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

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?

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

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

Chicago – New Healthcare Fraud Hot Bed?

April 19th, 2011

Medicare fraud is hitting Chicago – hard. Chicago’s vulnerable population of senior citizens is receiving the brunt of the fraud, with the unethically targeting nursing homes and elderly living communities. A recent scheme involving elderly immigrants and durable medical equipment was snuffed out by authorities, but not before the fraudsters stole Medicare ID numbers.

Other recent Chicago healthcare fraud schemes include:

Dr. Jaswinder Rai Chhibber, owner of Chicago’s Cottage Grove Community Medical Clinic – charged with ordering unnecessary diagnostic tests for seniors and other patients in an effort to boost revenues from Medicare and Medicaid. Tests included echocardiograms, electrocardiograms and lung function tests, among others.

Marilyn Maravilla, a Chicago nurse, and four others were charged in a criminal complaint with paying kickbacks to various health care providers in exchange for referrals to her agency, Goodwill Home Healthcare Inc. of Lincolnwood. This fraud is part of a bigger, $200 billion scheme brought down by the HEAT taskforce.

Virgilio Orillo and Merigrace Orillo, owners of Chicago’s Chalice Home Healthcare Services Inc., were charged in a criminal indictment with falsifying documents in an effort to boost Medicare payments. The alleged scam, according to the government: Patients were listed as being homebound and in need of skilled assistance when it wasn’t true. (Medicare pays for home health care only for patients who meet these criteria.)

Thanks for reading!

Your healthcare resource – Rebecca Busch

Counterfeit Drug Update

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

Avoiding Fraud, Medical, and Billing Errors in the Healthcare Arena

March 21st, 2011

A HealthGrades report indicates that there have been between 400,000-1.2 million error-induced deaths during 1996–2006 in the United States. On top of that, $60 to $80 billion is lost each year in the healthcare system due to fraud, waste, and abuse. How can you protect yourself from these alarming numbers?

As a patient you have many resources at your fingertips. Before you even visit a healthcare facility or provider, perform a due diligence check on both the facility and the provider.

How to Research a Doctor

First, confirm your physician’s NPI number – all physicians are required to have a NPI number for Medicare billing. Even if a physician is not billing Medicare, they need to have a NPI number to refer patients to other physicians.

Here is a free site to find your physician’s and facilities’ (where you will be receiving the treatment) NPI number.

Second, authenticate your physician’s and facilities’ information with the NPI registry. Here you will be able to confirm the provider’s legal business name and/or location, contact information, and NPI number. The NPI Registry is a free service located here.

Third, research the background history of your provider to see whether he/she has been disciplined, fined, or has had a suspended license. The State of Illinois License Lookup allows you to confirm all licenses distributed by the State of Illinois including MD, RN, PharmD, DO, etc.

Finally, a simple Internet search on the provider/facility may garner surprising results. Oftentimes, pending lawsuits and court filings appear at the top of Internet searches if the provider/facility is involved.

If you suspect anything, remember to request a copy of your medical records and billing statements. By performing your own mini-investigation you will be able to determine if your provider is supplementing or omitting information from your medical records or billing statements.

Useful sites:

NPI Registry

NPI Number Lookup

State of Illinois License Lookup

Are Digital Computers the Doctors of the Future? Elementary My Dear (Dr.) Watson

February 19th, 2011

IBM made a splash this week introducing the first computer competitor in the hit game show Jeopardy. Watson, as “he” is so affectionately called, won the battle Man vs. Machine besting champions Ken Jennings (highest Jeopardy earner) and Brad Rutten (highest amount for a single game). While Watson certainly provided much entertainment value (answering the same wrong as Jennings in one round and other slight glitches) there are higher implications for this robot.

How can IBM harness this power and intelligence to benefit the health community?  A collaboration is under way between Watson’s creators at IBM and experts at the University of Maryland’s School of Medicine.

According to Dr. Siegel, director of the Maryland Imaging Research Technologies Lab at the University of Maryland School of Medicine in Baltimore, Watson, “has incredible potential to revolutionize how we interact with medical records; to be a really valuable assistant to me; to read all the literature pertinent to my practice … to always be at my side and help suggest problems, things in the medical records I need to know about; to suggest diagnoses and treatment options I may not have considered.”

Are you ready for a Dr. Watson in your next operating room? I wonder what his bedside manner will be like.

Click here to read the full article.

Most Wanted Healthcare Fugitive List

February 9th, 2011

And cue… “Bad boys, bad boys, whatcha gonna do, whatcha gonna do when they come for you?”

The Office of Inspector General (OIG) of the Department of Health & Human Services launched a Most Wanted Fugitives List for those criminals wanted by authorities on charges of healthcare fraud and abuse. This most wanted list is a tool to bring attention to the fugitives and their crimes against the healthcare system.

The list on the OIG website includes photos, profiles, and a list of crimes of each featured fugitive. The 10 individuals on the list have allegedly cost taxpayers more than $124 million in fraud. In all, OIG is seeking more than 170 fugitives on charges related to healthcare fraud and abuse.

Included on the Most Wanted Fugitives List:

1. Eduardo Moreno

Moreno allegedly stole hundreds of thousands of dollars from the Medicare program, submitting false and fraudulent claims for durable medical equipment (DME) “and related health care benefits, items and services” that were medically unnecessary.

Moreno was a sneaky fraudster, using a “straw owner” and other methods to hide the money and property he obtained. (A straw owner is an individual who maintains the appearance of owning property in order to disguise the identity of the real owner.)

2. Leonard Nwafor

Nwafor billed Medicare for $1.1 million and collected $525,000 in fraudulent claims for such durable medical equipment (DME) as motorized wheelchairs, scooters, and hospital beds for beneficiaries. This investigation was led by the Medicare Fraud Strike Force, including OIG investigators, which was created to identify and prosecute fraudulent DME companies and laboratories in the Greater Los Angeles area.

The website also provides you with the opportunity to report any of the fugitives or any other individuals believed to have committed healthcare fraud. The site also includes a toll free number.

Take a look at the fugitives and spread the word! These are the individuals causing healthcare costs to increase and benefits to decrease.

Can Health & Wellness Programs Fight Obesity?

January 21st, 2011

According to a recent report titled, “Obesity and its Relation to Mortality and Morbidity Costs” almost 30% of the adult population is overweight, obese, or morbidly obese.

  • Overweight – 19.2% (Body Mass Index of 25.0 to 29.9)
  • Obese – 7.4% (Body Mass Index of 30.0 to 39.9)
  • Extremely Obese – 4.2% (Body Mass Index of 40.0 +)

Some other shocking finds concerning obesity and health from the New York Times:

  • Obese Americans spend about 42% more on health care than normal-weight Americans
  • Obese Americans spend about $1,429 more on health care each year than the roughly $3,400 spent by normal-weight Americans
  • The average American consumes 250 more calories per day than just two decades ago
  • Medical spending on obesity-related conditions is estimated to have reached $147 billion a year in 2008. A figure that represents almost 10% of all medical spending

How can health and wellness programs curb this epidemic? First, group programs and working with others on a common goal keep people on track (think Weight Watchers). If employees are accountable for their actions to others, they will more likely stay on task. This also builds comradery and teamwork skills.

Second, you can show your employees that you care for their well-being and want them to be healthy. You can also reduce absenteeism, increase employee loyalty and witness a major decrease in health insurance costs by offering health and wellness services.

What are some services you can offer? Weight management, healthy eating, healthcare financial services, patient advocate services, concierge visits, gym memberships, group fitness programs, counseling, etc. to name a few.

The major thing is to show your employees you care about their well-being and want them to be healthy and feel great. We can fight obesity by re-learning healthy eating/living habits and decrease healthcare spend exponentially.

When Do You Need a Patient Advocate?

January 15th, 2011

Health and healthcare are private, yet extremely important issues that affect your life every day. If you aren’t feeling well, that affects your mood. If you have a headache, you’re less likely to be productive. If you’re worried about your health or that of a loved one, that stress can lead to more illness and frustration.

Who are you supposed to turn to when your healthcare situation gets out-of-hand, like you aren’t staying on top or your bills (even afraid to open them) or you haven’t researched adequate treatment options and you’re scared to confront the doctor? Patient advocates are an invaluable resource during troubling health experiences.

When might hiring a patient advocate make sense?

1.       You’re overwhelmed with your bills.

2.       You recently obtained power of attorney of the health of a family member or loved one.

3.       You feel “stuck.” You aren’t receiving answers to questions on care or insurance and are unsure of what to do next.

4.       You have a chronic condition that requires constant monitoring.

5.       You receive advice/an opinion and it doesn’t make sense to you.

6.       You are told that no options exist.

What is a patient advocate?

A patient advocate will help you sort through your bills and develop a personal health record or portfolio of all your important health information. A patient advocate will research treatment options with you and provide multiple physicians/other resources in your area or that best treat your condition. A patient advocate will also contact insurance carries and providers on your behalf to sort through your healthcare finances.

Remember a patient advocate can truly be a life saver. However, all patient advocacy services are not alike. Research the advocacy organization and know the credentials of your advocate.

Good luck and great health!