Saturday, October 23, 2010

Added to the Document Archive

Records retention grid - and more to be added very soon.

Any requests? If we have a policy, procedure or checklist we will add it - or write it.

Friday, October 15, 2010

Document Archive

Seminar handouts, consulting checklists, white papers and much more will be gradually accumulated in our new Internet publishing site at

healthcarethinktank document archive

Thursday, October 14, 2010

Compliance: "Leave the gun, take the cannolis" (1)

The changing face of health care fraud is becoming more evident, especially fraud committed by non-providers - such as non-existent durable medical equipment shops.

These groups often combine computer hacking, identity theft and bill-and-run phony front offices.

Now a little bit of a new twist.

Today (October 13th) the federal government arrest 73 people charged with racketeering for creating more than 100 phony clinics in more than a dozen states and billing Medicare and Medicaid something like $163 million. The crooks, allegedly with an Armenian "godfather" in charge, stole the identities of both doctors and patients before blitzing the feds with phony billings from non-existent clinics. The "godfather" is in lockup today.

Meanwhile the feds are auditing legitimate providers with contract auditors and cranking up requirements for compliance work. Maybe the feds should pay more attention to internal controls before paying crooks?

(reported via several major wire services)

(1) from The Godfather (part 1)

The (Premium) Stuff is Hitting the Fan

Many companies are on calendar year contracts for health insurance. New quotes are often delivered in October, decisions to keep or switch policies are made, and an open enrollment period (sign ups for new coverage and changed coverage) takes place in November so paperwork can be in place by January 1.

It is no secret premiums are going up, and some are going to way, way up. This will likely induce recession-battered employers to pass more costs on to employees, effectively a cut in net pay for employees. The memos will be passed through organizations in the next few weeks, and employers will have meetings with grumpy employees.

PPACA (Obamacare) requires more lives covered in the group and more services (especially preventative) covered by the plan. This plus the usual issues of utilization and cost are driving up premiums.

This was all very predictable.

Some day these changes may start to bend the cost curve, but probably not soon enough for President Obama.

Do not stand in front of the fan.