Cartoon – Treating Patients as Individuals
Monthly Archives: October 2016
California Reforms Target Workers’ Compensation Fraud
California is cracking down on graft in the state’s system of medical care for injured workers with two bills recently signed into law by Gov. Jerry Brown.
The reforms will prohibit medical providers who are felons from billing for workers’ compensation care and rein in a court-governed payment system that gave rise to hundreds of millions of dollars in unsanctioned treatment.
Lawmakers who introduced the bills cited an investigation by Reveal from The Center for Investigative Reporting that examined more than $1 billion in alleged fraud in the medical system for injured workers.
Reviewing more than a dozen prosecutions and analyzing state data, the investigation found that alleged scams affected more than 100,000 injured workers. Many were monolingual Latinos who were targeted in aggressive marketing efforts in Southern California. They encountered everything from kickback-fueled spinal surgeries to fraudulent providers to $1,600 tubes of pain cream.
Alleged scammers included felons and doctors banned from billing Medicare for malfeasance. Many fraud defendants exploited a feature of California’s workers’ compensations system that let them file a “lien,” or a demand for payment, for services after insurers refused to pay. They included therapies like shock wave pain treatments or unwanted drugs, such as the pricey pain creams.
The new laws would ban certain medical providers with troubled pasts from treating injured workers and also aim to limit the avalanche of liens that clog the docket in two dozen workers’ compensation courts throughout the state.
Christine Baker, director of the Department of Industrial Relations, which administers workers’ compensation, said she hopes the laws improve care for people who seek help for an on-the-job injury.
“I think both abuses and fraudulent activities prey on the most vulnerable populations and we’re hopeful that appropriate treatment will be provided to workers when needed,” Baker said. The laws “should reduce costs, because a lot of costs are tied to fraudulent activity, and that frees up dollars for the injured workers.”
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Big Soda sponsored 96 health groups — a big conflict of interest, study says
Nearly 100 national health and medical groups — including the American Heart Association, the American Diabetes Association and the Centers for Disease Control and Prevention — enjoy sponsorships by Coca-Cola Co. or PepsiCo, according to a new study by two Boston University researchers.
The report lands as the sugar industry’s supersized role in shaping — and spinning — health policy has come under increasing scrutiny. It also comes as the negative health effects of sugar and sugary drinks, including a link to rising obesity rates, are better understood.
“Now, most organizations refuse tobacco money,” write the study authors, Daniel Aaron and Michael Siegel. “Perhaps soda companies should be treated similarly.”
The authors identified 96 sponsorships, from 2011 to 2015, by Coca-Cola or PepsiCo to 96 “health organizations,” which they defined as any group or program “involved in the public’s health.” During that period, the researchers identified 29 proposed public health bills or regulations that one or both of the two companies lobbied against. All aimed to reduce soda consumption.
The American Beverage Association, which represents both Coca-Cola and PepsiCo, responded to the study with a statement saying: “America’s beverage companies are engaged in public health issues because we, too, want a strong, healthy America. We have a long tradition of supporting community organizations across the country. As this report points out, some of these organizations focus on strengthening public health, which we are proud to support.”
Coca-Cola and PepsiCo did not respond to a request for comment about the study.
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A closer look at single-payer health care and how it works
http://hub.jhu.edu/2016/10/11/single-payer-health-care-101/
Johns Hopkins experts explain health insurance alternative mentioned during presidential debate
During Sunday’s heated presidential debate, an audience member raised the issue of health care, asking Hillary Clinton and Donald Trump about their plans to bring down costs and to make coverage better.
Both of the candidates’ responses included references to a “single-payer plan.” What does that mean, and could it work in the U.S.? For insight, we turned to experts from Johns Hopkins University’s Bloomberg School of Public Health.
In a segment of WYPR’s On the Record on Monday morning, Bradley Herring, an associate professor in the Department of Health Policy and Management at the Bloomberg School, explained what a single-payer system is and how it works.
Image caption:Bradley Herring (left) and Gerard Anderson
“The simplest way to think about a single-payer system is one in which the government is the single payer for all health care services for all citizens,” Herring said.
Countries around the world have successfully adopted single-payer health systems. An obvious example—and the one Trump pointed to in the debate—is Canada.
HENRY KOTULA 