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Thursday, November 17, 2011

Stretching Your Medicare Dollars

Much has been said about Medicare fraud and abuse, and cutting wasteful spending, but this story has me at a loss for words.

An Illinois man accused of shipping unwanted "penis enlargers" to diabetes patients as part of a Medicare fraud scheme has pleaded not guilty in an arraignment in federal court in Providence.

Under an agreement with prosecutors, Gary Winner plans to change his plea in a second hearing later Thursday. The deal calls for the 49-year-old Winner to admit he bought $26 penis enlargers from an adult website, repackaged them and shipped them to patients with information claiming the "erectile pumps" helped "bladder control, urinary flow and prostate comfort."

Prosecutors say Winner billed Medicare an average of $284 for each item, claiming they were used to treat erectile dysfunction.

The Northbrook, Ill.-resident has also agreed to forfeit $2 million.

Winner could face up to 33 years in prison.

At least give the guy points for creativity.

Gourmet Salt Under Scrutiny

A study published today from Consensus Action on Salt and Health suggests one in four people mistakenly believe rock and sea salts are healthier than table salt. The report discovered that the amount of sodium chloride found in gourmet salt is almost 100%, which presents exactly the same health risks as regular salt despite the 'natural' claims of the manufacturers.

Many chefs use copious amounts of sea and rock salt on tv, which may have led to people believing that it's ok to use excessive amounts when cooking. There is also a group who feel it's more fashionable to use these products instead of regular table salt and are needlessly spending additional money for essentially the same product.

It has encouraged fresh calls to continue reducing the salt levels in food, particularly processed foods, to help reduce the health risks
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Puzzling Carrier/Government Tricks

Last week, I had the pleasure of once again hosting the Health Wonk Review, which included a post from our very good blog-friend Louise Norris that really piqued my interest:

"For the last several months, individual health insurance applications in Colorado have included a new set of questions to determine whether an applicant’s premiums are going to be paid or reimbursed by an employer."

For as long as I can remember, carriers here in Ohio have forbidden employers from directly subsidizing premiums for individually-owned plans. Although this applied across the board, it was specifically aimed at those small companies that offered to payroll deduct individuals' premiums and then send them in to the insurance company (often called "list billing").

Let's take an example:

Sam works for ABC Widgets, which does not offer group health insurance. But Sam, Joe and Sally each own individual plans from (for example) Anthem. Their boss offers to set up a list billing arrangement, whereby he deducts the appropriate amounts from their paychecks each week, and then sends that all in to Anthem at the end of the month. In this case, he's just acting as a conduit, providing nothing more than a convenience.

But if the boss were to go a step further, and offer to kick in, say, $25 a week towards each of their plans, this could create a major problem: it could very easily be argued that he now has a group health plan, and the Anthem could potentially be on the hook for expenses not contractually covered under the individual plans.

So carriers forbid this practice, and life goes on.

But that's Ohio, and as Louise points out in her post, Colorado had no such moratorium.

Until now.

I've asked Louise to explain in more detail for InsureBlog readers:

In Colorado, it has also been illegal for many years for employers to an employee's individual health insurance policy. It was illegal for brokers to even discuss individual plans with an employee at their place of work - everything about individual policies, from the application to the billing, had to be done outside of work. But then federally legal HRAs came on the scene and started to muddy the waters a bit. Some HRA companies were actively soliciting brokers to get them to encourage employers to switch from a group plan to an HRA and have the employees seek out individual health insurance policies that the employer could reimburse via the HRA. The big problem with that tactic is that some employees won't be able to qualify for medically underwritten coverage in the individual market and are left with no option other than CoverColorado, the state's high risk pool. A flood of employees into CoverColorado threatened to destabilize the risk pool.

Earlier this year, the Colorado legislature passed Senate Bill 19, which changed the rules considerably regarding the legality of employer funding of individual health insurance* Employers can now fund individual health insurance premiums for their employees via an HRA or wage adjustments - as long as the employer has not had a group health plan in place in the past 12 months. Senate Bill 19 has resulted in a new section on individual health insurance applications in Colorado wherein the applicant has to state whether or not an employer will be reimbursing any portion of the premium, and if so, whether or not the employer has had a group policy in place in the last 12 months. If yes to both, the application will be declined (unless the employee agrees to pay all of the premiums without any assistance from the employer).

Senate Bill 19 was a big change to the legal landscape of individual health insurance in Colorado. It's not a perfect system by any means, but it does allow employers - who wouldn't otherwise be able to afford group insurance - to kick in at least a small amount of money towards their employees' health insurance premiums. The provision requiring 12 months between coverage under a group plan and reimbursement for employees' individual policies will hopefully help to prevent employers from dropping group plans just to send their employees into the individual market and CoverColorado. This should help to prevent destabilization in both the small group market and CoverColorado. But it's also causing some employees to be declined for coverage when they may not have any other option at all (assuming their employer has already dropped the group plan and isn't going to reinstate it, and assuming that they were relying on the contribution from the employer to be able to afford a new individual policy.)

Starting in 2014, this shouldn't be an issue anymore, as all policies are slated to be guaranteed issue by then. But for the next couple of years, it's likely to cause some headaches.

Thanks, Louise, for helping to put this in perspective!

Claims Against NHS Highlight Need Professional Liability Insurance

According to a report in the Daily Telegraph recently, Professional Indemnity Insurance claims against the NHS increased by 30% since the beginning of the year. In monetary terms, these claims have cost the NHS about £ 863m in compensation and £ 257m in legal fees.

Although the NHS is, of course, exceptional organizational size and scope of these statistics have led some, such as the Kent-based QuoteMeToday brokers, emphasizes the need for all professionals - but also to work in the public sector, which may be particularly susceptible credits - to protect their own liability insurance.

Wednesday, November 16, 2011

ObamneyCare© Glitch - IB Ahead of the Curve

Over two months ago, Bob noted that citizens in states that opted out of creating their own Exchanges would be ineligible for premium subsidies. Since so few states have thus far even begun exploring how to set up an Exchange, this has now hit the radar.

As Cato's Michael Cannon writes in today's Wall Street Journal:

"[Obamneycare©] offers "premium assistance"—tax credits and subsidies—to households purchasing coverage through new health-insurance exchanges ... [Obamneycare©] authorizes premium assistance in state-run exchanges (Section 1311) but not federal ones (Section 1321)."

Ooops.

So folks in states utilizing Exchanges run by the Federales will have a choice: buy (and pay for) unaffordable health insurance, or go to jail.

So not only didn't they read it before they passed it, they didn't even debug it.

Less Health Care - You Can Live Without It

Is it just me, or is Washington sending a message that they want to RATION our health care? The Obama administration seems to favor placing those people who want bigger government and less access to health care in charge of our senior population.

Consider this.

During a Congressional recess Obama appointed Donald Berwick, a socialist that adores nationalized health care such as exists in Great Britain, to head the Center for Medicare Services. The timing of the appointment to a position that had been vacant for over a year is suspicious.

By making the move while Congress was not in session the appointment avoided the normal scrutiny of a Senate committee.

In essence, Mr. Berwick was appointed to a powerful government position without the normal vetting process.Frankenstein's monster

Now the president wants to place Henry Aaron (no, not THAT Henry Aaron) as head of the Social Security Advisory Board.

Let's look at this in more detail.

Berwick, to whom Obama issued a dubious recess appointment to circumvent the usual Senate confirmation, has become notorious for statements like, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open” — and, in progressive-speak, “The social budget is limited.”

Aaron, a recent Obama nominee, has expressed similar views. He wrote a piece earlier this year called, “The Independent Payment Advisory Board — Congress's ‘Good Deed.’” The grisly IPAB, one of the most underreported of Obamacare’s myriad of liberty-sapping features, would have the power to cut Medicare spending each year — if Obamacare isn’t repealed first. The dictates of its 15 unelected members would effectively become law. In fact, Congress couldn’t even overturn the IPAB’s decrees with a majority vote in each house and the President’s signature.

Power to CUT MEDICARE SPENDING.

Even Congress cannot overturn their decisions.

How much power does Washington need over our lives?

Aaron praises the IPAB, although he does admit to having a few problems with it. He thinks that its largely unchecked power isn’t unchecked enough, as the board should be able to order payment reductions for other aspects of medical care that have so far escaped its statutory grant of power. He writes,

“I admit that the provisions governing the IPAB are less than optimal. For example, recommendations regarding payments to acute and long-term care hospitals, hospices and inpatient rehabilitation and psychiatric facilities are off-limits until 2020; and those to clinical laboratories are off-limits until 2016. These politically motivated restrictions should be repealed as early as possible so the IPAB’s recommendations can comprehend the delivery system as a whole.”

In other words, Mr. Aaron wants more power sooner rather than later.

“If Americans are serious about curbing medical costs, they’ll have to face up to a much tougher issue than merely cutting waste, says Brookings Institution economist Henry J. Aaron.

“They’ll have to do what the British have done: ration some types of costly medical care — which means turning away patients from proven treatments.

Yes, we all know how well the British health care system works . . .

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