IRVING, TX--(Marketwire -08/15/12)- To address the complexities resulting from sweeping health care reform, including value-based payment models and reduced reimbursements, VHA Inc., the national health care network, today announced the launch of its VHA Center for Applied Healthcare Studies. A collaborative think tank, the Center is comprised of top industry experts in the areas of safety, quality, delivery models, economics and finance, who will work with VHA and its member organizations to develop, pilot and evaluate innovative approaches addressing high quality, affordable care delivery.

Industry advisory group leaders include:

VHA advisory group representatives are:

"Our members are progressing well on their journey to necessary financial, clinical and operational improvements that will be important to the future of quality health care," explained Keith Kosel. "The Center will play an important role in developing and testing evidence-based approaches to some of the industry's most challenging issues that systems can assimilate seamlessly and quickly."

The Center is organized into two divisions: Policy and Research, and Demonstrations.

Policy and Research focuses on understanding the environmental and governmental drivers of future health care models. The studies will be accomplished via VHA-directed and VHA-sponsored research studies covering topics such as bundled payments, population health, care coordination, and patient engagement and experience.

To ensure relevant insight, the Center will maintain relationships with national health care organizations tasked with setting standards and policy tied to health care reform. The Center will work closely with VHA's Washington, DC-based public policy group, providing a focal point for understanding the scope, structure, participants and policies related to current and emerging health care legislation. Kosel said, "Keeping close tabs on what is happening in Washington will help us anticipate trends and events that affect important areas for research such as episode-based payments and population health management."

The Demonstration division focuses on delivering both large- and small-scale tests of change within VHA's hospital membership. These demonstrations are linked to national initiatives through the Centers for Medicare and Medicaid Services as well as with commercial payers or health plans. Early projects will include testing new payment models such as episode-based payments and new delivery models such as patient-centered medical home-neighborhoods.

Currently, VHA is engaged in two demonstration projects that are housed in the Center.

First is a clinical improvement collaborative sponsored by the CMS Partnership for Patients Initiative. Last fall, CMS awarded VHA funding to be one of 26 Hospital Engagement Networks charged with reducing hospital-acquired conditions by 40% by the end of 2013, compared with 2010, and cutting readmissions by 20% during the same period. Working with 200+ participating hospitals, VHA's HEN employs proprietary tools including its Rapid Adoption Network Contextualist methodology, peer networks and leading practices to drive culture change and address the CMS contract goals.

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VHA Inc. Launches Center for Applied Healthcare Studies

13-08-2012 17:41 In an appearance on NBC's "The Tonight Show" with Jay Leno on Monday, First Lady Michelle Obama explained why she's most proud of health care reform in her husband's first term.

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Michelle Obama most proud of health care - Video

Leading healthcare analytics and business intelligence solutions provider offers a new version of KnowledgeEdge that delivers enhanced capabilities, while the Value-based Purchasing application will enable hospitals and health systems to identify opportunities to secure more Medicare reimbursements.Columbus, Ohio (PRWEB) August 14, 2012 Health Care DataWorks, Inc. ...

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Health Care DataWorks Unveils New Version of KnowledgeEdge™ With Advanced Portal and Value-based Purchasing Application

Standing in what will one day be Windham Hospitals new cancer care center, Steve Larcen predicted that the future of health care is being built on the hospitals campus.

Larcen, CEO and president of the hospital, and about 50 people celebrated a milestone in the construction of the hospitals new Windham Hospital Family Health Center by signing walls that will become part of the facade of the building. The hospital strives to excel in patient care and to be seen as a trusted source of delivering personalized coordinated care, Larcen said.

This facility will help us on every one of those points, Larcen said. That is a big predictor of the future success of Windham Hospital.

Construction of the 30,000-square-foot facility is slated for completion in the spring. The $10.3 million facility, funded in part by $8.3 million in state bond money, will house dozens of primary care physicians, medical oncologists, physical therapists and rehabilitators, laboratory workers, orthopedic surgeons and general surgeons.

Elliot Joseph, CEO and president of Hartford HealthCare, which owns Windham Hospital, said the building would not have been possible without state money. He said about 60 percent of the hospitals patients are on Medicare. The hospital is reimbursed for 87 cents of every dollar of care it delivers to those patients, he said. Another 12-13 percent are on Medicaid, and the hospital is reimbursed 67 cents for every dollar of care it delivers to Medicaid patients, Joseph said.

It would have been impossible for a hospital to build this on its own, Joseph said. We, like all community hospitals, are vital and extremely fragile assets in the community.

State Sen. Donald Williams, D-Brooklyn, said state funding for the project makes sense when you consider all the benefits. In the short term, it has meant more jobs, he said. About 100 people have been employed during the construction phase. In the long term, Williams said, the building will mean quality health care for the residents of northeastern Connecticut.

What this truly represents is nothing less than saving lives, William said.

Robert Bundy, medical director of Windham Hospital, said the new building helps the hospital attract and retain top medical professionals because it represents the trend of delivering quality outpatient care. Windham Hospital has long been an epicenter of community care, he said, pointing out the variety of medical office buildings on adjacent Quarry Street.

This hospital has been delivering unconditional care for decades, he said. The focus is on the patient and offering compassionate and humanistic care. This facility allows us to do that at a time when more and more health care is being delivered in the community and on an outpatient basis.

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Wall signers welcome new Windham Hospital health center

By Tia Mitchell, Times/Herald Tallahassee Bureau Tia MitchellTampa Bay Times In Print: Wednesday, August 15, 2012

TALLAHASSEE Florida's largely unsuccessful challenge of the federal health care law cost state taxpayers $70,000, the state Attorney General's Office said this week.

The total cost of the lawsuit, including appeals, cost much more: $338,827. Those costs were shared among the 25 other states that joined Florida's legal challenge.

Attorney General Pam Bondi continues to herald the legal challenge as a partial victory for Florida even if most of the provisions in the Patient Protection and Affordable Care Act were allowed to stand. Most often, she points to the court's decision that states can opt out of expanding Medicaid to cover more people without losing billions of dollars in existing Medicaid funding.

"For all of those who care about fiscal sanity and protecting the taxpayers of our states, the court's decision on the Medicaid issue was a big win," Bondi said during a speech at an event this month sponsored by conservative advocacy group Americans for Prosperity.

Florida's total bill, $69,827.21, includes travel and expenses under Attorney General Bill McCollum, who filed the lawsuit immediately after President Barack Obama signed the health care bill into law in March 2010.

In December 2010, Florida and several other states hired the Baker Hostetler law firm at a total cost of $57,000. Later, the coalition of states hired former U.S. Solicitor General Paul Clement to take the case to the U.S. Court of Appeals and later the Supreme Court for a fee of $250,000.

Under a cost-sharing agreement, the 26 states split the financial burden according to their level of involvement with the case. Nebraska and South Carolina had the second-highest shares, contributing $26,000 each.

Five states are listed as co-plaintiffs but did not lend any money to the cause: Washington, Indiana, Mississippi, Iowa and Kansas. Jenn Meale, a spokeswoman in the Attorney General's Office, said these states either couldn't afford it or were legally restricted from using money for such endeavors.

Tia Mitchell can be reached at tmitchell@tampabay.com or (850) 224-7263.

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Health care lawsuit cost Florida taxpayers $70,000

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Even before being tapped as Mitt Romney's VP pick, Congressman Paul Ryan was considered a rising star among Republicans for his budget plan, which was a stark contrast from what President Obama was proposing. Now, it's his health care plan that's getting a lot of attention. Grace Rauh takes a closer look at how Ryan's proposals compare to President Obama's.

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UNITED STATES More than any other election, this is a choice about two different visions for the country. For two different directions about where America should go, President Barack Obama said.

When it comes to health care, the differences between the Democratic and Republican candidates for president are stark.

Mitt Romney and his running mate, Congressman Paul Ryan, have pledged to undo the president's massive health care reform law. It is the single biggest legislative achievement of the president's first term.

In June, the Supreme Court upheld most of the law, including the individual mandate. It would require most Americans to obtain health insurance in two years or pay a fine. Insurers will be required to cover people with pre-existing conditions. And it allows young adults to remain on their parents' health plans until they are 26. The President also sought to expand Medicaid, the government health program for low-income Americans. But it was dealt a blow when the court ruled that states can opt out.

In addition to scrapping the law, Ryan has also proposed deep reductions in Medicaid spending. Henry Aaron, a senior fellow at the Brookings Institution, says the cuts would have a severe impact.

And would eventually, virtually end the program as we currently know it, Aaron said.

Ryan and Obama's budget plans both call for more federal spending over the next decade. But Ryan would spend about $5 trillion less over the next decade than President Obama.

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Ryan's health care plan coming under scrutiny

A group lobbying for more health care services in French says the New Brunswick government isn't keeping up its end of a deal struck two years ago.

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Francophone group says province failing on health commitments

Posted: 11:15 am Tue, August 14, 2012 By DanHeilman Tags: Andrew R. Biebl, CliftonLarsonAllen, Health Care, Internal Revenue Service, Lehrman Flom & Co., Small Business Health Care Tax Credit, Steve Warren, U.S. Patient Protection and Affordable Care Act

Image: Dreamstime

Buried deep in the health care reform law is a provision that seems set up to reward small businesses for providing health coverage for their employees. But does it really do that or much of anything?

The Internal Revenue Service has said that 15,400 small businesses are eligible for the Small Business Health Care Tax Credit, which is aimed at making health insurance more affordable for their employees.

Congress created the tax credit (available on IRS Form 8941) in 2010 as part of the overhaul of the health care system, and it was intended to be an incentive for small businesses to offer health insurance.

But companies and their accountants have found that the process for filing a claim is top-heavy, and the potential credits start to vanish if businesses dont meet exacting standards.

Nobodys using it, and not because they dont know about it, said Andrew R. Biebl, a certified public accountant and partner with CliftonLarsonAllen in Minneapolis.

The U.S. Patient Protection and Affordable Care Act of 2010, whose constitutionality was upheld in June by the U.S. Supreme Court, provides a tax credit thats 35 percent of a businesss health premium as long as the business meets a three-part standard:

The instructions should be reviewed [by] anyone considering completing the form, said Steve Warren, CPA, and director of taxation with Lehrman, Flom & Co. in St. Louis Park. The calculation can be relatively time-consuming and complex.

Assuming your business meets the three criteria, you would look at all of your health premiums and compute 35 percent of that as your tax credit. If youre a nonprofit, its 25 percent of the premiums. Also, the law doesnt require a timely election, so business owners who have missed out to this point can file two amended returns to claim back credits.

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Health care tax credit available for business owners, but is it worth the headache?

YELLOWKNIFE, NORTHWEST TERRITORIES--(Marketwire -08/14/12)- An equitable health care system is built on the foundation of a public, non-profit system, according to research by Canadian Doctors for Medicare.

Taking Action on Health Equity in Canada, a new policy document by Canadian Doctors for Medicare builds on the excellent CMA papers and focus on equity at General Council, but goes further to call for action needed by governments for an equitable health care system.

"We can't have an equitable health care system if it's based on Canadians' ability to pay instead of their health care needs - we must address the inequities created by for-profit delivery of health care, and lack of access to life-saving medications," said Dr. Vanessa Brcic, executive board member of Canadian Doctors for Medicare.

The policy paper outlines six essential areas where the CMA can play an essential role in advocating for conditions that would improve health equity in Canada:

"An equitable health care system is also a sustainable one," said Dr. Bob Woollard, board member of Canadian Doctors for Medicare. "Evidence shows that a public health care system costs less and produces better outcomes for patients - we need our leaders, both among physicians and politicians - to recognize that the right thing to do is the smart thing to do."

The full report can be found at http://www.canadiandoctorsformedicare.ca.

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For Health Equity, Docs Prescribe Public Health Care

13-08-2012 08:42 Jill's story: Featuring people like Jill, who have pre-existing conditions, MyCare is an initiative to educate Americans about new programs, benefits, and rights under the health care law. Visit and sign up to receive email updates from HealthCare.gov: -- Take health care into your own hands. US Department of Health and Human Services (HHS) http We accept comments in the spirit of our comment policy: HHS Privacy Policy

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MyCare: Jill H. in Durham, NC - Video

Dr. James (Jim) Weinstein is currently CEO and President of Dartmouth-Hitchcock, a health care system and academic medical center that employs more than 9,000 people in New Hampshire and Vermont. In addition to his career as a spine surgeon at Dartmouth-Hitchcock, he has spent much of his career bridging his clinical work with his research efforts at The Dartmouth Institute for Health Policy and ...

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Health Care: Don't We All Want Social Value and Success? (Part One)

OAK BROOK, IL--(Marketwire -08/14/12)- This July, the global offices of Ronald McDonald House Charities (RMHC) awarded three grants, totaling $749,094 to other non-profit organizations working to provide health care education, training and resources to health care professionals in communities in Africa, Latin America and the United States. Through its global grants program, RMHC seeks to fund sustainable projects that include a "train-the-trainer" model to their methodology and demonstrate measurable results as they address some of the most urgent issues related to children's health. RMHC funded these three projects in July 2012:

Through its Global Grants program, RMHC invests in U.S. based organizations, operating domestically or internationally, that implement long-term projects with proven results in the areas of performance, community outreach and financial sustainability. Funds for these three organizations will extend access to high-quality pediatric care for more than 11,000 children in rural Rwanda; provide proper treatment and care for 960 children born with clubfoot in Ecuador; and further the education and capacity of child life specialists, helping approximately 30,000 children with cancer in the United States.

"At RMHC we aim to do the most good, for the greatest number of children. But we realize that we can't do it alone. Our Global Grants program enables us to direct funds into areas where it's most needed, to other non-profits solving some of the toughest issues in pediatric care efficiently and effectively," said Marty Coyne, president and CEO, RMHC. "Grants to organizations like Partners in Health, CureSearch and miraclefeet expand our capacity to make a sustainable and measurable impact on children around the world."

Since 1974, RMHC has been part of the change and part of the solution in eliminating barriers that prevent children from getting the care they need by investing in longstanding not-for-profit organizations like CureSearch. "CureSearch for Children's Cancer is honored to receive a grant from RMHC so that we can provide Child Life Specialists with ongoing education and skills for working with children with cancer," said Erica Neufeld, vice president of Communications, Education and Advocacy. "We hope that the training we will provide will translate into positive interactions between the Specialists and the patients they care for." Ultimately, the RMHC Global Grants program helps the charity quickly move donation dollars to children and communities in their greatest time of need.

This is the Charity's second cycle of grant funding for the year. RMHC will continue to invest in charitable organizations that work to improve access to health care. Grant proposals for the fall grant cycle is now available. New applicants can apply here. For more information, visit the Charity's grants page at: http://rmhc.org/what-we-do/grants/.

About Ronald McDonald House CharitiesRonald McDonald House Charities (RMHC), a non-profit, 501 (c) (3) corporation, creates, finds and supports programs that directly improve the health and well being of children. Through its global network of local Chapters in 57 countries and regions, its three core programs, the Ronald McDonald House, Ronald McDonald Family Room and Ronald McDonald Care Mobile, and millions of dollars in grants to support children's programs worldwide, RMHC provides stability and resources to families so they can get and keep their children healthy and happy. All RMHC-supported programs provide a bridge to quality health care and give children and families the time they need together to heal faster and cope better. For more information, visit http://www.rmhc.org, follow us on Twitter (@RMHC) or like us on Facebook (Facebook.com/RMHC Global).

The following trademarks used herein are owned by McDonald's Corporation and its affiliates: Ronald McDonald House Charities, Ronald McDonald House Charities Logo, RMHC, Ronald McDonald House, Ronald McDonald Family Room, and Ronald McDonald Care Mobile.

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RMHC Grants Provide Access to Medical Care for Children and Families

CHICAGO (CBS) Operators of a home health care service have been indicted, along with a nurse and two marketers, for kickbacks related to $5 million in Medicare billing.

As WBBM Newsradios John Cody reports, the owners of Goodwill Home Nursing Services in Lincolnwood Marilyn Maravilla and Junjee Arroyo; a nurse Ferdinand Echavia; and two marketers Rakeshkumar Shah and Jean Holloway have been charged with giving and receiving $400,000 in kickbacks for finding and retaining patiens, whose home health care bills could be charged to Medicare.

U.S. Attorneys office spokesman Randall Samborn says the issue isnt whether or not someone made home care visits.

These services should be based on medical necessity, and on whats in the patients best interests, and not based on whether or not someone in the medical industry is receiving a kickback for giving a loan, Samborn said.

So far, marketers Holloway and Shah have pleaded not guilty.

Samborn says so far, four dozen people have been charged with health care fraud since a federal strike force began operating last year in Chicago.

LISTEN: WBBM Newsradios John Cody reports

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Home Health Care Service Operators Accused In Kickback Scheme

PALO ALTO, CA--(Marketwire -08/14/12)- Simplee, the best way to save money on medical bills, today released its 2012 Second Quarter Health Care in America Out of Pocket Spending statistics. Overall results reflect expected slowdowns from Q1 2012 spending because of the number of family deductibles that have already been met. However, flat spending in comparison to the same quarter last year indicates that consumers are being more deliberate in medical spending decisions.

"Even with the expected seasonal slowdown in spending, there is evidence that consumers are taking more control over their health care costs and driving down out of pocket medical spending," said Tomer Shoval, co-founder and CEO of Simplee. "We found no increase in spending when comparing year over year results, which means that consumers have negated the effects of inflation and rising medical costs through more deliberate spending decisions."

The Simplee quarterly statistics track patient spending from the more than $300 million in health care expenditure and hundreds of thousands of doctor visits within the Simplee database. Key findings are recorded in the tables below. All numbers reflect costs for an average family of four.

Key Findings:

Additional findings include:

For more information on Simplee and how to take control of your health care expenses please visit http://www.simplee.com. For more information on the Simplee Health Care Spending in America statistics, please contact a Simplee representative.

About Simplee

Simplee is a privately held company that empowers consumers to take control of their health care expenses. The free, web-based service helps users better understand and manage their health care expenses, and identify ways to save money and find better care at lower costs through an easy-to-use, simple dashboard with a set of powerful customization tools. The company is located in Palo Alto, California, and maintains a development center in Israel. For more information visit: http://www.simplee.com.

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Simplee: Seasonality Drives Q2 2012 Slowdown in Consumer Medical Spending

LOS LUNAS A new medical facility and a new approach to health care is coming to the village of Los Lunas early next year.

After recently being selected to insure village employees and their family members, Lovelace Health Plan announced its plan to open a primary care clinic in Los Lunas.

The clinic will be available for all of the nearly 500 village employees, their family members and anyone with Lovelace Health Plan insurance.

Coverage for village employees began July 1. The addition of the employees will mean Lovelaces health plan now covers more than 10,000 people in Valencia County, according to Doug Gullino, the vice president of commercial sales and service for Lovelace Health Plan.

Gullino said the clinic will introduce a health care approach residents of the county probably dont have available.

It really gives folks access to medical care in a way we should have always been doing, Gullino said. It gives better care, better access to the whole system, to all the different services and providers we offer.

Called a patient centered medical home model, Dr. John Cruickshank, chief medical officer at Lovelace Health Plan, said this is a change that is sweeping the country.

When he ran his private family practice for 18 years, Cruickshank said he would start his day double booked from 9 a.m. to 5 p.m.

If we got a call at 1 p.m., we either had to triple book or we couldnt see them, Cruickshank said. That model and experience in New Mexico caused trouble because of the access and availability of physicians. People were forced to go to the ER, which is a higher cost, and really just aggravating. And after treatment, the patients primary doctor might not be in the loop.

One big change this medical home model will bring, is the allocation of a certain percentage of appointments reserved for same day access at the new Lovelace clinic, Cruickshank said.

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Lovelace To Open Los Lunas Clinic

A home health care agency in suburban Lincolnwood, two nurses who are part owners of the company and a third nurse affiliated with them, along with two marketers---one of whom resides in Des Plaines---were indicted on federal charges for allegedly participating in a conspiracy to pay and receive kickbacks in exchange for the referral of Medicare patients for home health care services, federal law enforcement officials announced Monday.

Defendants Marilyn Maravilla and Junjee L. Arroyo, both part owners of Goodwill Home Healthcare, Inc., and three other defendants allegedly conspired to pay and receive approximately $400,000 in kickbacks to themselves, nurses, marketers and others for the referral and retention of Medicare patients that enabled Goodwill to bill Medicare approximately $5 million.

Also indicted were Ferdinand Echavia, a licensed nurse who referred patients to Goodwill, and Jean Holloway and Rakeshkumar Shah, both of whom marketed Goodwills services to Medicare patients.

The 29-count indictment was returned by a federal grand jury last Thursday and unsealed on Friday following the arrests of Holloway, 41, of Bellwood, and Shah, 46, of Des Plaines. Both were released on bond after pleading not guilty in U.S. District Court.

Maravilla, 55, of Chicago; Arroyo, 44, of Elmhurst; and Echavia, 39, of Chicago, all licensed nurses, together with Goodwill as a corporate defendant, are scheduled to be arraigned on Aug. 22 in U.S. District Court.

All six defendants were charged with one count of conspiracy to pay and receive illegal kickbacks for Medicare patient referrals, and each defendant was also charged with the following number of counts of violating the anti-kickback statute: Goodwill, 16 counts; Maravilla, 15 counts; Arroyo, 16 counts; Echavia, five counts; Holloway, three counts; and Shah, eight counts.

The indictment was announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services, Office of Inspector General; and Robert D. Grant, Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation.

Paying kickbacks to refer Medicare patients is illegal. Money cannot be permitted to be the basis of a medical referral over medical necessity or quality of service, Mr. Pugh said. The investigation is continuing, the officials said.

Between August 2008 and July 2010, the indictment alleges that Maravilla, Arroyo and two other individuals one an officer and an owner of Goodwill, and the other a certified public accountant and Goodwills bookkeeper paid and caused Goodwill to pay kickbacks to nurses, marketers and other home health care workers who referred patients to Goodwill; assisted in re-certifying patients as homebound; or caused patients to begin new 60-day care cycles of home health care with Goodwill. By offering kickbacks, Maravilla, Arroyo, and others sought to increase Goodwills patient census and to enrich themselves and Goodwill. During this time, Goodwill obtained referrals of approximately 900 cycles of home health care, including new patients and the re-certification of existing patients for additional 60-day cycles of care.

According to the indictment, the amount of the kickback payments varied, but generally ranged from approximately $400 to $700 for each new care cycle, and approximately $100 to $300 for each re-certification. The payments were intended to induce nurses, marketers and others in the home health industry to refer patients to Goodwill for services to be reimbursed by Medicare, the indictment alleges.

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Health Care Providers Indicted In Alleged Kickback Scheme

Photo by Alex Wong / Getty Images

Above: Rep. Paul Ryan, R-Wis., points to piles of the health care overhaul legislation during a markup hearing before the U.S. House Budget Committee last year in Washington, D.C.

The addition of Rep. Paul Ryan to the GOP ticket is certain to elevate health care as a campaign issue this fall. Most of the debate is likely to be about Medicare, and Ryan's controversial plan to transform the popular program for the elderly and disabled.

But some of the attention is likely to focus on Medicaid, the health care program for those with low incomes, as well.

Medicaid not Medicare is actually the nation's largest health insurance program, covering some 60 million Americans with very limited incomes. But you'd be excused for not knowing that, because Medicaid doesn't get nearly as much attention as Medicare does.

That may be changing, however. The Supreme Court earlier this summer put the program in the news when it ruled that the Medicaid expansion in the 2010 health law must be optional for states.

That's given more ammunition to Republicans, including presidential candidate Mitt Romney, who want to offer states far more responsibility for Medicaid.

"The state is the best place to determine what is the best way to help those poor," Romney said in a health care speech at the University of Michigan in 2011. "And so I would therefore block grant to the states' Medicaid funds, and say to the states, 'You now use these monies as you feel appropriate to care for your own poor.' "

Only there's a catch, said President Obama in a speech to Associated Press editors in April. Under the Republican congressional budget Romney has endorsed, Medicaid funding would not only be turned back to the states, it would be cut substantially.

"They would have to be running these programs in the face of the largest cut to Medicaid that has ever been proposed," he said, "a cut that, according to one nonpartisan group, would take away health care from about 19 million Americans."

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Medicaid Fight Enlivened With Romney-Ryan Ticket

ATLANTA--(BUSINESS WIRE)--

LexisNexis Risk Solutions today announced the availability of LexisNexis Provider Integrity Scan, an advanced data solution to assist private and public health care payers in verifying and monitoring health care provider licensing and credentials, and detecting and preventing fraudulent or criminal provider activity. Organizations using Provider Integrity Scan benefit from reduced health care costs by identifying potentially fraudulent providers and businesses enrolled or attempting to enroll in health-related programs.

In todays health care environment, if an improper claim payment is made, health plans have a less than 50 percent chance of recovering the funds. CMS estimates Medicaid fraud, waste, and abuse alone to be over $30 billion annually, while NHCAA estimates conservatively that overall fraud accounts for 3 percent of our nation's annual health care spending or approximately $69 billion. These factors require health plans to systematically monitor payment activities and diligently ensure that the risk of improper payments and other forms of provider fraud is reduced.

Health care payers continue to be challenged with increasing regulations from the Centers for Medicare and Medicaid Services (CMS) to ensure enrollment is limited to legitimate providers and suppliers, pending standards within state agencies and rising losses associated with fraud and improper payments, said Harry Jordan, vice president and general manager, health care, LexisNexis. Knowing the best way to reduce fraud, waste, and abuse is to prevent it, LexisNexis helps payers take a proactive approach to uncovering derogatory attributes linked to providers. This approach reduces a payers exposure to fraud before it impacts their bottom line, regulatory compliance and patient safety.

LexisNexis Provider Integrity Scan automates a variety of provider verification searches and ongoing monitoring options, and provides automatic red flag alerts for a wide range of high risk indicators. It gives payers the ability to efficiently process multiple searches and obtain critical information contained within massive volumes of provider data within the nations public and private health plans.

The solution offers payers efficiency in processing power, utilizing LexIDSM and access to more than 40 billion public and proprietary records from more than 10,000 sources.LexID is among the fastest linking technology available, enabling customers to identify, organize information quickly and link records together. This speed and accuracy is important in combating fraudulent providers who use family and cohorts to set up new businesses in other cities or states once theyve been flagged or sanctioned by health care payers.

For more information about LexisNexis Provider Integrity Scan, please visit http://www.lexisnexis.com/risk/hc-identity-management.aspx .

About LexisNexis Risk Solutions

LexisNexis Risk Solutions (www.lexisnexis.com/risk/) is a leader in providing essential information that helps customers across all industries and government predict, assess and manage risk. Combining cutting-edge technology, unique data and advanced scoring analytics, Risk Solutions provides products and services that address evolving client needs in the risk sector while upholding the highest standards of security and privacy. LexisNexis Risk Solutions is part of Reed Elsevier, a leading publisher and information provider that serves customers in more than 100 countries with more than 30,000 employees worldwide.

Our health care solutions assist payers, providers and integrators with ensuring appropriate access to health care data and programs, enhancing disease management contact ratios, improving operational processes, and proactively combating fraud, waste and abuse across the continuum.

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LexisNexis® Provider Integrity Scan Identifies Fraudulent Providers and Organizations, Reduces Health Care Payer Costs

TAHLEQUAH Women across the U.S. no longer have to pay for certain health care services, including birth control, which are now covered under the Patient Protection and Affordable Care Act.

Effective Aug. 1, PPACA requires most health insurance plans to cover eight preventive care measures without charging a co-payment or deductible: well-woman visits; gestational diabetes screening; domestic and interpersonal violence screening and counseling; FDA-approved contraceptive methods and education; breastfeeding support, supplies and counseling; HPV DNA testing for women 30 and older; and STD counseling, and HIV screening and counseling.

In May, more than 40 Catholic institutions filed 12 lawsuits in federal jurisdictions, asserting the contraception rule violated religious tenets. But according to the U.S. Department of Health and Human Services, the law allows some nonprofit religious employers to choose whether to cover contraceptive services.

Kathleen Sebelius, secretary of HHS, said an additional element has been added: Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until Aug. 1, 2013, to comply. Employers who want the extra time must certify they qualify for it.

According to a recent report by Bloomberg, organizations such as churches, which may not provide insurance coverage for contraception, are still exempt from the requirement, as are primary and secondary schools affiliated with religious organizations. But universities, charities, hospitals and other religiously-connected entities must comply.

Despite the recent Supreme Court ruling that PPACA is constitutional, Becky Bernhardt, assistant press secretary for Sen. Tom Coburn, R-Okla., said he believes the rule is unconstitutional. Coburn says it dangerously expands the federal governments role in health care, and takes away even more of our individual and religious freedoms.

Coburn is a physician who specializes in obstetrics and gynecology. He is also opposed to PPACA.

Forcing Americans to finance contraceptives and abortifacients is an assault on religious freedom and individual liberty, said Coburn. This mandate is also completely unnecessary, as these products are already widely available at extremely low prices at clinics across the country. This mandate has nothing to do with serving women, and everything to do with expanding governments control over health care.

Dr. Jena Rogers, M.D., who specializes in internal medicine at Tahlequah Medical Group, believes the ruling is beneficial for all women.

No matter what community you are talking about, preventive health visits for women, and for men, are beneficial, said Rogers. Technology and education in health care have improved so much over time that it is much easier and safer to get tested. The percentage of women who now have mammograms have almost doubled in the past 15 years. Screening for diabetes is also much easier and cost-effective.

Continued here:

Law expands preventive care for women

Republican Paul Ryan's blueprint for Medicare could prove as polarizing in the campaign as President Barack Obama's health care overhaul has been. Even Mitt Romney may not want to go there.

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GOP VP pick's Medicare plan back in spotlight