Tangled Web, Redux

Why am I not surprised by this:

“Ohio’s sixth-largest school district says it was a victim of fraud resulting from secret commissions that its health-insurance company paid to a broker in return for delivering the district’s business.”

As Yogi Berra once observed, “it’s déjà vu all over again.” Two weeks ago, it was United HealthCare and a Columbus area broker named Grady.

Today, it’s UHC and a Columbus area broker named Fritz Neuhart; once again, a rather ordinary web-site and a nondescript agency name. Nothing to indicate that Mr Neuhart had (allegedly) pocketed a cool $1 million in fees and commissions. Kinda makes a piker out of poor Mr Grady.

For now, the Department of Insurance is mum on this, although they’re "aware of the situation."

So far, that’s two school districts caught up in similar webs. I wonder how many other superintendents are even now rifling through their insurance files, trying to determine if they, too, have been stung.

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A Slick Operation...

What if your employer paid you to have that knee surgery in India? How about that carpal tunnel correction in Thailand? Or your hip replacement in Singapore?

Sound far-fetched? It’s not:

“With US medical costs out of control, companies like Blue Ridge Paper Products of Canton, N.C., see outsourcing as an employee benefit. The carrot? The patient would get to take a family member and then pocket some of the firm's substantial savings.”

“Medical Tourism” has become big business. The idea is that folks can travel to a foreign country, receive medical care equal to (or potentially better than) services available here, and still save money (even factoring in travel expenses). Companies like Blue Ridge Paper have determined that, by encouraging their employees to go this route, the company and the employee save money.

I’m not so sure:

For one thing, such expenses are not going to be eligible for reimbursement under a qualified plan (HSA, HRA, FSA, etc). For another, what about accountability? For all the grief we hear about malpractice insurance rates here in the good ol’ U S of A, at least (most of) our providers have it. Will the same be true of Dr Singh in Bombay? Don’t know. And what about complications?

“A Rhode Island woman died in India after traveling there for cosmetic surgery that she believed was too costly and difficult to obtain at home.”

The single mother of three apparently died of a blood clot (a not uncommon complication). She did, however, save almost $16,000 by undergoing the surgery overseas. Where’s the gecko when you need him?

According to Time magazine, this business is booming:

“Trehan [a renowned robotic cardiac surgeon] plans to launch next year, in partnership with GE, the first installment of a vast, $250 million specialty Escorts hospital complex near New Delhi that will feature luxury suites, a hotel and swank restaurants for patients and their families. "We will be the Mayo Clinic of the East," he says. Max Healthcare is also planning a specialty complex in New Delhi.”

Whether these types of facilities will begin seriously impacting US providers remains, of course, to be seen. And we also know that there is currently a large supply (foreign facilities and providers) with little demand (it’s still somewhat of a novelty). But if and or when that changes, and demand begins to mount, it will be interesting to see if those low, low prices will stick.

So far, I haven’t had any of my groups (or prospects) ask me about this; be interesting to see if that changes.

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Cavalcade of Risk (Debut Edition)

Welcome to the very first Cavalcade of Risk. In keeping with its mission statement, the following entries run the gamut from insurance to finance, taxes, and even murder. Several are from blogs that are new to me, but to whom I gladly say: Glad to meet ya!

And now, on with the show:

■ It's Just Money

LA Money Guy tells us about two (not so) Golden Gals who weren't relying on Social Security alone. He also raises some pointed questions for insurers.

■ Trader Knowledge

Knowledgeable Trader Dominic takes a look at momentum trading and how, if properly applied, it can lead to a high probability of financial gain (with low risk).

■ Jon Swift

Jon asks: "Why should I pay for diseases I'll never get?" A much better system would be to have insurance companies sell insurance for different diseases individually. He avers that a la carte insurance could be applied across the entire industry.

■ Workers Comp Insider

As if worrying about host liquor liability isn't enough, WCI's John Coppelman takes a look at hidden risks in company-sponsored summer outings. Employers beware the $200,000 "umbrella torpedo!"

■ Wenchypoo's Warehouse

Blogress Wenchypoo (no kidding!) explores the phenomenon of "luxury-creep:" material things once the province of the well-to-do (stainless steel kitchens, SUV's, even polo shirts) are now just everyday items to us peons. But when is enough, enough?

■ Med Bill Advisor

Why are accurate and current medical records so important? Host Chris Parks explains why they're crucial for our financial health.

■ Roth & Co

When disaster strikes, our first thoughts aren't necessarily about our tax records. But Joe Kristan has some great tips, and warnings, about the need to safeguard our financial info.

■ Health business blog

What do tuna fish and tea have in common? David Williams tells us about the potentialy dangerous amounts of mercury in some herbal concoctions.

■ California Medicine Man

One of my favorite bloggers, Dr John Ford (who posts, IMHO, all too infrequently), has an online debate with the founder of a new diet craze. Interestingly, he's not as concerned about the diet itself, but how it's being "pushed."

■ Cato Blog

Dr Ford's not the only debater in this edition: Cato Institute blogger Michael Cannon dukes it out with Matthew Holt on the merits - and potential downsides - of HSA's (Health Savings Accounts).

■ InsureBlog

Our own Bob Vineyard tells us of his recent epiphany regarding specific-disease policies. Sometimes, even the best health insurance doesn't cover all the potential risks.

The next edition is June 21st, hosted at It's Just Money. Be sure to check the C of R home page, for upcoming hosts.

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A Truly Grand Rounds...

Grand Rounds is up over at Health Voices. Our host, Dmitriy, has used his new submission gizmo to organize over 40 posts, including insights and info on each one. Bravo!

Since Bob and I have both recently posted on medical records, I found Carol Kirshner's post on electronic medical records timely and informative (and I share her frustration).

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Habla Espanol?

The two out of five Los Angeles residents who speak Spanish at home would find it easier to buy a can of paint at Lowe's than explain to a public hospital emergency room doctor where it hurts.

The home improvement store offers foreign language interpreting in less than a minute over a special telephone line at the customer service desk. But there is only one fulltime, trained, Spanish-speaking medical interpreter in L.A.'s five public hospitals and clinics;

This is a little talked about side effect of immigration, illegal or otherwise.

“Mastering any language well enough to describe your symptoms to a doctor takes years, and the same federal government that wants immigrants to learn English and to assimilate is doing little or nothing to support either process.”

OK, but how difficult can it be to learn enough English to respond to "tell me where it hurts"?

Two decades ago, Miami paramedics defined "intoxicado" as "high on drugs" instead of "nauseous." This led to a series of emergency room miscommunications and a malpractice settlement that could amount to $71 million over the lifetime of a former high school athlete. William Ramirez was 18 and able-bodied before he collapsed; when he awakened, he was quadriplegic. More than 36 hours reportedly passed without treatment for what really ailed him -- an acute subdural hematoma and other brain injuries.

I am thinking there is more to this story.

Intoxicado does translate as intoxicated. Surely they could find SOMEONE nearby who could translate. I mean, this is Miami . . .

The 1964 Civil Rights Act bans discrimination based on national origin. This requires any health care provider receiving federal funds -- practically all of them do -- to offer free interpreting to patients with limited English skills.

Don't you know there a lawyers just waiting to make a few bucks off this?

It would cost about $268 million annually to pay for professional medical interpreting in the United States,

So who is going to pay?

Two guesses . . .

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A Ticket for HIPAA

[Editor’s note: Great minds really do think alike. As I was writing the following, Bob was posting his take on the same issue. Wow]

While I'm no fan of HIPAA (IMO, it created more problems than it solved), it is the law of the land. So I am puzzled, bordering on angry, that

“(i)n the three years since Americans gained federal protection for their private medical information, the Bush administration has received thousands of complaints alleging violations but has not imposed a single civil fine and has prosecuted just two criminal cases.”

According to the WaPo, the complaints reported most often fall into these categories:

■ personal medical details were wrongly revealed
■ information was poorly protected
■ more details were disclosed than necessary
■ proper authorization was not obtained
■ patients were frustrated getting their own records

I can sort of see that last: most physicians' offices charge a fee for those records. Contrary to popular belief, they are not "your own," any more than the service records your mechanic keeps on your car are. Still, it's not supposed to be a frustrating experience.

In this day of identity theft, there really is no excuse for personal information to be "poorly protected," either.

Turns out, three quarters of the cases were deemed to be non-violations, which seems about right: just because you’re ticked with a given provider doesn’t mean they’ve done something illegal. I’m not as sanguine about that other 25%, though:

“(H)ealth plans, hospitals, doctors' offices or other entities [were allowed] simply to promise to fix whatever they had done wrong, escaping any penalty.”

Certainly there needs to be some flexibility in the system, but that’s an awful lot of it. HHS counters that they’re striving for “voluntary compliance,” which they think is working. Of course, the providers are all in favor of the voluntary model (preferring carrots to sticks), but privacy advocates are nonplussed:

“The law was put in place to give people some confidence that when they talk to their doctor or file a claim with their insurance company, that information isn't going to be used against them," said Janlori Goldman, a health-care privacy expert at Columbia University.”

As the clock is ticking toward across-the-board implementation of EMR (Electronic Medical Records), the stakes are getting higher. Part of HIPAA requires that medical record safe-keeping adhere to a set of stringent federal guidelines, instead of on a state-by-state basis, but that raises its own set of problems, namely: security of the records. As we saw recently with the VA, this is far from a slam-dunk.

I’ll let a “neighbor” have the last word:

"It's like when you're driving a car," said consultant Gary Christoph of Teradata Government Systems of Dayton, Ohio. "If you are speeding down the highway and no one is watching, you're much more likely to speed. The problem with voluntary compliance is, it doesn't seem to be motivating people to comply. "

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