Wednesday, August 27, 2014

Medical ID Theft Revisited

Back in February, we again sounded the alarm about Medical Identity Theft:

"Most identity theft in the United States is medical-related ... In 2012 alone, medical identity theft increased by nearly 25 percent, affecting 1.85 million Americans"

And things haven't really improved since then.

So what's the big draw for hackers looking to steal your records?

How about $50 a pop? Multiply that over thousands - or tens of thousands - of unsuspecting victims, and you've got quite the successful business model.

On the other hand, there may are some common sense ways to protect yourself from this risk (or at least mitigate it). A security consultant writing at LinkedIn offers some pointers for healthcare providers - might be a good idea to see if yours is taking the threat seriously:

■ Encryption. This seems pretty obvious, but it's also a pain (and we're all familiar with the ubiquitous sticky notes hanging from monitors).

■ Biometrics. This is even better, but of course it's also more expensive. On the other hand, higher demand may force prices down, so this may be the future.

Go read the whole thing - it's a quick read, and pretty informative.

And Now a Word From Our Sponsor

Did you buy one of those brand spanking new Obamacare plans? If you did, you may get an email from (Carrier) that reads something like this:

Immediate attention is needed to keep your health coverage. Take action before Sept. 5, 2014.

Carrier wants to help you keep your current insurance coverage and maintain your current monthly payment amount.

IMPORTANT: The federal government-sponsored Health Insurance Marketplace (also known as the “Exchange”) has been attempting to reach you. At the request of the federal government, we are reaching out to you because you are at risk of losing your current Carrier coverage or any financial assistance you may currently be receiving, also known as Advance Premium Tax Credit (APTC). 

The deadline to take action is September 5, 2014.

What you need to know:

• The federal government-sponsored Health Insurance Marketplace needs more information to ensure you can keep your current coverage. They have been attempting to reach you for one of two reasons: 
• The marketplace would like you to provide proof of your yearly income for 2014 for everyone who was on your tax return, if they had income.
• The marketplace would like you to provide proof that you are a U.S. citizen, U.S. national, or have an eligible immigration status.

What do you need to do immediately?

• To determine which documents the marketplace is requesting, please contact the Marketplace at 1-800-318-2596. There are marketplace experts ready to answer your call 24 hours a day, seven days a week.
• For either situation, you need to provide a copy of the documents the marketplace is requesting. You can do so by adding copies to your “My Account” online at (this is the fastest way to get your documents processed) OR mailing the documents to:
Health Insurance Marketplace
Attn: Supporting Documentation
465 Industrial Blvd.
London, KY 40750

*If you have any issues adding copies to your “My Account” please contact the marketplace at 1-800-318-2596. There are marketplace experts ready to answer your call 24 hours a day, seven days a week.
*If you have already provided this information to the marketplace and/or you have heard from the marketplace that they have received the additional information, please disregard this note.

What will happen if the additional documents are not received by the federal government-sponsored Health Insurance Marketplace?

• The marketplace will terminate your Carrier coverage or no longer provide you with financial assistance. When the marketplace does this, they will notify Carrier. Carrier will then follow instructions from the marketplace that requires us to send you a notification of changes with your coverage. These changes will include either a termination of coverage OR a change to your monthly payment.

Again, Carrier wants to help you keep your current coverage and maintain your current monthly payments. Please provide the requested documentation to the marketplace no later than September 5, 2014. If you have questions, contact the marketplace at 1-800-318-2596. There are marketplace experts ready to answer your call 24 hours a day, seven days a week.

Thank you again for being a Carrier member. 

We look forward to continue being your partner in health.
Protecting your privacy is important to us. To learn more about our privacy policies, view our Internet Privacy Statement and our Privacy Practices.
Please visit for additional information.

Any questions?

Smoke them if you have them.

Tuesday, August 26, 2014

IRS Form 1095-A

Obamacare fans, here is what you have been waiting for.

If you bought an Obamacare plan through and received a premium subsidy or APTC, you will need to file form 1095-A with your taxes.

Here is your link to a DRAFT of 1095-A

But wait, there's more.

You (and your tax adviser) might also be interested in form 8962

And you thought this was going to be easy.

Who Do You Believe

According to CNN, the Inspector General is expected to release a report that claims there were no deaths due to excessive wait times or denied access to care at the Veterans Administration facilities.

Monday, August 25, 2014

(Sex) Ch-ch-changes

Well, it took some time, but the future is finally here:

"Then Payne, who had a wife and four children, realized she could no longer live as a man."

Wait, what?

Demonstrating the mother (er, father?) of all "pre-existing conditions," Ms Payne (and what a gloriously appropriate moniker) waited until her wife died of alcohol-related liver disease (gee, who could have seen that coming?) and then went shopping for a surgeon.

Thing is, this is expensive (if entirely elective) surgery, and she didn't think it was fair that she shoulder that burden alone. Her Blue Shield-issued ObamaPlan (and we taxpayers who foot some - maybe all - of the premiums) is now on the hook for some yet-to-be-determined chunk of change:

"She found an out-of-network doctor in Palo Alto who would do the surgery ... got a cashier’s check for nearly all her savings, $27,000, to pay the doctor, hoping her insurance plan would reimburse most of it."

You're welcome.

Her friend Jenny (Jerald?) hasn't been so fortunate: she also bought an ObamaPlan, but from the Volunteer State Exchange. Her doc was also out-of-network, and she had "no hope of reimbursement." Part of that is because her hormone regimen is only dispensed to women, and her ID still listed her as male (how cisgendered!). One supposes that that would be an easy fix (so to speak), but apparently not.

So of course she's moved to California, where she hopes to also glom onto a Covered California plan.

Wait, you didn't know that moving enabled you to buy a new plan?


On the other hand, they probably don't have to worry about the free birth control.

Two Timely P&C Notes

■ Now that things seem to have down a bit in Ferguson, it's worth noting that the clean-up from all the looting and rioting will take some time, but that it's unlikely any of the damage will be covered by business owners' insurance policies.

According to P&C Guru Teresa S, "riots are not covered, therefore anything resulting from a riot is not covered.  It usually goes back to the government.  Looting, I would say is not covered due to it being part of the rioting."

So of course, you and I will become the insurers.

■ Now that school's starting back up, lots of student athletes will also be warming up on and off the field. Some of them, though, will become injured, perhaps bad enough to effectively end their college sports career - and scholarships.

Never fear, though,  California-based EPIC Insurance Brokers is now marketing their Education Protector plan:

"[T]he first of its kind policy that provides funds for tuition reimbursement in the event a student athlete is injured between receiving a verbal offer for an athletic scholarship or grant and signing a Letter of Intent, which binds the athletic scholarship or grant."

Apparently, they've done their homework [ed: heh] and determined that over 126,000 student athletes are expected to receive some $2 billion in scholarship money. That's a lot of cash at risk.

Cool idea.

Friday, August 22, 2014

Has Medical Tourism Jumped the Shark?

Over the years, we've written many times about medical tourism: from folks traveling to the US for treatments to folks who found better options abroad.

But this, this boggles the mind:

"The number of foreigners traveling to Switzerland to commit assisted suicide doubled over a four-year period"

Europeans made up the bulks of their "customers," the article didn't mention how many Yankees participated.

Tax Form 1040(OY)

Let's suppose that, against all odds, you've successfully navigated the site and enrolled in an ObamaPlan. And let's further suppose that, against all odds again, you're deemed eligible for a subsidy.

Now - and bear with me here - let's suppose even further that you're gainfully employed and need to file your taxes. Piece of cake, right?


"Obamacare customers won’t be able to file their tax returns next year until the government sends them a form detailing their coverage and tax credits"

Well, we're all familiar with the prompt, efficient and accountable IRS, so no problem, right?


If you're due a refund, well then you're stuck: until you can attach those forms to your return, you're getting bupkis.

But that may be the least of it: what if you owe taxes? You can't complete the return without the form, so will you now owe penalties and interest, too?

And there's this: if you miscalculated (or just had a stroke of mid-year good luck) and end up making too much income, you're going to have to refund at least some of your subsidy back to Uncle Sugar. That's only fair, right?

Click here for a more detailed explication.

Carefree, or Free to Care?

Dr Rob Lamberts (whom we interviewed a few short years ago, when he dove into the concierge medicine pool) has a touching, sad but ultimately hopeful post on end of life care, and the compassion one can bring to the table:

"Thank you, sir, for letting me into your home.  Thank you for trusting me when you didn't want to trust a doctor.  Thank you for letting me help you stay at home and live out your last days as you wanted them to be."

Read the whole thing.

Thursday, August 21, 2014

What's Old is New: The AMA, Medicare and Value

Almost four years ago, we wrote about a little known committee, nestled deep in the bowels of the American Medical Association (AMA), that exercised outsized power over how much money doctors will receive in Medicare reimbursements:

"Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars"

As reported at the time in the Wall Street Journal, "the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous ... the impact of the decisions made by the doctors on the RUC goes well beyond physician fees"

And indeed, the effects are still incredible: that committee "with the assent of the government, has enormous power to determine Medicare prices by assessing the relative value of the services that physicians perform."

Pretty cozy: the government feeds them, and they divvy up the loot. Nice gig (for them).

But how does that affect thee and me?

Well, it's actually not that complicated: Primary Care docs (representing about 30% of US physicians) are at the bottom of the food chain, even though they are critical frontline actors when it comes to assessing a problem and recommending alternatives. And by "alternatives," we increasingly mean "specialists." And how does that work?


"[T]he committee has ... skewed Medicare fees in favor of expensive specialists over ordinary general practitioners ... Because Medicare fees are the baseline for the rest of the pricing in the health care system, this has had a broad effect, contributing to a situation where primary care doctors are in general underpaid, underappreciated."

Now , we're not playing the Rich Doctor, Poor Doctor game here, but it's worth noting that the docs who are most involved in our initial care are the ones with the least time at the payment feeding-trough. Here's why: Medicare fees drive (to a significant extent) private insurers' reimbursement schedules. So when that Relative Value committee essentially sets Medicare's fees, they're also effectively setting Anthem's, and Aetna's and Humana's (to name a few). And since most (but not all) docs still accept insurance, the effect is magnified.

It's also worth remembering that the AMA itself represents less than 17% of all US physicians, yet wields this enormous power with little (if any) accountability or oversight. Food for thought.

Wednesday, August 20, 2014

Wednesday Potpourri

■ Craig Gottwals has the scoop on the latest Golden State efforts to come into line with the new group waiting period requirements:

"A year and a half ago, California decided that the 90-day waiting period limit imposed by PPACA ... was too long and cut that period to 60 days via a series of confusing state laws."

After driving benefits folks nuts trying to comply with conflicting federal and state requirements, the state's finally shelved their own ill-advised rule. Click on through for why this is so critical.

Speaking of small groups, the news on the alleged SHOP (small group marketplace) isn't promising for the folks in DC:

"[Secretary Burntwell] is allowing insurance commissioners in states that are part of the federally facilitated marketplace to opt out of SHOP’s employee-choice provision for 2015 if they determine that it would produce adverse selection. So far, 18 states were given permission to do so."

That's about half of the states with Fed-run Exchanges. Something about preference cascades?

And it's not just small businesses looking for group cover; entrepreneurs have long had to procure coverage on their own, something that's becoming easier said than done. FoIB Holly R tips us to this story of one such fledgeling businessman who left his previous employer to strike out on his own:

"I quickly discovered I would need to qualify for a “special enrollment period” to purchase a new plan at this time. Otherwise, it appeared, I would need to wait for open-enrollment season in November ... Please Note: If you enroll in COBRA you are not eligible for special enrollment until the next open enrollment period or until your COBRA maximum period expires."


Do you ever get the impression that the site was designed and implemented in (and for) Bizzaro World? You may not be too far off:

"Investigators at the U.S. Government Accountability Office (GAO) created 12 fake health insurance test applicants and, for now, at least, have gotten qualified health plan (QHP) coverage for 11 through the [ website]."

And that's the (ostensible) good guys; wonder what the Chinese hackers are up to....

Remember Fuller Brush and Avon folks? Well, they're no longer pushing cleaning and beauty supplies:

"[Some Navigators] can sell exchange plans and services door-to-door ... "

The new regs apply primarily to those working for the Fed-run Exchanges, but could also impact state-run ones, as well.

Remember, though, these are folks with no background checks or accountability, and minimal insurance training. But sure, let 'em in the house, they're (mostly) harmless.

Finally, Thanks to Bob, we'll leave you with this eye-opening video of Aetna Chairman Mark Bertolini discussing the major changes to our health care system. Bottom line: our new ObamaTax-based system is unaffordable (but you knew that):

Tuesday, August 19, 2014

Facebook for Physicians

Earlier this month, the Wall Street Journal reported that Wellpoint and Blue Shield of California are partnering to create a Health Information Exchange, or HIE.

An HIE is a federally-funded network designed to “allow patients’ records to be shared digitally among the providers caring for them.”

HIE’s already exist in several parts of the country.  The Journal article cites an HIE in Indiana in which more than 100 hospitals and 25,000 physicians participate.   There is an HIE in my state, Connecticut.

According to the article, the California HIE will - for example - ensure that physicians will have immediate access to patient information in emergencies [which suggests the database is not strictly limited to a patient’s own physicians after all] or ensure that a specialist could review past test results and avoid ordering duplicates.

In general, the theory behind an HIE predicts that when physicians have more complete and readily available patient information, duplication and patient risks decline, and patient outcomes improve.  This is a rational prediction based on experience; HIE’s simply bring better technology to bear.

The theory also appears to predict that more effective care will be less costly by much more than enough to offset “user fees” that the HIE charges to its participating providers.   HIE’s will test this theory.

And in theory I suppose, the HIE databases will be secure – which is not quite to say unhackable.  No doubt this will also be tested.

According to the Journal, the two California insurers “want hospitals, doctors and other insurers around the state to contribute their patients' information as well. In turn, they will be able to draw on records for their patients that were placed in the exchange by other participants.”   The Journal further explains what “contribute” means.  It means automatically posted - i.e.,  “Patients' records automatically will be included in the new California network if their health plans or health-care providers join”

However, individuals will be able to “opt out and block their information from being shared.“ [btw, I don’t recall being offered this opt-out in Connecticut].

Also, “Patients initially won't be able to see their own records but should get that ability later, the insurers said.”

So let’s review.  These California insurers and providers are bringing up a huge new hackable database of personal health information; the database will automatically contain the information they post for their members/patients; all physicians can readily access the database; but, initially at least, the members/patients won’t be able to see their own records.

Cool.  It’s Facebook for Physicians.

UPDATE [HGS]: FoIB David Williams has a related post discussing Patient Portals:

"They’re good for checking lab results, asking non-urgent clinical questions, renewing prescriptions, managing appointment schedules, patient education and paying bills."

Transparency redefined

We've long been fans of transparency in health care, both its delivery and its financing. That is, the ability of the consumer to pre-determine how much a given procedure or med may cost, in order to make an informed decision.

But transparency only works well when both parties participate: providers and insurers offering useful and informative tools (generally on-line) and consumers taking advantage of them.

But what happens when the biggest provider and financer of health care refuses to play?

Well, then, you get this:

"The White House has rejected a request to publicly disclose documents relating to the kinds of security software and computer systems behind the federal health care exchange website ... We concluded that releasing this information would potentially cause an unwarranted risk to consumers' private information"

Orwell called this "doublespeak," and it's an excellent example of the genre. We already know what a complete mess the various contractors have made of the Exchange's so-called "security." To add insult to injury, "Obama instructed federal agencies in 2009 to not keep information confidential "merely because public officials might be embarrassed by disclosure, because errors and failures might be revealed, or because of speculative or abstract fears."

Seems they weren't so abstract or speculative, after all.

Cavalcade of Risk #215 – Dog Days of Summer Edition is up

Paul Dzielinski makes his CavRisk debut (a day early, how's that for promptness!) with an excellent round-up of interesting posts, and his own helpful insights on each one.

Bravo, Paul!