June 14, 2010

Today the Obama Administration issued new rules that govern whether individual and employer-sponsored health insurance plans can remain exempt - or "grandfathered" -- from the new health care requirements passed by Congress and signed into law by the President in March.  The New York Times wrote, "... in some respects, the rules appear to fall short of the sweeping commitments President Obama made while trying to reassure the public in the fight over health legislation."  Sen. Chuck Grassley, ranking member of the Committee on Finance, made the following comment on the new rules.

"My goal in health care reform always is to fix the parts of our health care system that are broken, but still allow people to keep the things they like.  Today's new rules from the federal government on 'grandfathering,' which were crafted without any opportunity for public input, are just more proof that despite all of the promises made by the President and other supporters, you actually can't keep what you like under the new partisan health reform law.  Change is coming for a lot of people, whether they want it or not."

It is that time of year again when days become longer and nights become shorter, and when the beautiful summer weather calls everyone to enjoy the sun's rays.  Simply being outdoors during the summer months can be quite a pleasure.  But it is also important to take precautions when heading outdoors.

For those with fair skin, being over-exposed to the sun's ultraviolet rays can have harmful effects.  In fact, one in five of us will develop skin cancer in our lifetimes, making it the most common form of cancer in the country.  And as the years go on, this number has only been rising.

But skin isn't the only victim. Long-term exposure to UV rays can also cause immune system suppression and premature aging.

In particular, we need to encourage the young people in our lives to take precautions.  Most Americans receive 50 to 80 percent of their lifetime sun exposure before they reach the age of 18.  Just one or two blistering sunburns in childhood may double the risk of developing melanoma.

Getting some sun exposure does have its benefits, the most important being the direct intake of Vitamin D, helping us to absorb calcium for stronger and healthier bones.  And spending time outdoors has countless advantages as well, such as the development of a more active lifestyle.

But we need to caution our loved ones from spending too much time in the sun and encourage them to take other precautions, such as wearing extra clothing, always wearing sunscreen and wearing a hat.

Here are six basic tips for protecting yourself and your family year round:

• When outdoors, use sunscreens rated SPF 15 or higher.  Apply the lotion liberally, uniformly and frequently.  Make sure the sunscreen you are using is broad-spectrum sunscreen (to filter UVB and UVA rays).
  
  
• Stay out of the midday sun (from 10am to 4pm) whenever you can.  You also should protect yourself from UV radiation reflected by sand, water, snow and ice.  UV radiation can go through light clothing, windshields, windows and clouds.
  
  
• Wear long sleeves and long pants of tightly woven fabrics, a hat with a wide brim and sunglasses that absorb UV.
  
  
• Stay away from sunlamps and tanning booths.
  
  
• Do not sunbathe - period.
  
  
• Teach your children good sun-protection habits at an early age.

The American Cancer Association also provides greats resources to better understand how to protect ourselves.  You can find this information at  http://www.cancer.org.

Being outdoors and enjoying the great Iowa weather is highly encouraged!  Just be careful and remember that simply protecting yourself from the sun's harmful rays can help you live a longer and healthier life.

By: Jane M. Orient, M.D.

http://www.aapsonline.org

All eyes are on the BP gusher in the Gulf, spewing pollution over the shoreline, but there's another big leak that will do even more damage to our economy: the one in the Medicare well.

Ever since 1965, when Medicare was enacted, the federal Treasury has been hemorrhaging dollars. Previously, "10%" was quoted and re-quoted as the amount of fraud. More recently, Senator Tom Coburn (R-OK) alleged it to be 20%.

Like BP's oil containment dome, previous efforts failed to plug the hole. Despite hundreds of millions of dollars shoveled into the Health Care Fraud and Abuse Control Program (HCFAC) by HIPAA (the Health Insurance Portability and Accountability Act), federal prosecutors say they need still more "resources" and "tools."

Attorney General Eric Holder is looking for people to prosecute for both leaks?which will do nothing to stop the pollution.

Containment efforts in new Medicare rules include requiring doctors to "revalidate" their billing privileges periodically. They'll have to show that their name, address, identifying numbers, and organizational status are exactly as registered. They'll have to give Medicare access to their checking account by electronic funds transfer (EFT) so that it can make immediate "adjustments" in case of overpayment.

The Patient Protections and Affordable Care Act ("ObamaCare") imposes additional screening requirements; some providers will have to be fingerprinted.

Ever-more aggressive private bounty hunters called Recovery Audit Contractors (RACs) are descending on doctors' offices, dissecting claims and patients' records, looking for a missing "bullet point" in the documentation, or an inaccurate digit in the billing code. ObamaCare increases the penalties for errors from $11,000 per item to $50,000. The government's burden of proof, already light, has been further decreased. There is no need to prove any intent to defraud, or even to show that any money was ever collected.

Also, the definition of "fraud" is expanded to include "unnecessary" services, "ineffective" services, or those that don't comply with Medicare requirements.

Prosecutors are making examples of "greedy providers." Dr. Ronald Poulin of Virginia was smeared all over the pages of his local newspaper before being convicted of "fraud"?that previously would have been called billing errors. Pictures of his home were posted on the internet?a nice house, bought with decades of hard work, now seized, along with his cars, his bank accounts, his medical license, his reputation, and his liberty. He sits in jail awaiting assignment to a federal prison.

One less oncologist will be prescribing expensive chemotherapy to cancer patients?and there are other effects that we don't see. Deterrence works. Trying to help sick people is becoming very dangerous.

But will these methods end the fraud? Dr. Kenneth Christman, a past president of the Association of American Physicians and Surgeons (AAPS) (www.aapsonline.org), states that the amount of fraud is actually 100%, because Medicare is a Ponzi scheme. Today's soon-to-be-retiring Baby Boomers have been bilked as surely as Bernie Madoff's investors were, and their "trust fund" is full of internal government IOUs that can be redeemed only by borrowing from a bigger sucker.

Leaving ultimate Medicare reform aside, can we eliminate true billing fraud? Eliminating doctors does eliminate billing?of all types, by those doctors. But organized crime is said to be moving in.

As Malcolm Sparrow pointed out in a book by that title, third-party payment is A License to Steal. Payment is made for a "clean claim," not for a messy service. And despite the government's legal advantages, it takes time to go through the process of destroying doctors. So here's the overnight solution.

Make insurance fraud, like credit-card fraud, self-revealing. Do away with "assignment of benefits," which means paying the "provider." Mail all insurance payments to patients, in the form of a dual-payee check.

Dead or fictitious patients don't cash checks. Real people who did not receive a worthwhile service generally do not pay for it.

Fire the RACs, and put prosecutors to work fighting real crime, not creating crimes from arcane codes.  Restore the natural regulatory system of customers reading understandable bills. Don't put medical dollars into a huge bank vault that criminals can open with computer codes, and the practice of medicine into a bureaucratic prison.

Prisons don't stop leaks.

http://www.aapsonline.org