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Archive for July, 2009

A Government bill to help reduce healthcare fraud? Finally.

Friday, July 31st, 2009

Healthcare fraud is a $60 billion industry. Fraud “rings” are popping up all over the country mainly because stealing from healthcare providers, patients and government run health programs is safer and easier than being a drug dealer. How can we deter criminals from stealing money from our already troubled healthcare system? Well, if the House of Representatives has anything to do with it, the proposed IMPROVE (Improving Medicare and Medicaid Policy for Reimbursements through Oversight and Efficiency) Act will hopefully provide enough barriers that criminals will find drug dealing/other crimes more lucrative.

The bipartisan bill would end the common practice of mailing reimbursement checks to post office boxes. However, we first should all be asking a very important question. Who thought it was responsible to send reimbursement checks to post office boxes in the first place? What reputable healthcare provider doesn’t have a permanent address where to send checks?

The Act will mandate that all government sponsored health programs pay healthcare providers and suppliers by using direct deposit. This certainly seems to be a step in the right direction and into the 21st century. Direct deposits will eliminate an easy way for criminals to get their hands on reimbursement checks, save the government money on stamps, envelopes, paper check etc., and don’t forget about the environment.

Congress, please say, “Yes,” to healthcare reform.

Will EHR adoption increase medical identity theft?

Saturday, July 25th, 2009

It would seem that having all your medical/health information in one place would be a good thing. You wouldn’t have to go from doctor to doctor requesting medical charts and cutting through red tape to access your “private” files. However, we all know from experience that the Internet is not always the safest place to store information – identity theft is running rampant throughout the country with thieves stealing your information right off of your personal computer.

President Obama, following former President Bush’s initiatives, is pushing for everyone to have an EHR or EMR by 2014 (EHR = Electronic Health Record, EMR = Electronic Medical Record). However the problem with this implementation is that currently, most hospitals do not have adequate safeguards to protect highly private and highly valuable medical information (medical identity information averages $50 per identity; a SSN will net thieves only $1).

In many cases, medical identity theft is committed by individuals with inside access to medical information – doctors, nurses, pharmacists, hospital workers etc. By allowing information to essentially “flow freely” throughout the healthcare marketplace we are opening ourselves up to fraudsters and thieves and making medical identity theft even easier than it was before.

According to the World Privacy Forum, 3% of all identity theft victims in the U.S. or 250,000 Americans reported that their identity had been used fraudulently to obtain medical treatment, services or supplies. The World Privacy Forum asserts that this number will only increase in the future.

While EHR adoption will push our country in the right direction in terms of quality of healthcare, what steps are we taking to prevent our most private information from being stolen and used against us?

How much does healthcare fraud cost us?

Tuesday, July 14th, 2009

See Rebecca Busch’s expertise quoted on the Examiner. Just a little teaser – healthcare fraud costs us an exorbitant amount of money.

Read full article here.

Insurance companies recover substantial amounts from healthcare fraud investigations

Wednesday, July 1st, 2009

It was announced yesterday that Blue Cross and Blue Shield health plans recovered close to $350 million thanks to a very efficient 2008 anti-fraud investigation. The total money recovered added up to a 43% increase from the previous year. Fraud activities included false claims, improper billing practices and non-covered procedures.

WellPoint – an independent licensee of Blue Cross and Blue Shield – also announced that they recovered $75 million due to waste, fraud and abuse in their system. According to their estimates, for every $1 spent on investigating fraud the company saves or recovers $11.

Read full article.

If insurance companies can find ways to combat waste, fraud and abuse in their systems, Medicare and Medicaid need to find more productive methods. An estimated $68 billion every year – or 3% – of all healthcare expenditures is stolen. The government could insurance millions with that “extra” money.