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The Continued Scamming of Healthcare
Here are just a few healthcare fraud cases of note during July 2016:
Three Miami men — $40 million in fines and restitution and 188 months of prison for billing for phantom home healthcare, money laundering, and kickback schemes.
New York surgeon — $25 million in false claims for billing for services not performed.
Maryland X-Ray company owner — 10 years prison for fraudulently billing bogus medical interpretations for diagnostic tests that resulted in two patients’ deaths.
New York physician — jail time for kickback with hospitals in exchange for referring patients to nursing homes.
South Carolina hospital — $17 million in fines for improper financial arrangements with referring physicians.
Illinois woman — $15.6 million and six years prison for fraudulent billing in home health services.
Texas physician — 63 months prison and $1 million in fines and restitution for falsely certifying patients for home health services.
Florida physician — 46 months prison and $2.1 million in fines and restitution for intentionally falsifying diagnoses to get higher Medicare advantage plan capitation payments.
The Relative Contribution of Multiple Determinants to Health
The last several decades have seen a growing interest in what defines and shapes health. Despite having the highest per capita health spending, the United States lags behind many other countries in many health indicators, and glaring health disparities remain. The United States devotes a small share of its health expenditures (less than 9 percent) toward disease prevention.
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Policy has often focused on health care rather than health, with a significant lack of emphasis on prevention, in spite of the fact, as the literature suggests, that the multilevel promotion and adoption of healthy behaviors stands to reap the most “bang” for our health care “buck.” Knowledge of the relative importance of health determinants can help design programs that prioritize interventions in areas where they are likely to have the greatest impact. However, addressing even the few determinants that are thought to be most responsible for good health requires policy makers to work across all sectors, public and private, and at the federal, state, and local level.
Go here for more on this very interesting study from Health Affairs and related research.
AHLA Health Law Curriculum Toolkit
The American Health Lawyers Association is devoted to education on the legal issues in the healthcare field. It has over 12,000 members.
The AHLA recently published its Health Law Curriculum Toolkit to address practice readiness of law school grads wanting to practice in the area of healthcare law. The Toolkit is illuminating as to what the field of health law is and the issues and requirements that law schools and employers have in dealing with law students and law graduates interested in the field.
Medibank Private to push benefits of preventive healthcare
MEDIBANK Private has been given the go-ahead to launch a co-ordinated attack on the costly chronic disease burden by promoting the benefits of user-pays and preventive health schemes that could result in lower premium increases.
Healthcare and controlling healthcare costs have become global concerns for the West. What is going on in the East — is health and healthcare better, or is concern over healthcare an unaffordable luxury for countries whose economies are woefully behind and desperately trying to catch up?
See on www.theaustralian.com.au
Back to Posting on the Good, the Bad, and the Ugly of Healthcare and Healthcare Reform
It’s been several months. Where has the time gone?
I have been watching the unraveling of the foundations of the Affordable Care Act. I have been depressed that the unraveling is coming from the President.
Then I saw the Republican “Plan” and I had hope. Oh, yes, they can’t stop talking about repeal, but that’s not really what their Plan is about. It is about improving.
It has always been my belief that our Republican elected representatives, patriotic men and women of good will, would adopt many of the same positive aspects of Obamacare, if they thought about it and shook themselves free of the closed and narrow minded of their constituents. Access to health insurance, no preexisting conditions … I mean, who does not support these items in Obamacare?
Implementing is where the Republicans always fall short, because they refuse to take any step that would look like our government is actually governing. A Republican omelet must look like a pan with eggs rolling around in it, since they have no stomach for breaking any.
I have hope that moderates of both parties follow the mandate they have had but have refused to acknowledge as they listened to the ranting of the flatworlder/Tea Party members.
By the way, in case you wondered …
Christensen, Flier and Vijayaraghavan: The Coming Failure of ‘Accountable Care’
In The Wall Street Journal, Clayton Christensen, Jeffrey Flier and Vineeta Vijayaraghavan say that the Affordable Care Act’s updated versions of HMOs are based on flawed assumptions about doctor and patient behavior. See on online.wsj.com
Beware the nay sayers. ACOs and other accountable care measures can only succeed if there IS a change in physician behavior. Changing the way healthcare is done in this country is the basis (and only workable basis) for meaningful improvement in healthcare while controlling costs at the same time. No one ever thought it would be easy or quick.
Obama, Ryan address AARP group in dueling speeches
NEW ORLEANS, La. — President Obama, speaking Friday by satellite feed just minutes before a speech by GOP vice presidential nominee Paul Ryan, took a pre-emptive shot at the AARP’s “Life@50+” convention, telling the group not to believe the criticisms that would follow.
“Contrary to what you’ve heard and what you may hear from subsequent speakers, Obamacare actually strengthened Medicare,” Obama said.
The Romney-Ryan camp claims the president’s health care law raids Medicare of billions of dollars, and it has made that assertion a central theme of its campaign.
Speaking to the group, which counts among its membership more than 37 million people over the age of 50, the president tried to discredit that argument.
“When you hear this notion … that we somehow took $716 billion, robbed it from Medicare beneficiaries and seniors, I want you to know that is simply not true,” he said. “What we did was we went after waste and fraud, and over-charging by insurance companies, for example. Those savings do come out to $716 billion.”
Moments later, Ryan tried going on the offensive — warning the crowd of what he claims will be catastrophic consequences to Medicare if voters stick with Obama.
His message was not well received.
“The first step to a stronger Medicare is to repeal Obamacare, because it represents the worst of both worlds. It weakens Medicare for today’s seniors and puts it at risk for the next generation,” Ryan said to a chorus of boos.
See on politics.blogs.foxnews.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Papa John’s CEO says health care reform law will increase price of pizza
See on Scoop.it – Hot Topics in Healthcare Law and Regulation
Expect to pay more for pizza orders in 2014 when key provisions of the health care reform law go into effect, says Papa John’s International Inc. CEO John Schnatter.
See on www.businessinsurance.com
U.S. Officials Brace for Huge Task of Operating Health Exchanges
See on Scoop.it – Hot Topics in Healthcare Law and Regulation
Obama administration officials are getting ready to set up and operate new health insurance markets in about half the states, where local officials appear unwilling or unable to do so.
The markets, known as exchanges, are a centerpiece of President Obama’s health care law, and running them will be a herculean task that federal officials never expected to perform.
When Congress passed legislation to expand coverage two years ago, Mr. Obama and lawmakers assumed that every state would set up its own exchange, a place where people could shop for insurance and get subsidies to help defray the cost.
But with Republicans in many states resisting the creation of exchanges or deterred by the complexity of the task, federal officials are preparing to do the job, with or without assistance from state officials.
“We realize that not all states will be ready to establish these exchanges by 2014, so we are setting up a federally facilitated exchange in those states,” said Michael Hash, the top federal insurance regulator. “We are on track to go live in October 2013, which is the beginning of the first open season for the individual and small group markets.”
Governors of 13 states with nearly one-third of the United States population have sent letters to the Obama administration saying they intend to set up exchanges. Complete applications are due on Nov. 16, just 10 days after the presidential election.
See on www.nytimes.com
Reform Driving Physicians Out of Private Practice to Reduce Costs
See on Scoop.it – Hot Topics in Healthcare Law and Regulation
So, the question is: Is driving a systemically distressed, contracting, dissatisfied and undercompensated physician sector to be forcibly absorbed by a traditional antagonist, but symbiotic hospital sector on the edge of distress itself and binding them together with miles of red tape and questionably reachable incentives going to reduce costs?
See on member.ubmmedica.com
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Physicians Practice
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Joseph Rugg's Health Law Blog 