8 Tips to Stop Healthcare, Insurance Inefficiency and Fraud



Inefficiency and fraud in healthcare and insurance has generated a ton of headlines. So a discussion about inefficiency and fraud has to include all stakeholders. 
That means patients, doctors and insurance companies – all must get a square deal for the healthcare system to work.

Firstly, it appears doctors are experiencing unnecessary challenges.

The Supreme Court rulings on ObamaCare didn’t solve anything for doctors – the undesirable law continues to remain a challenge to doctors in multiple ways. This also means ramifications for you as a patient.

Doctors are stressed by decreasing reimbursements for patient care by insurance companies, Medicare and Medicaid.

ID-10033362 photostockTrue, some doctors, who have good instincts, are better than others. It’s not uncommon for a patient to be misdiagnosed only to get a differing diagnosis from a different doctor.

This underscores the need for diagnostic proof in order for them to get paid, and explains why some doctors order more expensive tests than others.

Then, there are the decisions by health insurance companies adversely affecting doctors – interfering in doctor-patient relationships by dictating care, fees and inflexible fraud regulations.

Doctors and hospitals must spend too much time and resources on paperwork. Insurance companies are only doing what they feel is best to stay in business.

It’s not uncommon for doctors to decline to treat Medicaid patients – affordability is an issue for 31 percent of doctors. They aren’t accepting patients insured by the federal-state insurance program, according to the publication, Health Affairs.

Doctors are turning new Medicare patients. They’re only paid 40 cents on the dollar.

How ObamaCare increases costs

You might recall that the Obama Administration and other proponents promised that more low-income patients will get healthcare. However, with 31 percent of doctors now declining Medicaid patients, such patients have to spend extra time and money to find a primary healthcare provider. 

ObamaCare means costs will continue to increase. Why? ObamaCare is mandating that insurance companies accept everyone – no matter what.

Many such patients will only purchase healthcare when they absolutely need it – not before. The IRS penalty for being uninsured is less costly than the cost of premiums.

Because patients will wait too long to buy coverage, Medicare, Medicaid and insurance companies will have to continue increasing premiums – translating into higher costs for healthcare and insurance.

But the healthcare problem will worsen:

ObamaCare’s $716 billion in cuts in Medicare payment to providers – doctors and hospitals – threaten their livelihoods. Their only hope is for an increase in Medicaid patients. However, many states have already announced they will not participate in the expansion of Medicaid.

Fraud prevention

At first glance, one good provision in ObamaCare is an increased emphasis on prevention of Medicare and Medicaid fraud.

Published reports indicate Medicare fraud is in excess of $60 billion. The fraud is largely perpetrated by supply houses and furtive brokers.

For instance in 2011, the nation’s fraud-detection system cost $77 million. There’s also new fraud-command center costing $3.6 million, which doesn’t include the expense of fraud investigators across the U.S.

The fraud enforcement system has its detractors. Over the last six months of 2011, the system only prevented one check, in the amount of $7,591, from being paid to con artists.

So Senators Orrin Hatch (R-UT) and Tom Coburn (R-OK) wrote a letter to Dept. of Human and Health Services Secretary Kathleen Sebelius. They asked her to stop spending money on the system until it can become efficient. Their concerns were ignored.

Eight tips to prevent fraud

Fraud affects all of us – patients, doctors, taxpayers and the federal government.

The Federal Bureau of Investigation recommends these fraud-prevention tips:

1. Never sign blank insurance claim forms.

2. Never give blanket authorization to a medical provider to bill for services rendered.

3. Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.

4. Carefully review your insurer’s Explanation of Benefits (EOB) statement. Make sure you actually received the treatments for which your insurance was charged, and question suspicious expenses.

5. Do not do business with sales people door-to-door or over the phone who tell you that services of medical equipment are free.

6. Give your insurance/Medicare identification only to those who have provided you with medical services.

7. Keep accurate records of all health care appointments.

8. Know if your physician ordered equipment for you.

From the Coach’s Corner, also see:

“There are three things in the world that deserve no mercy, hypocrisy, fraud, and tyranny.
-Frederick William Robertson

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Author Terry Corbell has written innumerable online business-enhancement articles, and is a business-performance consultant and profit professional. Click here to see his management services. For a complimentary chat about your business situation or to schedule him as a speaker, consultant or author, please contact Terry. 

Photo courtesy of photostock at www.freedigitalphotos.net

Fiscal Fact-Check: Deficit, Social Security, and Medicare


Updated March 16, 2015-

America’s economic system is in grave danger. Like your personal finances, fiscal discernment in U.S. public policy is important for our economic recovery.

A Harvard study reveals that massive U.S. borrowing and spending have wasted trillions of dollars in flawed efforts to stimulate the economy.

In addition, the study also reveals government spending causes companies to cut back.

ID-10034937 AmbroAmerican voters should demand what’s best for the citizenry now and for the generations to come.

Consider these salient facts:

The U.S. debt

This month, the U.S. has a $18+ trillion deficit and it’s still climbing.

The debt is tracked by different organizations, which you can watch in real time at two Web sites.

They are www.usadebtclock.com and www.usdebtclock.org.

Countless countries actually own America

In June 2014, according to U.S. Treasury Department data, here were the 10 biggest owners of U.S. Treasurys:

1. China, Mainland – $1268.4 billion

2. Japan – $1219.5 billion

3. Belgium – $364.1 billion

4. Carib Bkg Ctrs 4/ – $308.3 billion

5. Oil Exporters 3/ $262.1 billion

6. Brazil – $253.7 billion

7. Taiwan – $179.4 billion

8. Switzerland – $175.9 billion

9. United Kingdom 2/ – $173.7 billion

10. Hong Kong – $158.2 billion

On the other hand, countless foreign governments own billions of dollars of U.S Treasury Securities.

Social Security now pays more in benefits than it collects in taxes

According to Social Security, there are too few Americans paying into the system, as workers retire. Millions of baby boomers have opted for early Social Security checks because they can’t get a job.

Five decades ago, in 1960, there were 4.9 Americans paying into Social Security for each person getting benefits. Now, there are only 2.8 workers. The Congressional Budget Office says the figures continue to worsen – only 1.9 workers will be paying for each beneficiary in 2035.

In 2012, the average retiree got $1,235. Disabled workers’ average was $1,111.

Some 56 million Americans get Social Security checks now, and the number will skyrocket to 91 million in 2035.

The Social Security situation worsens the federal budget deficit

Because the federal government and its agencies have spent far more than they get in tax revenue – Congress has been raiding Social Security, which used to have a surplus.

Congress justified the raids by ordering the Treasury Dept. to issue two special bonds, which are worth $2.7 trillion, for trust funds. One fund is for retirees and the other is for disability recipients.

Social Security is surviving by tapping into the interest from the trust funds. It’s forecast to be bankrupt in less than 20 years.

“In 2012, outlays exceeded noninterest income by about 7 percent, and CBO projects that the gap will average about 12 percent of tax revenues over the next decade. ” according to the Congressional Budget Office (CBO) Web site.

It gets worse.

“CBO projects that under current law, the DI trust fund will be exhausted in fiscal year 2017, and the OASI trust fund will be exhausted in 2033,” write the budgeters. “If a trust fund’s balance fell to zero and current revenues were insufficient to cover the benefits specified in law, the Social Security Administration would no longer have legal authority to pay full benefits when they were due.”

In 2012, Social Security was forecast to have a $166 billion shortfall, including the $112 billion from the temporary payroll tax reduction. The temporary reduction actually hurts American workers – as a result, they’ll earn less money for their retirement.

Social Security was scheduled to pay out $789 billion in 2012, but only receive $623 in payroll taxes.

Medicare’s fiscal issues are worsening

President Obama and his fellow Democrats claim they’re working to save Medicare. So far, the facts from the CBO show otherwise.

To partially fund ObamaCare, Democrats began taking $716 billion dollars from Medicare for nine years starting in 2013. What’s worse, the ObamaCare legislation implements more than 160 changes adversely affecting Medicare.

It also hurts health services. (See: Healthcare Crisis – What the Plight of Doctors Means to You)

Efforts to save Medicare are stymied by politics.

As a member of Congress, Paul Ryan (R-Wis.), introduced a plan that would upgrade Medicare and change the government’s role by providing senior citizens with grants, net amounts or vouchers – whatever term you choose to use.

Over a nine-year period, the CBO estimated it would have saved $30 billion and recipients would pay an out-of-pocket $6,400.

But 100 percent of the Democrats voted against the plan.

So, Rep. Ryan teamed up with a liberal counterpart – Sen. Ron Wyden (D-Ore.) to come up with a compromise. After Rep. Ryan was named as a running mate for Mitt Romney, Sen. Wyden sought to distance himself for political reasons. But he says he’s still committed to fixing Medicare’s fiscal problems.

Rep. Ryan’s new reform’s key elements:

— Senior citizens will be allowed to stay with the current system.

— No one over 55 would be affected. After 2023, 65-year-olds can choose either the status quo or a government-provided net amount.

— The average out-of-pocket expense to senior citizens will only be $800.

— Medicare would not go bankrupt.

Other issues affect the nation

They include consistently high unemployment or under-employment for workers seeking family wage jobs, sluggish economic growth, uncompetitive school systems, crumbling infrastructure, and increasing poverty (one out of six Americans).

There are pocketbook issues for everyone. Food costs have been climbing even before the drought, and motorists in many areas are suffering from high prices at gas stations.

So it doesn’t help with the administration imposing unnecessary regulations on the petroleum industry, assailed important exploration tax breaks, and hasn’t approved new areas for exploration.

As a matter of fact, both political parties have played a negative role:

— Pres. Bush didn’t veto one pork bill from the Republican-dominated Congress until six years into his presidency. The deficit started under his watch.

— The Obama Administration hasn’t kept one promise made to small business –the nation’s jobs engine – prior t0 the 2008 election. None of his policies has worked to solve the nation’s issues. The deficit continues to explode.

Such fiscal dysfunctions prompt this question: Why do we want to risk burdening our children and grandchildren?

Let’s insist on three Ps – productive public policies – to benefit this great nation. That means understanding the facts and taking steps for fiscal sanity.

From the Coach’s Corner, related issues:

— Nonpartisan Study: Obama’s Tax Plan Hits 53% of Business Earnings

— Is it Too Much to Ask For Civility and Honesty from Mr. Reid and the Press?

— Economic Analysis by noted economist Peter Morici, Ph.d.

“If you ever injected truth into politics you have no politics.”

-Will Rogers

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Author Terry Corbell has written innumerable online business-enhancement articles, and is a business-performance consultant and profit professional. Click here to see his management services. For a complimentary chat about your business situation or to schedule him as a speaker, consultant or author, please contact Terry.

Image courtesy Ambro www.freedigitalphotos.net

Healthcare Crisis – What the Plight of Doctors Means to You



America’s shortage of doctors is a widespread concern, and the stories you’ve heard about the difficulties experienced by doctors are true. Their payments from Medicare have been slashed. As a result, many physicians aren’t accepting new Medicare patients.

Their difficulties were aptly explained by a 2012 study mentioned in an article published by Medscape Medical News. The doctors’ plight has often been repeated since.

That also indicates ominous prospects for patients’ access to healthcare – a problem not solved by ObamaCare.

ID-100102373 stockimages.The headline: “26% of Small Practices May Close, Survey Says.” Doctors with small group practices – 10 or fewer people – expected their 2012 income to be less than the year before.

Their financial situations may prompt more than a quarter of them to stop treating patients. 

Forty-nine percent told the study’s sponsor, medical-news Web site MDLinx, they have cut operating expenses by slashing services and staff. 

“This poll is quite startling in the revelations about small practices, the healthcare lifelines to many communities,” says MDLinx Chief Marketing Officer Stephen Smith, according to Medscape. “Physicians have had missiles raining in on their practices at an increasing pace – the economy, regulations, paperwork, insurance, lawsuits, etc.” 

Twenty percent of the responding physicians have had to borrow money for operating expenses, and 23 percent have resorted to tapping into their personal assets. 

The data is less bleak for larger practices – 13 percent believed they’ll earn less income.  

In scanning the  poll’s responses, Medscape noticed that 56 percent of the doctors indicated that 75 percent of their income is derived from Medicare. 

If Congress doesn’t reverse the decision to slash Medicare payments by $500 billion, 61 percent indicated they’ll have to cut back more services. Seven percent said they’d go dormant. 

“The coming retraction this survey hints at,” Mr. Smith says, “would mean longer drives to less-personal, higher-cost medical care for millions of Americans.”  

In a letter to the editor at The New York Times, Dr. Jeremy Lazarus as president-elect of the American Medical Association, addressed the Medicare-payment dilemma. 

We agree that Congress must pass a permanent solution to the broken physician payment problem that plagues Medicare with frequently scheduled cuts, but eliminating this problem by putting in place other physician cuts rather than true payment reforms will only continue to threaten patients’ access to care,” he wrote.

Dr. Lazarus said the doctors’ Medicare payments have stayed the same for 10 years, but physician costs are up more than 20 percent.

“It is time for Congress to permanently eliminate the flawed payment formula, end the scheduled Medicare cuts, and put in place a payment system that reflects the cost and practice of 21st-century medical care and provides stability for physicians and patients,” he added.

Amen. Listen Congress.

Medicare must work for both patients and doctors. Further, instead of capitulating to the lobbying of lawyers, something concrete needs to be done about the high cost of malpractice insurance.

Just like any other business, physician practices need to be profitable. Turnaround situations aren’t hopeless. But doctors have to implement the right strategic plan.

P.S. Senior citizens with whom I’ve talked fear the Medicare changes. Seniors and all concerned citizens should contact their elected officials in Congress to lobby them to do the right thing for their doctors and for themselves.

From the Coach’s Corner, related articles: 

Inefficiency, Fraud in Healthcare and Insurance – How You Can Help — Inefficiency and fraud in healthcare and insurance has generated a ton of headlines. So a discussion about inefficiency and fraud has to include all stakeholders. That means patients, doctors and insurance companies – all must get a square deal for the healthcare system to work. But it appears doctors are experiencing unnecessary challenges.

Fiscal Fact-Check: Deficit, Social Security, and Medicare — America’s economic system is in grave danger. Like your personal finances, fiscal discernment in U.S. public policy is important for our economic recovery. A Harvard study reveals that massive U.S. borrowing and spending have wasted trillions of dollars in flawed efforts to stimulate the economy.

“Risk comes from not knowing what you’re doing.”

-Warren Buffett

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Author Terry Corbell has written innumerable online business-enhancement articles, and is a business-performance consultant and profit professional. Click here to see his management services. For a complimentary chat about your business situation or to schedule him as a speaker, consultant or author, please contact Terry.

Photo courtesy of stockimages at www.freedigitalphotos.net

Seattle business consultant Terry Corbell provides high-performance management services and strategies.