March 30th, 2011 by Emergiblog in Health Policy, Opinion
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We hear so much about health care fraud and how much it costs us all in terms of higher Medicaid, Medicare and private insurance costs, and if we could just rein in this fraud we could make our health care system pay for itself.
My trusty Mac widget dictionary defines fraud as:
- a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities and
- wrongful or criminal deception intended to result in financial or personal gain.
Well, I’m wondering, what is actually considered fraud?
Let me give some examples, and help me understand whether or not this is fraudulent behavior. The examples are purely hypothetical and do not represent any known individuals, living or dead, or specific situations in any known emergency department, living or dead. Read more »
*This blog post was originally published at Emergiblog*
March 29th, 2011 by AnneHansonMD in Opinion, Research
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I briefly scanned the Robert Wood Johnson synthesis report on mental and medical co-morbidity so I thought I’d summarize the highlights for the blog. If you’d rather watch the recorded web seminar you can hear it here.
The report relied on systemic literature review to look at the relative risk and mortality associated with co-morbid medical and mental health conditions. The looked at studies using structure clinical interviews, self-report, screening instruments and health care utilization data (diagnostic codes reported to Medicaid).
This is what they found:
- 68 percent of adults with a mental disorder had at least one general medical condition, and 29 percent of those with a medical disorder had a comorbid mental health condition
- These findings support the conclusion that there should be strong integration of medical and mental health care Read more »
*This blog post was originally published at Shrink Rap*
March 4th, 2011 by DavidHarlow in Health Policy, Opinion
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Medicaid has been front and center this week as President Obama addressed the National Governors Association, and several governors testified before the House Energy and Commerce Committee. Obama told the governors that he supports the Wyden-Brown bill, which would accelerate the availability of waivers under the Affordable Care Act (ACA), so that states would not have to first create health insurance exchanges under the law, and then have the right to dismantle them and replace them with other mechanisms to achieve coverage goals of the law without additional cost to the federales. (See Wyden-Brown fact sheet.) The sponsors’ home states, Oregon and Massachusetts would otherwise have to dismantle parts of their own health reform efforts in order to align with the federal mandates. (Wyden has been a longer-term proponent of experimentation and innovation in health reform.)
The mini-med waivers granted to states (in addition to those granted to corporations and unions) are just one example of interim steps needed to harmonize federal and state health reform. When in 2014 mini-med plans will no longer be permitted at all under the federal health reform law, there will either need to be a significant dislocation of the underinsured “Young Invincibles” in Massachusetts and underinsured employees in capped health plans elsewhere in the country, or a change in the law.
Similar difficulties await state Medicaid programs, which will be faced with expanded eligibility, and other state agencies, which will need to set up exchanges per the ACA. The cost associated with eligibility expansion will be overwhelming — or maybe it won’t. There are, of course, expert opinions across the board on the financial impact of health reform on state budgets. As the saying goes, “Where you stand depends on where you sit.” Some reports inflate state expenses by not accounting for the fact that the federal share of Medicaid expansion covers 92 percent of the total. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
February 3rd, 2011 by BobDoherty in Health Policy, Opinion
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A Florida’s judge’s ruling that the Accountable Care Act (ACA) is unconstitutional doesn’t resolve the underlying constitutional issue (which will ultimately have to be decided by the U.S. Supreme Court) but it has introduced new uncertainty for the $2.3 trillion health care industry, and emboldened the law’s critics to push even harder for repeal (not that they weren’t trying already).
The Wall Street Journal’s (WSJ) health blog reports that “states and companies that are supposed to be implementing the law trying to figure out what to do next. The WSJ reports that the 26 states that are parties to the suit are considering whether to ask the Supreme Court to take up the case now, before it has fully wended its way through the legal system. The New York Times (NYT) quotes the governor of Florida as saying that until the fate of the law is clear, “we’re not going to spend a lot of time and money” to implement it. Other states, even if part of the suit, will move ahead,” the NYT says. The WSJ also reports that most health care companies plan to “stay the course” and continue to plan for the law’s implementation. Meanwhile, the Obama administration says that the judge’s ruling will have no effect on the implementation of the law or the requirement that states (including those who brought the suit) comply with its mandates and claims that most constitutional experts agree with the administration.
Now, I am not a lawyer, so I don’t have any expertise on the legal arguments over the ACA’s constitutionality. For those of you who want to hear more about the constitutional questions from people who might actually know what they are talking about, I recommend this Health Care Blog post from attorney Mark Hall, a critic of the Florida judge’s ruling. He notes that “at least half of the relevant part of the opinion is devoted to discussing what Hamilton, Madison, Jefferson and other Founding Fathers would have thought about the individual mandate” (Judge Vinson concluded that they would not have approved of it) but “the same Founders wrote a Constitution that allowed the federal government to take property from unwilling sellers and passive owners, when needed to construct highways, bridges and canals.” The Washington Post’s Ezra Klein — a supporter of the Affordable Care Act — has posted an excellent overview of what legal experts are saying about the ruling, pro and con, including a link to a posting that argues Judge Vinson ruled correctly. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
January 19th, 2011 by GruntDoc in Health Policy, Opinion
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Via an article entitled “Proposed Law Would Ban Docs From Asking If Patient Owns Gun” from First Coast News:
TALLAHASSEE, Fla. — A state lawmaker has filed a bill that would ban doctors from asking their patients if they have a gun in the home.
Rep. Jason Brodeur, R-Sanford, said he has heard of a number of cases in which doctors asked their patients that question, which he thinks should be off limits.
“What we don’t want to do is have law-abiding firearm owners worried that the information is going to be recorded and then sent to their insurance company,” he said. “If they’re on Medicaid maybe it’s sent to the government. If the overreaching federal government actually takes over health care, they’re worried that Washington, D.C. is going to know whether or not they own a gun and so this is really just a privacy protection.”
Under the legislation, a doctor could face a fine of up to $5 million or be sent to prison for up to five years for asking about guns in the home.
I understand the stated intent as recorded in this news item: Gun ownership is being recorded, lots of things are reported to insurance companies and the government, and this bill is an attempt to keep this information out of those circles, at least as obtained in a doctors’ office where people still believe what they say is between them and their doctor. It should be, but lots of things should be absolute that aren’t. Read more »
*This blog post was originally published at GruntDoc*
