV). It is estimated that, throughout the world, over 33 million people have HIV. This is a staggering number. Equally concerning is that only about 4 million are receiving appropriate HIV treatment.

HIV is one of the leading cause of deaths worldwide. The bright spot regarding this disease is that we have seen a steadying of the number of new cases for the last several years. Increased awareness, prevention programs, medications, and testing have largely been a success.

Some great Websites:

A good website for the UK is www.worldaidsday.org

The White House put out a proclamation found here; http://www.whitehouse.gov/the-press-office/presidential-proclamation-world-aids-day

The CDC and HIV incidence: http://www.cdc.gov/hiv/topics/surveillance/incidence.htm

US Government and AIDS: http://www.aids.gov/

World wide campaign and local events: http://www.worldaidscampaign.org/en/Key-events/World-AIDS-Day/Events-Calendar/WAD-2009-Events-Calendar

Is Medicaid really that important?

Medicaid began in 1965 under the Social Security ACT under Title XIX

Harry Truman initiated the idea of a national health insurance plan in 1945. Many worried about a “socialized health care” transformation and it wasn’t until 1965 that President Lyndon Johnson signed this plan into law. – Medicaid was initiated along with Medicare.

The purpose initially was to help families who would be classified as “low income“. These families would get help with their health care. the plan would typically cover hospital visits, doctor’s visits, medications , prenatal care, and other necessary treatments.

Other possible eligeble individuals that could qualify would include: foster children, adopted children, certain protected individuals, disabled individuals, and other pregnant or underage children.

Children who are U.S citizens are eligible even if the parents are not.

Medicaid is the largest resource of federal money that is spent on HIV/AIDS. Qualification to this program depends on T-cell count of less than 200 before qualification is often granted.

The area that is quickly becoming oversaturated with medicaid needs deals with nursing home residents. As the shift continues towards a larger portion of individuals who require this type of care, an increased strain will be seen on this program

The individuals applying for this program may have a small amount of insurance, however the insurance does not adequately cover the family or more commonly, no medical insurance at all.

This is a very expensive program and is often the second most funded program in each state behind education. It is believed that each states spends between 15% and 22% of their budget on medicaid alone.

Medicaid is funded by a joint governing body of federal and state programs.

The United States appears to have always placed some importance in the health care of the lower income status. It is administered by each states and guidelines may be subjective from each state.

Some 50+ million people take advantage of this program with some $200 billion or more spent on it annually.

Participation on a state level is strictly voluntary, but all states have been a party to this program since 1982

*** The concerning aspect of this program is that up to 60% of those who have fallen below the poverty line will not qualify for medicaid.

The need for this program appears to be evident in the number of those who attempt to get qualified.

Certain individuals however, are not so sure that this program is being effective. The strictness or restrictiveness of this program is currently under fire. Many argue that those who really need the program are not the ones on the program. Standards for this programs are state sponsored but a basic framework has been in place.

Who benefits from Medicaid?

Often payment while on medicaid does not go to the individual themselves but rather to the provider that is seeing them. A co-pay in some states is often required. Additional payment for services is done by the government.

Medical providers themselves are paid on a much lower basis per person on medicaid than an individual on private insurance. So they, in essence, take a loss of income when seeing a medicaid patient.

Each states “Medicaid Report Card” is different, with many states failing the quality of care and several large disparities may be seen. Therefore, specific states are at risk while other states are consistently in the top performance for their category.

In our world today, insurance is practically required with expounding medical concerns and cost. This program affords a large amount of people who would otherwise be without medical insurance or without an option for medical treatment.

The burden without this program would be so overwhelming that emergency rooms and other doctor’s offices would be forced to treat patients with little or no hope of recuperating any money from their visits. And although this still occurs in many cases – adding another 50 million insurance-less patients would be overwhelming to say the least.

Therefore – Is medicaid a good program – the answer has to be yes…but it is far from perfect.

As a result — health care reform may be better suited to improve the current program of medicaid then change the system and require an additional 50 years of pitfalls and problems that will most likely be seen with any new program.

This blog was originally posted at InterActive Health

To have a C-section or not to have a C-section? – That is the question!!

Recently I spoke with a women who was not very far along in her Pregnancy. We discussed several issues such as:  how long she had been trying, what she was giving up, her “planned pregnancy”,  her worries, her symptoms,  and other concerns. Then she threw me for a loop by saying that she was planning on having a C-section rather than vaginal delivery because she didn’t want to go through the pains of childbirth.

I wasn’t even sure that was an option. Is elective C-section so planned that one may decide to have a C-section for non medical reasons? A very interesting concept and can be a great argument starter at family parties. My personal jury is still out deciding on a verdict…. but what do you think?

Background

Giving birth by Cesarean section or also called Caesarean section and C-section can be a difficult choice. For many it becomes a life saving measure during an emergency while giving birth. It is another option other than vaginal delivery

The raise in number of C-sections is astounding. Consider that in 1970 only 6 percent of all births were by C-section. Back in 2005 that number had increased 5 times to over 30% of pregnancies.

C-section is a abdominal surgery then through the uterus to allow for the birth of a child. It is often considered riskier than vaginal birth but both procedures cause a risk for mortality of both the baby and the mother.

The following are several reasons to have a C-section planned:

1.) A previous C-section – although not must – having a previous C-section does not prohibit you from ever having a vaginal delivery again

2.) Your baby is breech [Bottom first]

3.) Your baby is transverse [sideways]

4.) More than one baby – C-section may be an option

5.) You develop a conditon known as Placenta previa

6.) Mother having HIV and a high viral load [HIV isn't passed through the placenta but can be transferred

during vaginal delivery

7.) Complication to baby that otherwise would worsen with vaginal delivery

8.) A very large baby

9.) Others

Unplanned C-sections1.) Difficulty during birth

2.) Distress of baby during birth

3.) Umbilical cord concerns

4.) Placenta abruption [placenta unattaches from uterine wall - loss of oxygen to baby]

5.) Others

*** – remember that over 90% of preterm deliveries are done by C-section http://www.marchofdimes.com/aboutus/22684_30185.asp

 

Elective C-section

- Some doctors endorse c-sections for medical reasons

- Some OBGYN clinics in Italy have a 80-90% C-section rate to prevent lawsuits

- In Brazil – hospitals are allowing 80% of births to be done by C-section

- Increase number of C-sections are being done for non medical reasons

My recent conversation isn’t unheard of and is increasing in value for many women. Some women report watching family members with difficult deliveries and others want an uncomplicated delivery. A reported increase in the number of women waiting to become pregnant until later in their lives may also be a factor. This is just one of many areas that women and physicians alike have drawn lines and have begun to debate the idea of non medical elective C-sections.