Medicare ID Theft Growing as Quickly as Boomer Elders

Digital medical records have become the favorite fraud outlets for ID theft hackers. Published reports from late last year stated that approximately $47 billion were stolen from questionable Medicare payments.

The Medicare system has become the "single biggest victim" of health care fraud in America, according to Rob Montemorra, chief of the FBI's Health Care Fraud Unit.

The payoff for health care identity fraud is mind boggling. In 2008, criminals pocketed more than $19,000 per incident of health care fraud, which is more than three times the amount gained through overall ID theft, according to Javelin. The cost to the individual victim was nearly $1,200, more than double that of overall ID theft.

Health care identity theft has outgrown all other crimes in the field last year, according to Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association (NHCAA).

"Since we all pay taxes, we are all our victims because the cost of this [crime] is coming out of our pockets," according to Montemorra.

Continue to encourage your clients to review their Medicare receipts and be cautious about who they share their medical health and billing information with. Promoting awareness and support about this issue will help strengthen relationships and prevent Medicare ID theft in your community.

Additionally, when Medicare fraud becomes rampant, it’s an easy decision for legislatures to tighten the belts on the Medicare system. It saves the system some money, and looks great on election day. Unfortunately, it means that the true savings are often negligible, yet the additional expense and increased scrutiny for good quality Medicare providers is a hardship.

Source: CNN

Hispanics More Likely to be Admitted to Poor Quality Nursing Homes

Mary Fennell, study leader and professor of sociology and community health at Brown University, found that the elderly among the Hispanic population are more likely than non-Hispanics to live in nursing homes of poor quality.

In traditional Hispanic households, care for family seniors has been handled by adult daughters at home. The dilemma is that there are an increasing amount of young Hispanic women that work outside the home.

When daughters are working full time and unable to attend to older family members during the day, they must seek out a solution. According to Fennell’s study, some 4.5 million senior Hispanics are expected to need care sometime in 2010.

From 2000-2005, the percent of Hispanic residents increased from 5 percent to 6.4 percent, but the percentage of non-Hispanic white residents dropped from just under 83 percent to 79.4 percent.

To reach the oringinal article that this post was inspired from or for more information about this study, click here.

“Avoidable” and “Unavoidable” Pressure Sores

The development of pressure sores on a client can easily go unnoticed to the untrained eye. They can cause serious infections, some of which can be lethal. Pressure sores are a major concern for any home care company.

The Center for Medicare & Medicaid Services (CMS) categorizes pressure sores under both “Avoidable” and “Unavoidable”. These definitions serve as a map for potential malpractice situations, and need to be understood by all home care companies.

“Unavoidable” pressure sores are defined as when the client developed a pressure ulcer even though the team had evaluated the client’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with client needs, goals, and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate.

“Avoidable” pressures sores are termed so because the clinical team was at fault because the process above was not implemented.

Pressure sores will be an unfortunate reality for many of your clients that are at high risk, such as those that use a wheelchair or are bed bound. You can use the CMS definitions as a starting point “checklist” to make sure that your company does everything possible to prevent, address and document pressure sore issues.

It is a good idea to assess each client for pressure sore risks at their first caregiver visit. Provide all of your caregivers with basic training about signs of pressure sores and sore prevention. A handy one page checklist tucked in a client journal can keep caregivers refreshed to this often overlooked, but serious issue.

How to Avoid Medicare Marketing Scams

The new post on the Private Duty Today blog has a great article about helping your clients avoid Medicare marketing scams. Click here for more information.

Parent's May Misguide Senior's Long Term Care

When seniors are searching for home care, they often seek the advice of their children first, particularly their daughters. Many seniors assume that their children have a better grip on the current economic situation and understand the health care system. The American Association for Long-Term Care Insurance found some unsettling results in a recent study.

Although the study was about long term care planning for women, if daughters of seniors misunderstand their own long term care plans, they also have the potential to misguide the care plans of their parents.

Almost 20 percent of women participants in a national survey believed that they already had long-term care coverage, while only about 5 percent of U.S. adults over the age of 45 actually had it. The survey suggests that many women may assume that their health coverage includes long-term care, when in reality it doesn’t.

Investigating long term care plans for both the senior and their child will help both understand the ins and outs of the system.

Blackberry Report: The National State of the Home Care Industry Study

The National Association for Home Care & Hospice (NAHC) has announced the completion of The BlackBerry® Report: The National State of the Home Care Industry Study. The study, conducted to provide insights into essential advances and reforms in the delivery of home
health care services, is intended to help providers of these crucial services
prepare for pending overall health care reform.

The study, the largest of its kind, is designed to drive best practices that
can be shared for the benefit of the whole industry. The study demonstrates
the collaboration within the home care industry to prepare for proposed
reimbursement cuts, and to retool to use technology and data to improve
quality and patient care.

The first analysis of the BlackBerry Report (available at
http://fazzi.com/research/state_of_industry_study.html) revealed key insights
that underscore the home care industry's commitment to the utilization of
technology to enhance quality and improve efficiencies and productivity
through the adoption of Electronic Medical Record Systems, Point of Service
(POS) Systems, hand held devices and telehealth.

Our friend and colleague, Dr. Bob Fazzi, presented the results of the survey at the NAHC annual conference in Los Angeles earlier this week. Some highlights from the study are:

• Just over 65% of all agencies now have Electronic Medical Record
         Systems.
  

• Eighty-three percent of these agencies report that the use of
         these systems has led to improvement in quality of care coordination.
  

• Nearly 40% of all agencies now use some form of POS system in the
  field.
  

• Handhelds account for 6.3% of hardware presently being used

• Just over 36% of those agencies seeking to purchase new hardware report that they are
         interested in handhelds.
  

• Twenty three percent of agencies report using telehealth systems.
  

Shield Healthcare Announces Story Contest to Honor Caregivers

VALENCIA, Calif., Oct. 14 -- Shield Healthcare, a leading
provider of medical supplies for care at home, is pleased to announce its 9th
annual story contest on "What Makes Caregiving Rewarding?" designed to
recognize and hear the voice of caregivers and home healthcare professionals,
featuring celebrity contest judge, Sandra Mitchell of KCAL 9/CBS 2 News.
Shield Healthcare understands that caregiving is a demanding job. A
significant number of our customers are family caregivers at home, tending to
a loved one with a chronic medical condition. They unselfishly take on the
challenge and responsibility of meeting the daily health and emotional needs
of the person in their care. This story contest is a positive way to recognize
and reward this important role. The contest runs through November 30, 2009 in
celebration of National Family Caregiver's Month.


Last year's winners included 3 mothers of special needs children, a nurse, and
a social worker. Winner Susan Agrawal wrote, "Among all the blessings that my
daughter has bestowed upon me, seeing her grow through inchstones has granted
me the best gift of all: the ability to see wonder and joy in the most
unexpected places."


The top three story winners will receive $1000 in American Express Gift
Cheques and a 1-year subscription to Today's Caregiver Magazine. The two
runner-ups will also be awarded the magazine subscription and $250 in American
Express Gift Cheques. All contest entries must be one-page, typed or
hand-written and postmarked by November 30, 2009. Entries should be mailed to
Shield Healthcare, Attn: Caring Solutions, 27911 Franklin Parkway, Valencia,
CA 91355 or emailed to caring@shieldhealthcare.com. Full contest details are
available on Shield's website at www.shieldhealthcare.com.