A Lot Happened This Week from Fraud Rewards to Congress Trying to Exempt Itself from ACA and 29 states get F in price transparency

In  This Issue:  Disparities in Health Month;  $39 Billion Misdiagnosis Costs;  Fraud Crackdown–$4.2 billion recovered in one year;  Why Health Care Costs are Slowing;  Congress trying to avoid ACA coverage; and states moving part-time workers to Federal Exchange–even here in Washington State.

April is Disparities in Health Month

Here is a quick fact sheet on Affordability of Health Care for Urban American Indians and Alaska Natives Compared to Their White, Non-Hispanic Counterparts


For more information on Minority Health, go to the Office of Minority Health website;


HHS Blueprint for Culturally and Linguistically Appropriate Health Care


Cost of Misdiagnosis:  $39 billion over 25 years

Missed or wrong diagnoses made up the lion’s share of U.S. malpractice payouts — which totaled nearly $39 billion — during the past 25 years, finds a new study of more than 350,000 claims.



          Crackdown!!  $4.2 billion Recouped in 2012:  HHS Expands Senior   Medicare Patrol to Increase Rewards for Reporting Medicare Fraud

Under the proposed changes, a person that provides specific information leading to the recovery of funds may be eligible to receive a reward of 15 percent of the amount recovered, up to nearly $10 million.  HHS currently offers a reward of 10 percent up to $1,000 under the current incentive reward program.


Health Care Fraud Prevention and Enforcement Action Team, a joint effort between HHS and the Department of Justice to fight health care fraud—recoups $4.2 billion in one year–fiscal year 2012.

To read a fact sheet about today’s proposed rule visit: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4584&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

       Fraud of the Week:  $63 million 

A federal jury today convicted a Miami-area supervisor of a mental health care company, Health Care Solutions Network (HCSN), for helping to orchestrate a fraud scheme that crossed state lines and that resulted in the submission of more than $63 million in fraudulent claims to Medicare and Florida Medicaid.


Why Health Care Costs are Slowing:

                          No one is sure  


                           What One Provider is Doing http://www.nytimes.com/2013/04/24/business/accountable-care-helping-hospitals-keep-medical-costs-down.html?nl=todaysheadlines&emc=edit_th_20130424&_r=2&

                            A Major Overlooked Program: Better Quality, Lower Costs,                       

“ACE” hospital units (Acute Care of the Elderly) reduce costs, drop lengths of stay, improve seniors’ functional abilities, decrease need for anti-psychotic drugs, pare days on urinary catheters, reduce readmissions and slash adverse events.

These specialized units have been operating for about 20 years, improving outcomes and lowering costs most everywhere they’re tried, we’re told.


Guess Who Wants to be Exempt from ACA? 

Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul, sources in both parties said.

Read more: http://www.politico.com/story/2013/04/obamacare-exemption-lawmakers-aides-90610.html#ixzz2Rb8dQ8uJ

Moving State Workers onto Health Exchange: Here in Washington?  

“The plan threatens to affect the federal budget and the pocketbooks of some part-time workers, as it would push a group of employees out of their current healthcare plans and into an exchange developed under the Affordable Care Act…..”

“Washington state appears to be the first major government to seriously explore the possibility of pushing workers into the exchange — but it probably won’t be the last. Rick Johnson, who advises state and local governments on healthcare policy at the New York-based consulting firm Segal Company, said he expects it will be an option some governments will look at in the years to come.”


Twenty-nine states get F in Price Transparency: http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/report-29-states-earn-qfq-in-healthcare-price-transparency.html

For full report see:  http://catalyzepaymentreform.org/images/documents/reportcard.pdf

Be sure to scroll quickly to about the 5 or 6th page of report for map of states who failed and those that passed.  Washington State received an F


Kathleen O’Connor (c) April 26, 2013

About Kathleen

Kathleen O’Connor: 30+ year health care consumer advocate, non-profit executive and author. For more information about Kathleen, please see "About" on the main content bar above.
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