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

Swine Flu Update

Vaccine Production for the Swine Flu is less than adequate then expected and desired by the public.

According to the CDC, over 1,000 deaths have been attributed to the Swine flu with 100 of those being children.

20,000 hospitalizations are attributed as well. Almost all states have serious flu activity. All but 3 or 4 are largely affected.

Worldwide almost 5,000 deaths have been reported but this may be only a small amount of related deaths.

A  recently signed document by President Barack Obama in attempts to allow certain changes in medical standards with regards to Swine Flu vaccine production.

It is unknown if this will decrease standards of production or the testing with regards to the Swine Flu.   Swine flu is definitely “heating up”.

President Obama believes that this is a critical point in treatment for the Swine Flu. Restrictions of  Medicaid and medicare may also be relaxed as well.

A big question regarding this recent change is the relation between the number of current vaccinations available and a possible emergency status of the Swine Flu. Recent discussions with the White House insists that it is not related to the obvious decrease in expected vaccines available.

The fight against the Swine Flu is just beginning and although we are currently behind our own expectations.

Wasting Money with Medical Malpractice

Imagine driving down the road, a small animal jumps out in front of your vehicle – you slam on the breaks and narrowly miss the animal. You determine that you would have easily missed the animal except your breaks are screeching and they couldn’t slow the car down effectively.

You take your vehicle to the nearest repair shop for a break check and replacement breaks. After an hour, the man behind the counter, comes and informs you that it will take an additional 3 hours to finish the diagnostic process. They will need to check the engine, the alignment, the transmission, the fuel system, and the oil pressure. They must check these out before starting repairs.

You believe that it is only the breaks involved – but they argue that for your safety, [and their protection] they must do an entire system check to make sure you are safe on the road.

This is somewhat similar to the medical field and the diagnosis process of defensive medicine!!

A few changes between the medical scenario is that, the man behind the counter, isn’t necessarily the medical provider; it is society, lawyers, and insurance companies. While with the vehicle repair shop the owner is “the man behind the counter” and he is the one that pressures you into additional diagnostic tests.

A Medical Visit to the Emergency Room

When a patient arrives at the emergency room – the medical staff is designed and determined to improve the status of the patient. Often tests are required such as X-ray for a broken foot or blood work, EKG, and much more for a heart attack.

Some diagnosis are very difficult and may require a great number of exams, tests, and procedures. Where as others are relatively straight forward.

But external pressure, especially because of unwarranted medical malpractice lawsuits, may push a provider to order tests that are unnecessary or unhelpful in the search for a medical problem and subsequent solution.

A recent analysis by Congress indicated that over $41 billion dollars over the next ten years could be saved if malpractice lawsuit awards and rulings became somewhat more reasonable. This would require tort reform

Typically the taxpayer or hospital is responsible for the changes in budget and over-expenditures whether through increased prices, payments, insurance costs, change in medicaid, and/or taxes.

“Recent research has provided additional evidence that lowering the cost of medical malpractice tends to reduce the use of health care services,” CBO Director Douglas Elmendorf wrote lawmakers.

Medical Malpractice

Is when a medical provider deviates from the standard of care. A standard is set for the medical staff and a change from that standard may, but not always, be considered for a lawsuit

The party reporting malpractice must establish 4 aspects of tort law. A duty was owed, a duty was breached, injury occurred, and damages were sustained. Without all 4 aspects – a lawsuit should not be held for trial.

True malpractice that occurs is not being considered as a waste of money. The term malpractice is being enlarged to include situations that malpractice does not involve. The excess amount of settlements and damages are currently believed to be too much. The relative increasing ease it is to file for malpractice when the 4 aspects of tort law are not being met is driving medical practice to “defensive medicine“. And hurts both medical staff and society.

Defensive Medicine

Some doctors feel obligated to order a MRI costing $1,500 for a patient with back pain that a simple $250 back X-ray would be sufficient because they must cover themselves to prevent an eventual lawsuit for missing a cancerous tumor.

Therefore, defensive medicine covers not only the specific complaint but attempts to cover everything under a “what if” policy and practice. A cancer patient could have symptoms of fever and chills, but so could the flu, tooth infection, stomach pains, and many others. A good medical judgment is essential – a need for a test should warrant a test. Fear of a potential lawsuit should not guide medical practice.

Shotgun medicine covers many things – but the cost has been considered as quite expensive.

The Patient concern

How often has an incidental tumor or other finding been observed because of an X-ray of the neck also showed a portion of the lungs or lab work for one concern brought to light another problem.

Patient advocates argue that patient diagnosis will suffer if too large of a cut back is put into place.

Many argue that several malpractice suits are not frivolous and that real harm has been suffered by some patients due to medical malpractice.

Limits on awards may improve medical cost but not always medical outcome.

What if your medical bills and social life were affected because of medical malpractice – yet because of limits to malpractice lawsuits you were unable to pay your bills and return to a functional living. Who would then cover your costs???

The White House

Obama has placed arguments on both sides. He does agree to limiting the overall use of “defensive medicine”. He is also on the side of patient advocates attempting to collect the appropriate compensation to problem.

Obama is currently looking into alternatives to filing a lawsuit or litigation.

Also a pilot plan was discussed last month that may initiate a tort reform. Limiting medical lawsuits has always been close to the heart of many Republicans.

$25 million dollars could be placed to initiate this program.

Conclusion

Although medicine is often more complicated then automobiles, many of us want a solution to the problem when we go to the emergency room

If a car part has a problem we want it fixed. If we have a medical concern – it is beneficial to have it fixed rather than several expensive tests to find a “possible” problem

A better control model for frivolous lawsuits needs to be put into place.

Medical Malpractice occurs and has scary and expensive consequences. No free ride or protection should be in place when a medical provider deliberately causes a problem. When something does go wrong, then appropriate compensation should be put into place.

Lets hope politics doesn’t get in the way of patient care, again!

Obama’s updated health care reform – where are we going??

Where is health care going??

A deadline of August for a Congressional decision to discuss the future of our health care appears to be in place. But increasing amounts of pressure has been placed on Congress and it is unknown what will be in the forecast.

Cost may be at the forefront. It has been estimated that “Covering 50 million uninsured Americans could cost as much as $1.5 trillion over a decade.” citation from “Obama team plans more active role on health”

Obama is attempting to allow Congress to progress at its own pace – which is slower than his initial anticipation and expectation.

Some beginning legislation is attempting to force employers to cover their employees or face a strict penalty. This would allow for coverage for every working employee. However, it is less known to what extent this would be applied.

Another option is an insurance plan that would be government sponsored. This would allow the public to choose between their current work provided health care or a government sponsored insurance plan. Those against this are private insurers who argue that they would be pushed aside and would soon be forced to shut their doors.

Obama stated in a radio and Internet address : “This issue, health care reform, is not a luxury. It’s not something that I want to do because of campaign promises or politics. This is a necessity. This is something that has to be done.”

Another recent issue that congress is muling over currently is to ask some 164 million Americans who are currently covered by their employers to “give up at least part of the longstanding tax exemption granted to such compensation.

Some believe that this will primarily affect the wealthy who receive the largest tax break due to exclusion of their income.

A similar idea was passed around during the Regan administration back in 1984

What does this actually mean? Currently we are not taxed on our insurance. Or in other words, our yearly income is not higher because our insurance does not play into our income. We therefore receive a “tax break”. This may lead to a coverage provided by employees that leads to higher deductibles or co-pays and/or a overall coverage that is less extensive and complete.

Recently Republicans from the Finance Committee gave a warning to President Obama and they insisted that he was making a mistake by supporting a government sponsored insurance plan directed at the middle class. Their concerns are that the government would begin to control the insurance market and that other private companies would be pushed out. Many Democrats remain mixed with many who support the idea but remain cautious with the finer details.

Reformation ideas are ever changing with the current need for a health care reform.

It will be interesting to watch as political dust is thrown in the air and watch where it lands and who is affected.

Originally seen at Health blog

Check out the following stories:

Health insurance ‘haves’ to pay for ‘have-nots’?

“Obama team plans more active role on health”