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Archive for the ‘Patient Advocacy’ Category

Attention Employers: Medical Identity Theft Concerns You, Your Bottom Line, and the Health of Your Employees!

Friday, April 6th, 2012

Opportunity for crime comes in many forms, from an open window for a burglar to a victim’s lack of information to avoid a fraudster.  At one point or another, many of us have fallen victim to a theft or have even just lost a wallet, but something that doesn’t often come to the forefront of our minds is protecting our medical identity in such a situation.

A patient in South Carolina, an ex-marine in good health, lost his wallet when he left boot camp back in 2005.  He went back home to California.  Over a year later he received a call from his mother informing him that he was the lead suspect in a string of auto thefts in South Carolina!  The man who found his wallet used his military ID and driver’s license to test-drive cars that he would never return to the dealership – grand-theft auto in our patient’s name.

This in itself is a tough resolution, but what’s even worse is that this man’s problems weren’t over; they also included medical identity theft.

The man who found his wallet and test drove those cars also racked up a $20,000 medical bill treating kidney stones and an injured wrist.  The ex-marine never thought to call and inform his insurance carrier, so he was on the hook for those bills.  He was hounded by collection agencies and the government even withheld his tax return!  These issues were finally resolved, but it took over a year of appeals, phone calls, withheld income, and finally the intervention of the US Secret Service to pinpoint the man who stole his identity – Arthur Watts. Not all of us would be afforded that luxury (the Secret Service was brought in by the US attorney’s office to help in this investigation).

When someone loses a credit card, the process is simple:  call your credit card company and notify them.  Any reputable company will refund your money – they investigate the claim, and within about a week you will have a resolution that will cost no more than $50 by law, and often nothing at all.  When someone loses their healthcare benefits card in that same wallet, there is no course of action that takes place regarding the benefit card, and most people don’t realize something is wrong until they start getting collection calls or run a credit report months or even years later.

This doesn’t just happen one victim at a time when wallets are lost either.  The implementation of Electronic Health Records in hospitals and doctors’ offices increases the scale of these problems.  The wrong person gaining access to the system can mean tens, hundreds, or even thousands of Social Security numbers and benefit profiles at risk.  Lax technological security is another issue with this type of information.  Earlier this month, BlueCross-BlueShield of Tennessee agreed to pay $1.5 million for a 2009 breach in which over 50 hard drives holding over 1 million patient profiles were stolen.[1]

This is a dangerous lapse by BCBS, who is entrusted by its patients to guard their most personal and valuable information, including names, SSN’s, and policy numbers.  It was an inside job that could happen again. This tells us two things: a person’s medical identity is a coveted asset in fraud, and there is significant opportunity due to the lack of detection and prevention.

The reality is that healthcare fraud occurs at a lower instance rate than credit card fraud, but with higher dollar amounts per instance.  This translates into less public awareness and education on the risks, and much more financial risk and discomfort for those afflicted by medical identity theft. The laws protecting medical identity theft are not the same as those protecting victims of credit card theft – it is harder to recover the money, it takes longer, and the money might not be totally recoverable.  Possibly the most devastating implication of medical identity theft, though, is the impact it can have on your medical record.

The changes to a medical record can impact insurance coverage and treatment by providers.  A legitimate healthcare claim for an emergency surgery can turn into a nightmare when it is denied by a carrier because the patient has “reached the maximum on benefits” thanks to this undetected fraud.  Even more difficult to resolve is being denied benefits, or even being dropped from coverage, all due to a medical condition that you don’t have, yet someone else has reported under your name.

Electronic medical records can be amended, but it’s much more work to have things deleted, because of the implications your medical condition has on insurance coverage and pricing.

This begs the attention of employers in protecting their employees.  Carriers need to dutifully encrypt information and protect their customers.  And, most importantly, patients must educate themselves and advocate for their own well-being. The Federal Trade Commission [FTC] agrees (http://www.ftc.gov/bcp/edu/pubs/consumer/idtheft/idt10.shtm).

  • Read your EOB’s and know what you are being charged for
    • Check the name of your provider, date of service, & service provided
    • Discrepancy? – call your healthcare provider
  • Review a copy of each credit report – annually verify the integrity of ALL information listed
  • Patient tracking of personal health and ideally annual comparison to medical records provided by insurance carrier

The next steps to take if fraud is suspected include filing a complaint with the FTC and a report with local police, exercising HIPAA patient rights and correcting any errors on your medical record, and activating a fraud alert and security (credit) freeze with the individual credit agencies (Experian, Equifax, Transunion). http://health.usnews.com/health-news/family-health/articles/2008/02/29/medical-identity-theft-turns-patients-into-victims.

A Look into Online Pharmacies

Thursday, November 10th, 2011

When someone says “online pharmacy,” what do you think? Discounted drugs, no need for a prescription, illegal activity… counterfeit or adulterated medications?

Online pharmacies tend to fall into the illegal activity and counterfeit medication categories. While there are some legal and legitimate online pharmacies out there (more on that in a minute), you need to be aware that more and more online shops are popping up selling expensive medications at better than wholesale prices.

Due to the fact that counterfeit versions of at least 40 of its drugs have been found in more than 100 countries, drug maker Pfizer and a national pharmacy standards group started a website warning consumers about counterfeit prescription drugs and explaining how to find legitimate online pharmacies.

One way to weed out the bad online pharmacies is to look at their prices. If they are too good to be true – they are. For instance, Pfizer’s drug Viagra typically is sold to distributors for around $18 per tablet. One online pharmacy sells 25mg tablets for between $1.09 to $2.49, and another list 130mg tablets from 99 cents to $1.31 per pill. How can they sell an $18 per pill drug for as little as one dollar? Where is the profit in that?

Scope of the Problem

While it is very difficult to measure how much illegal pharmacies are making from selling counterfeit medications, a case was recently in the spotlight concerning these online pharmacies. In August 2011, the U.S. Department of Justice demanded Google to forfeit $500 million in revenue generated by online ads for online pharmacies. $500 million on advertising is a big chunk of change – if these pharmacies can afford that, this business model is obviously lucrative.

Legitimate Online Pharmacies?

The controversy exits with online pharmacies. I am sure you have people (including your physicians) telling you not to purchase medications over the internet. However, there are legitimate safe online pharmacies. How can you find them? The National Association of Boards of Pharmacy (NABP) developed the VIPPS accreditation program, which evaluates Internet pharmacy practice. A VIPPS accreditation verifies that the online pharmacy is a virtual equivalent to a brick and mortar shop down the street. But please, keep a watchful with online pharmacies – it should be noted that there are only 29 online pharmacies holding VIPPS accreditation.

Don’t Want to Be Duped?

Now you are thinking, “How can I protect myself from these online predators?” First of all, the easiest way is to avoid online pharmacies. However, there may be some instances where you cannot avoid it. What should you do then?

  1. Buy drugs only from trusted retailers (VIPPS accreditation) and stay away from non-regulated online pharmacies.
  2. If traveling abroad, please bring medications with you and avoid purchasing from countries with a high counterfeit mix (most notably African countries).
  3. The easiest and most resourceful way to avoid counterfeit products is to education yourself on the medications you take. An informed consumer is an empowered consumer. If the drug isn’t acting how it was when you took last month’s supply, it could be counterfeit. If the bottle looks tampered with, check with your pharmacist.
  4. If you have any questions or are worried about your medication, talk with your pharmacist about any recent counterfeit products or check the FDA or drug manufacturer’s website.

CommunityHealth – Illinois Largest FREE Health Clinic

Friday, November 4th, 2011

I would like to introduce an organization that is extremely important to the Chicago community – CommunityHealth. I support CommunityHealth and its mission as a board member, contributions in kind, and direct cash donations.

Healthcare is expensive and costly. I can tell you from personal experience that many individuals go without badly needed primary care services as a result of the expense.

On that note, I have had the privilege of working for a great organization – CommunityHealth – which provides free healthcare services to the underserved and uninsured. If you have 2 minutes, I would appreciate you watching this short video explaining just how important CommunityHealth is to the community, and what you can do to help.

Donate to Chicago Community Health

To all my clients, friends, and loyal readers, if you take the time to donate $500, I provide you with a free copy of my healthcare advocacy book – Personal Healthcare Portfolio: Your Personal Health & Wellness Record (a $20 value). If you donate $1,000 you will receive a copy of all three of my books (PHP, Healthcare Fraud: Audit & Detection Guide, and Electronic Health Records: Auditing & Detecting – a $130 value).

To donate to CommunityHealth please click here. Remember, unlike other organizations who have large overhead costs, $.97 of every $1 donated goes directly to patients in need. Your money matters.

Fight for Your Rights – Patient Advocacy at Its Best

Monday, August 29th, 2011

Recently an employee came to me terribly worried about her child. Her daughter had been finally diagnosed with a severe lactose allergy after months of testing, countless doctors’ visits, and numerous theories of the cause for her tiredness, chronic hives, and other symptoms. However, my employee’s daughter wasn’t out of the gate yet. She takes a few medications to help with her allergies and her Attention Deficit Disorder.

Lactose in Drugs Can Affect Allergies

Now, here is the problem. What happens when these necessary medications contain lactose or eggs – two ingredients the child is allergic to? First, you need to ask your doctor or pharmacists what ingredients are in your medications – all the ingredients. Many medications use lactose as a filler. You also need to be aware of vaccines as well – many (including the flu vaccine) contain lactose.

For my employee, she asked her pharmacist if her child’s medication could contain lactose. Her pharmacist firmly replied that is takes too long to look up the ingredients of drugs. (Subsequent calls to other pharmacies did not pose this same problem, so hopefully in her case it was a moody pharmacist). However, if you receive this reply, first indicate that your child has a severe allergy and could be seriously harmed or even die if the product contains any milk (or peanuts, eggs, etc.). Second, ask to speak with another pharmacist. If you don’t receive an adequate answer find a pharmacy that will accommodate your questions and go directly to the drug manufacturer’s site to look up the ingredients in your child’s medication.

The good news is, that with most lactose allergies, many people can continue taking medication that includes milk. According to Walgreens, “Most people who are lactose intolerant can tolerate the lactose in oral medication because it usually takes around 12 to 18 gm of lactose—about the amount in 8 to 12 oz of milk—to cause the symptoms that include gas, bloating, diarrhea, and abdominal pain. Most oral medications contain far less than this amount. However, some individuals may still experience those symptoms from very small amounts of lactose. In these cases, lactase enzyme supplementation may help. These supplements, available over the counter, help by breaking down lactose. Probiotics, which contain beneficial bacteria that may help break down lactose, are another possible remedy.” So for those of you that only have a mild lactose intolerance, medications including milk might be fine for you to take (please consult your physician or pharmacist before doing so).

Again, be the informed patient. Most people might not think that the medication that is supposed to be helping them, might actually be severely hurting them. Keeping a Personal Health Record will help you keep control of your allergies and inform your healthcare providers on changes in your health condition.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Cutting Healthcare Costs through Patient Advocacy

Tuesday, July 12th, 2011

During a recent conversation with a colleague, she informed me how she has been responsible for taking care of her elderly mother, driving her to appointments, filling her prescriptions, etc. She mentioned that her mother’s previous doctor always ordered tests – looking at her bone density, mammograms, chest X-rays – the whole nine yards. Initially, this didn’t surprise me, her mother is 87 and has emphysema and osteoporosis – the doctor is just trying to keep her healthy. However, after my colleague enlightened me, I thought about the subject a little differently.

First of all, let’s look at the age. Her mother is 87. She has stated repeated that these tests hurt her (mammograms especially, and she has very sensitive skin that tears easily). Even if these tests were positive or showed some sort of abnormality, she would most likely elect not to have surgery, radiation, or other forms of treatment.  Her mother’s attitude, “I am 87, I want to live a pain free, non-complicated life. Going to the doctor every month isn’t fun for me, or my daughter who has to take work off in order to drive me.”

I mentioned previous doctor in the first paragraph because my colleague’s mother was so fed up with all these tests and appointments that she went to a new doctor. The new doctor was very candid. She said, “Yes, I can order these tests. Yes, I could see you once a month. However, you’re pretty healthy and these tests aren’t going to tell us anything that we don’t already know, or that we could fix.” Now, the doctor could have been reimbursed by Medicare and secondary insurance for these tests – the mother wouldn’t have had to “pay” out-of-pocket anything. But, in that sense, we all are paying for unnecessary tests and visits.

This is only part of the problem. Luckily my colleague and her mother were informed enough to understand that they can say, “No” to these unnecessary tests and procedures. Other individuals might be scared into participating. This is an instance were having a patient advocate on hand, informing the patient of his/her rights would be ideal. A second ear to listen to diagnoses and conditions, and a trained mind to realize that an elderly person who is sensitive might not want these tests because they hurt or the results won’t produce anything the person doesn’t already know.

The moral of this story is to speak up when communicating with your physician. If you find yourself wondering why your physician is ordering tests, consult with another physician. Patients can cut healthcare costs on the front end by being savvy consumers.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Pill Mills: New Laws, New Offenders, Same Old Scheming

Thursday, June 2nd, 2011

What is a Pill Mill?

A Pill Mill consists of a doctor, clinic or pharmacy that is prescribing or dispensing powerful narcotics inappropriately or for non-medical reasons.

How do pill mills work?

  • Only accepts cash
  • Pain is the only illness “treated”
  • No physical exam is needed
  • Pain is only treated will pills, no other methods are examined

New Laws

Rules in Pill Mill hotbeds of Florida and Ohio have recently been put into place to stop these schemes. In Ohio a bill passed that will enhance “reporting requirements for physicians who also furnish drugs, establish a clearer definition of “pain management clinic,” and require the state Medical Board to develop standards for operating such clinics.”

The bill also mandates that Medicare and Medicaid systems be better managed to weed out individuals who are getting the prescription medications and then selling them.

In Florida, lawmakers have made more requirements for doctors looking to operate pain management clinics. The law will also impose new administrative and criminal penalties for doctors who overprescribe narcotics.

Recent Crackdowns

A February raid of 11 pain clinics from Miami to West Palm Beach lead to the arrests of 23 people, including four physicians, and seized $2.5 million in cash and dozens of cars.

Something good to come from these recent raids – Oxycodone pills are harder to find in street deals nowadays, evidenced by the rise in prices from around $5 per pill to $20.

Cracking down on prescription drug abuse will hopefully lead to fewer prescription drug related deaths.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Patient Advocacy – More Tips on How to Be an Empowered Patient

Wednesday, May 18th, 2011

What can you do if a doctor refuses to treat you as a patient?

First of all, if a doctor doesn’t want to treat you, is that the type of person you want in charge of your health? Probably not, so the best tip is to find a new doctor.

However, if you believe that this doctor is the only doctor in your area that can treat your disease, or you have heard such marvelous things about this doctor and you can’t give up just yet, you have a couple of options.

1.       File a complaint with the State. You can report the doctor to the State for refusing to treat you. You should be weary though, this will not likely result in any disciplinary action unless the doctor has discriminated against you due to sex or race.

2.       Report the doctor to the insurer. If you report the doctor to the insurer, the insurer might investigate and warn the doctor or even drop the doctor from its plan. Once again, this is unlikely unless there is some sort of discrimination attached.

Overall, patients should be careful when pursuing this avenue. If word gets around that you’re complaining about doctors, less and less doctors might be less willing to take you as a patient.

What is the “fail first” medication policy some insurers use?

Many insurers require the least expensive medication or treatments be exhausted first before they are willing to shell out more money for the more expensive medications and treatments. This might make sense, but many times, the less expensive medications and treatments do not work, wasting a patient’s time and resources before they can receive the drug they need to heal.

Advocates in New York are trying to stop this practice saying it puts the patient through unnecessary pain and suffering.

Is your insurer doing this to you? Write your Congressmen, join an advocacy, and spread the word that this is happening.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Medical Identity Theft: What is it? How does it happen? How can it affect you or your loved ones?

Friday, May 13th, 2011

Some stats for thought:

  • As many as 500,000 Americans have been victims of medical identify theft, according to the World Privacy Forum.
  • At one medical clinic in Weston, Florida, a front desk clerk downloaded information of more than 1,100 Medicare patients and gave it to a cousin who made $2.8 million in false Medicare claims.
  • Thieves use your identity to buy prescription drugs. They then sell these prescriptions or use them to feed their own addictions.

What does this mean to the average person?

If you find yourself being a victim of medical identity theft, you might receive hospital bills in the mail for services you never received. You might visit an area hospital only to find your records include false or wrong information, like blood type or previous surgeries you’ve never received. You could even have your kids taken away like this unassuming woman almost did during her ordeal with medical identity theft.

Anndorie Sachs, a mother of four from Salt Lake City, has always considered herself a loving, caring mom.  So one can imagine her surprise when a state social worker called Sachs and accused her of having given birth to a baby girl with methamphetamines in her system and abandoning her in the hospital.

Even more unthinkable, according to Sachs, the state told her over the phone she was an unfit mother, and planned to take custody of all her kids.  “I definitely went into shock,” she says.  But, Sachs hadn’t given birth to a baby with meth in its system. In fact, she hadn’t given birth in two years.  Anndorie Sachs was a victim of medical identity theft.”

How can you avoid becoming a victim?

If you don’t monitor your EOBs fraudsters have a better chance of stealing your Medical Identity. This can cause both financial and physical harm – if someone else’s information is included in your medical record you could receive false diagnoses. Take ownership of your healthcare finances and request your medical records and bills once a year.

If your wallet is stolen, notify your insurance company — not just credit-card companies — because your benefit card is like a credit card without a limit.

Be an empowered patient and take charge of your health and healthcare finances.

Thanks for reading!

Your healthcare resource – Rebecca Busch

Protect Yourself from Counterfeit Products and Medications

Tuesday, April 26th, 2011

Johnson & Johnson recently discovered fake diabetes test strips in India – these strips were found in their ongoing worldwide effort to eradicate counterfeit and tampered products.

Johnson & Johnson suspects the strips were made in China and repackaged in counterfeit packaging in India (a whole production).

The good news for American consumers is that Johnson & Johnson has seen no evidence of fake OneTouch strips in the U.S. over the past three years; however, counterfeits continue to periodically crop up in other countries, including Egypt last year and Pakistan in 2009.

How can you, as a consumer, protect yourself from tampered products and medications?
The U.S. Department of Health & Human Services and the FDA provide great resources for consumers.

Some of their tips include:

  • Read the label. Be alert to the tamper-evident features on the package before you open it. These features are described on the label.
  • Inspect the outer packaging for signs of tampering before you buy a product.
  • Examine the medicine itself before taking it. Check for capsules or tablets that differ from the others that are enclosed. Do not use medicine from packages with tears, cuts, or other imperfections.
  • Never take medicine in the dark.
  • Examine the label and the medicine every time you take it or give it to someone else.
  • Tell somebody if the product doesn’t look right. Do not buy or use medicine that looks suspicious. Always tell the store manager about questionable products so that they can be removed.
  • Before buying any medicine, you should stop and take a look. Before taking it, you should look again.

Ensuring Safe Use of Medicine

Thanks for reading!

Your healthcare resource – Rebecca Busch

Counterfeit Drug Update

Tuesday, April 12th, 2011

Text messages to combat counterfeit drugs:

In Africa, counterfeit drugs are a growing health concern. Some estimates say that nearly 50% of the drug supply is counterfeit. What is one way to combat this growing epidemic? Text messages. That’s right, African’s can submit a verification code hidden in the medicines packaging and submit it to a service to verify whether it is authentic. This pedigree system puts the power back into patient’s hands.

Medicine supply chain breach – worst ever

A British man was found guilty and sentenced to eight years for his involvement in a scheme known as Operation Singapore, which centered on the importation of more than two million doses of counterfeit life-saving medicines into the country.

More than half of these were captured by the Medicines and Healthcare products Regulatory Agency, but a huge amount – almost 900,000 doses – initially reached pharmacies and patients.

Despite an immediate recall of the drugs Zyprexa (olanzapine), Plavix (clopidogrel) and, Casodex (bicalutamide), 700,000 doses were left unaccounted for, putting the health of consumers in jeopardy.

Fake drugs are threatening public health

Consumers look to the FDA and the National Agency for Food, Drug Administration and Control (NAFDAC) to prevent counterfeit drugs from breaching the system. What strong holds are they putting into place to combat this growing problem?

“Recent developments have revealed that only a cross-functional and integrated approach can be successful in defeating counterfeiting and fraud as well as the diversion of pharmaceutical products. That is why the use of these anti-counterfeiting technologies should be embraced extensively by consumers of pharmaceuticals products and pharmaceutical companies should equally employ security technologies in packaging, primarily to support product authentication, provide an indication of a drug purity and allow supply chain to be tracked.”

To read more about new initiatives visit here.

Thanks for reading!

Your healthcare resource – Rebecca Busch