Acting Assistant Attorney General Stuart F. Delery told lawyers at the American Bar Associations ninth National Institute on the Civil False Claims Act and Qui Tam Enforcement that health-care prosecutions have worked for taxpayers.

"Since January 2009, the Civil Division, working with our partners in the U.S. Attorney offices, has recovered over $11.1 billion under the False Claims Act," Delery told the group last week, according to text of his speech. "Of this amount, more than $7.4 billion was recovered in health care fraud matters, with the largest recoveries coming from the pharmaceutical and medical device industries. These are historic figures."

Qui tam is the abbreviated Latin phrase that translates, in practical terms, to whistle-blowers speaking up about what they perceive as malfeasance.

While whistle-blowers sometime benefit financially if a case gets all the way to conclusion, many have started out frustrated by attempts to fix the problem within their company.

The audience included attorneys who represent companies.

"Protecting taxpayer dollars is one of the Attorney Generals core priorities," Delery said. "This includes a commitment to increase our efforts to reduce fraud at the outset. Although the recoveries I discussed earlier reflect the impressive work of this department, it would be better if we did not need to bring these cases at all. The department is well aware of the fact that litigation can only plausibly reach a fraction of the fraud committed against U.S. Government programs which likewise makes the prevention of fraud a more potent tool for protecting the interests of the United States than efforts to undo the damage of completed schemes.

"That is why we continue to pursue non-monetary remedies and other measures to help prospectively reduce fraud. And it is why we want to engage with you and your clients to encourage self-reporting, discuss forward-looking compliance measures, and generally work cooperatively to try to eliminate fraud. Litigation to recover the costs of fraud is a far inferior option to preventing fraud in the first place."

Delery's full speech is here.

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Health-care fraud investigations paying dividends, Justice Department official says

Sharply higher premiums, deductibles, and a slimmer roster of doctors are options that employers are considering for employees if health reform is struck down, or partially overturned.

NEW YORK (CNNMoney) -- How Corporate America will react if the Supreme Court overturns the landmark 2010 health care reform law is a big fat -- scary -- question mark.

And that leaves more than 160 million people who get their insurance directly through their employers in the dark.

The Supreme Court is expected to rule later this month -- maybe as soon as Monday. Industry experts say the justices could uphold the law, overturn it completely or overturn just some provisions.

In the meantime, the health insurance industry and consumers are bracing for a possible big change. Even though the law's main provisions don't kick in until 2014, several significant ones have already taken affect.

Earlier this week, a number of big health insurers, including two of the very largest -- UnitedHealthcare (UHC) and Humana (HUM, Fortune 500) -- committed to offering some provisions of health reform, such as coverage of adult dependents up to age 26, regardless of how the court rules.

But those commitments would only apply to the 15 million or so consumers who buy their insurance directly from insurers or work for businesses that do so.

A vastly larger pool of people get their insurance through employers that are "self insured," meaning they act just like an insurer. They create their own health care plans and set premiums and deductibles for their employees.

Premiums for employer-based coverage have already gone up 8% to 9% annually in the past few years.

And if the Supreme Court throws out the Affordable Care Act, there's a real risk that employees could see an "exponential jump" in premiums going forward, said Paul Keckley, executive director for Deloitte Center for Health Solutions.

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Employers' 'plan B' if health reform is axed

Washington — Despite a recent easing of medical costs, the nation's health care spending will keep outpacing economic growth for the foreseeable future, government experts said Tuesday.

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Health costs to beat growth

WASHINGTON If only the economy were growing as fast.

Despite a recent easing of medical costs, the nations health care spending will keep outpacing economic growth for the foreseeable future, government experts said Tuesday in a forecast that signals more upheaval for Medicare and Medicaid, as well as private insurance.

President Barack Obamas health care overhaul will add $478 billion in spending over the 2011-2021 period covered by the projections, expanding coverage to some 30 million uninsured people. But the issue of rising costs will not go away even if the Supreme Court overturns Obamas law or his Republican foes ultimately succeed in repealing it.

By the beginning of the next decade, health care spending will be growing roughly 2 percentage points faster than the overall economy, which is about the same differential experienced over the past 30 years, said the report from Medicares nonpartisan Office of the Actuary.

The findings have implications for both sides of the political divide. If health care spending isnt brought in line with overall economic growth, Americans will eventually face agonizing choices between paying medical bills and funding other priorities such as education and infrastructure.

By 2021, health care will account for nearly 20 percent of the U.S. economy, the report found, up from under 14 percent in 2000. Controlling costs is one of the keys to solving federal budget woes, but that probably cant be done without major changes to Medicare and Medicaid.

The annual spending projections usually attract little attention. But with health care a central theme both of the nations polarized political debate and the federal budget, the report is now getting close scrutiny.

This year the biggest looming question has been whether fledging payment revisions in Obamas law, also mirrored by private insurance plans, are succeeding in holding costs down. The rate of growth the past three years has hovered under 4 percent, historically low. Thats coincided with a shift to paying hospitals and doctors for better quality, not just their sheer volume of tests and procedures.

Obama has argued that his overhaul would begin to bend the cost curve to more affordable levels.

The analysts remained skeptical.

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Cost of health care will continue to rise

Five hospitals sit within an easy drive of my Indianapolis home. It's comforting to know, considering that my wife will deliver our second child in late August.

But that information will become temporarily useless next month when we take our annual family vacation to Holden Beach, N.C., a strip of Atlantic Ocean sand about an hour's drive from even a small city. The lack of beach-side maternity services won't keep us from making the trip. It just requires planning and prudent steps that doctors recommend for all travelers, regardless of whether they are great with child.

Here are some health care considerations to think about before hopping in a car or plane for your summer vacation.

1. DO A LITTLE RESEARCH

If you're staying somewhere for more than a few days, do a quick Internet search to learn what health care help might be available, especially if you have a medical condition. In our case, a new medical center with birthing rooms and a nursery is located roughly 30 minutes inland from the beach house if the baby comes early.

If time and my wife's contractions allow us to drive farther, we might be able reach a hospital in Wilmington, N.C., that provides a neonatal intensive care unit equipped to handle premature babies.

It's not enough to just know what's available. Know which hospitals are in your health insurer's provider network. Costs can pile up quickly for care outside the network.

Depending on the plan, a patient may have to pay a separate deductible. You also could pay a higher co-insurance percentage. That's the amount of the bill leftover after the deductible is met.

On top of all that, the doctor or hospital can bill patients for the balance between what they charge and what the insurer pays, something they can't do for in-network care. All this can add up to thousands of dollars in extra expenses.

Big insurers like UnitedHealth Group Inc. or Cigna Corp. maintain national provider networks, but don't fret if you have coverage through a small insurer. Check to see if they offer the use of a larger insurer's network under certain conditions.

Continued here:

3 steps to avoid health care hassles on vacation

WASHINGTON Even as President Barack Obamas health care law expands health coverage and transforms the way millions of Americans get medical care, it will have little effect on the nations total health care bill, according to a new government report on national health care spending.

Total U.S. spending on health care is expected to continue to surge over the next decade, hitting about $4.8 trillion in 2021, independent economists at the federal Centers for Medicare and Medicaid Services estimate.

That is up from $2.8 trillion this year and will push health care spending to nearly 20 percent of the U.S. economy by the beginning of the next decade.

The new estimates the latest in a series of annual projections from the federal government undermine claims by some critics that the law will dramatically drive up health care spending. At the same time, they also underscore some of the laws limitations.

The growth rate of national health spending is projected to be fairly similar with or without the Affordable Care Act, said Sean Keehan, lead author of the report.

Total spending on health care over the next decade will be approximately 1 percent higher or about $478 billion as result of the new law, even with the federal government spending hundreds of millions of dollars to guarantee nearly all Americans health coverage for the first time.

After the law is fully implemented in 2014, total health care spending is expected to grow slightly more slowly than it would without the law, the report said.

The economists estimate that 30 million more people will gain health coverage over the next decade, with major expansions of the government Medicaid program for the poor and the creation of insurance exchanges, in which consumers who do not get coverage at work will be able to shop for insurance plans starting in 2014.

Many of those people are expected to qualify for federal subsidies that will be available to people making up to four times the federal poverty line, or $92,200, for a family of four.

But the new estimates also show how little the law will do to fundamentally change the trajectory of health care spending.

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Health spending likely to keep rising with or without Obama's plan

Jun 13, 2012 11:52am

The Supreme Court isnt expected to rule until later this month on the constitutionality of the Affordable Care Act, but theres been some interesting developments as outside interest groups prepare for what they say might occur.

This week a few of the larger health insurancecarriers UnitedHealth, Aetna and Humana announced that no matter how the Supreme Court rules on the health care law, they would allow some of the more popular insurance reforms to go forward. UnitedHealth, for instance, said it would allow young adults to stay on their parents health plans, a popular provision of the lawthat is currently in effect.

The protections we are voluntarily extending are good for peoples health, promote broader access to quality care and contribute to helping control rising health care costs. These provisions make sense for the people we serve, and it is important to ensure they know these provisions will continue, said Stephen J. Hemsley, president and CEO of UnitedHealth Group, in a statement.

Read More About the Insurance Companies Announcement

But today a public interest group supporting the health care law Health Care for America Now issued the following warning: Dont be fooled by the Big Insurance Companies.

In the statement the group said that the insurance companieswere going on a PR offensive and hoping to send a signal tothe high court:

The coordinated announcements by three of the five biggest health insurance companies is a cynical tactic to signal to the high court that its okay to gut the law and remove its consumer protections because the health insurance companies will act responsibly and police themselves. No more insurance company abuses. The free market wont cost consumers their health anymore. The insurers message to the court, it would seem, is that its a new day so we can stick with the old rules.

And what Health Care for America now says what will really happen is this:

What the insurance companies didnt say and what they wont do is the real story. They arent saying they will stop discriminating against people with pre-existing conditions as the law requires beginning in 2014. That would be a big deal, because that part of the law will stop 129 million people with chronic conditions like diabetes, high blood pressure and asthma from being overcharged or being denied coverage. They also have not offered to keep covering children with pre-existing conditions a provision which has already taken effect and insurers have fought.

See the article here:

Health Care Law Supporters Hoping to Send Signal to High Court

The Supreme Court isn’t expected to rule until later this month on the constitutionality of  the Affordable Care Act, but there’s been some interesting developments as outside interest groups prepare for what they say might occur. This week a few of the larger health insurance carriers –...

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Health Care Law Supporters Say Carriers on PR Offensive - Hoping to Send Signal to High Court

Speaker John Boehner recently told Republicans in a private meeting to change their tone on health care and fast: stop using job-killing to describe the Obama health care law.

Instead, emphasize that the law drives up costs and makes things worse for small businesses.

Why? The job-killing message was polling poorly, sources said.

The episode underscores both the GOPs recognition that it needs to be ready to respond to the Supreme Courts looming decision on the health care law and the delicacy with which Republicans must fashion that response.

Theres no time to waste: GOP leaders plan to bookend July with a weeklong debate on health care after the court releases its ruling in late June and a tax-cut fight at the end of the month.

The strategy the finalization of months of deliberations by GOP leaders over whether to rebut Obama on health care and tax cuts before the summer break comes at a time when many rank-and-file Republicans are grumbling that they dont have much to show for the last year and a half in Washington.

So Republican leaders wanted to give their members a platform to frame their side of the political debate as the campaign season heats up with the added bonus of giving fuel to tea party Republicans as well as the tax-minded establishment. It also lays markers on taxes and health care, which will be key in the lame-duck session of Congress and beyond.

These are the fights going into the election, one GOP aide told POLITICO.

The message: This is the Republican position on taxes and health care. Weve got a plan, and we can execute it.

But GOP insiders insist they havent finalized that plan quite yet an acknowledgment of the tricky task of putting together a health care response that satisfies both moderates and conservatives and comports to a yet-unknown Supreme Court ruling.

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GOP adjusts health care strategy

ORLANDO, Fla.--Mitt Romney used President Obama’s health care law on Tuesday to hammer him as out of touch with the economy, arguing that Obama is naively unaware of the impact of the Affordable Care Act on small businesses. 

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Romney Calls Obama Out of Touch on Hiring Impact of ‘Obamacare’

TUESDAY, June 12 (HealthDay News) -- Health care spending in the United States from 2011 to 2013 is expected to grow 4 percent, which is slightly more than the historic low of 3.8 percent in 2009, government officials said Tuesday.

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Modest Health Care Spending Rise Expected for 2013: Report

Fighting for re-election, President Barack Obama is playing down his historic health care overhaul and the multibillion-dollar recession-fighting stimulus — two landmark efforts of his first three years in office. Those signature policies are unpopular, and voters clearly want the candidates to focus instead on jobs.

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Obama doesn't emphasize issues he fought hard for

Trinidad Contreras enjoys gardening and playing dominoes at his adult day health care center, but a state ruling has the 79-year-old fearfully anticipating an isolated existence.

"At this age, being old and being in the apartment alone, I'm afraid to be alone. I'm afraid I'll get depressed again," he said, speaking in Spanish through an interpreter.

He began to cry.

Until this year, California paid for him to attend Gardner Adult Day Health Care in San Jose.

To save money, the state limited Medi-Cal coverage for such care to those with the most serious needs. Contreras, who sometimes needs help eating because of Parkinson's disease tremors, did not make the cut.

The state this year found 7,000 seniors ineligible out of 35,000 participants in a program originally meant to save money by keeping medically fragile people out of more costly nursing homes and high-cost emergency rooms.

Some 1,800, including Contreras, have appealed, and some centers, unwilling to leave people without services, are sagging under the financial pressure of keeping their doors open to people the state no longer pays for.

In Santa Cruz County

That's the case at Elderday in Santa Cruz, the only adult day health care facility in the county. Program Director Sheri Anselmi said state rate cuts mean the center is losing about $55,000 a month, jeopardizing the Elderday's future.

Elderday sees about 130 enrollees who receive transportation to the center, meals, physical and occupational therapy, mental health services, nursing and dietician services and therapeutic activities.

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Seniors program's launch brings confusion, delays for Californians

ORLANDO As the Supreme Court prepares to rule on the constitutionality of President Obamas health-care overhaul, Mitt Romney laid out an alternative on Tuesday that would make the health insurance system more like a consumer market.

Addressing supporters in Orlando, Romney fleshed out a plan that he proposed earlier, one that would apply free-enterprise principles to the nations health-care system rather than operate it like a government-managed utility, letting competition drive down prices and increase quality. He also vowed to divert federal Medicaid money and other federal funding to state governments, making them responsible for covering the uninsured. And he promised that his plan would help cover people with preexisting conditions, one of the more popular components of Obamas law.

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Romney outlines plan to make health-care system like ‘consumer market’

In a bid to serve its members better, the health insurer behemoth UnitedHealth Group Inc. (UNH) took a big step by declaring that it will continue with some of the health care insurance provisions doled out by the Health Care Reform Act 2010. The insurer is planning to keep these provisions regardless of the outcome of the pending Supreme Court ruling on the reform.

Some of the provisions that UnitedHealth aims to keep include an insurance cover for children until the age of 26, as part of their parents insurance plan.

Additionally, the company will carry on providing preventive health care services without charging co-pays. A co-pay is a type of plan wherein the insured has to pay a specified dollar amount for the service availed, while the insurer pays the rest.

The health insurer is of the opinion that chopping off the co-payment clause from the plan will make preventive services more attractive to the members. These services, which include yearly medical checkups, testing for high blood pressure and standard immunization, go a long way in lowering member health care costs.

UnitedHealth also announced elimination of lifetime dollar limits on benefits received by members. Until the Health Care law was proposed, many health insurance policies used to carry a lifetime dollar limit clause. As per the clause, the enrollee would pay for the benefit, over and above the limit set up in the plan. This would often result in bankruptcy for members suffering from serious illness.

Moreover, if the policy holder crossed the lifetime dollar limit, they would get no further coverage from their health insurance plan. They were also shunned insurance coverage by other insurance companies, owing to pre-existing condition limitations.

UnitedHealth also announced that it would not rescind individual coverage policies, except in case of fraud. Prior to the Health Care Reform, insurers would defensively rescind coverage if an individual fell sick. This policy of insurers to save their claims money attracted national attention.

UnitedHealth also assured its members necessary support and assistance when they sought to appeal against an unfair decision made by the insurer. The insurer would provide its members an external appeal process, wherein the members will have a right to appeal against the denied claim to an independent reviewer. External appeal processes have been successful amongst consumers.

UnitedHealth has indeed taken a very bold step, which reflects a change in the conduct of the insurer. The move will ensure increased accessibility and affordability of health insurance for its members. The initiative will strengthen consumer and patient rights as well. Since UnitedHealth has already made a start, we expect other health insurers like Aetna Inc. (AET), CIGNA Corp. (CI), WellPoint Inc. (WLP) and others to soon follow suit.

Read the Full Research Report on WLP

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Good News for UnitedHealth Members

WASHINGTON--(BUSINESS WIRE)--

Department of Veterans Affairs clinicians offer a comprehensive review of the health concerns of Iraq and Afghanistan Veterans and practical management guidelines for primary care providers in an article entitled Post Deployment Care for Returning Combat Veterans, and published in Journal of General Internal Medicine (JGIM).

We at VA are always seeking ways to improve the quality of health care we provide to our Veterans, said Secretary of Veterans Affairs Eric K. Shinseki. This article provides valuable insight into the fastest-growing segment of the Veteran population at a time they are currently returning from combat.

Since September 11, 2001, approximately 2.4 million military personnel have deployed to Iraq and Afghanistan. The health care needs of this particular patient population are complex, and require a well integrated interdisciplinary approach to care.

The article, written by Juliette F. Spelman, MD; Stephen C. Hunt, MD, MPH; Karen H. Seal, MD, MPH; and Lucile Burgo-Black, MD, reviews how combat deployments can impact the physical, psychological, and social health of Veterans and describes their unique health care needs. This includes the need for assessment and management of injuries associated with blast exposures (including mild traumatic brain injury) as well as mental health conditions such as posttraumatic stress disorder, depression, and substance abuse.

Other important health concerns discussed include chronic musculoskeletal pain, medically unexplained symptoms, complications from environmental exposures, heightened suicide risk, sleep disturbances, and impairments in family, occupational and social functioning.

The article summarizes evidence which supports elevated frequencies of physiological and behavioral cardiovascular risk factors, including hypertension and tobacco use, raising concerns about future health implications for these Veterans. In light of relationships between physical, psychological and psychosocial concerns in this population, the VA authors recommend an interdisciplinary approach to care directed toward mitigating the long-term health impacts of combat.

This comprehensive review by VA clinicians will help both VA and non-VA health providers offer Veterans the best possible care as they return from combat deployments. It affords all involved the opportunity to develop greater collaboration between VA and community providers to insure optimal post-deployment care and services for our returning combat Veterans and their families.

Each VA medical center has a highly specialized Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Care Management team in place that coordinates and oversees transition and care for OEF/OIF/OND Servicemembers and Veterans. A dedicated case manager is assigned to work with the Servicemember/Veteran and family to screen for case management needs and implement a plan of care to completion, or as long as needed.

JGIM is the official journal of the Society of General Internal Medicine. It promotes improved patient care, research, and education in primary care, general internal medicine, and hospital medicine. Its articles focus on clinical medicine, epidemiology, prevention, health care delivery, curriculum development, and some non-traditional themes. JGIM offers early publication on http://www.SpringerLink.com to reach a broad audience,with online access to abstracts and full articles rapidly growing each year. Learn more about JGIM at http://www.sgim.org/go/jgim.

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VA Medical Article Discusses Specialized Iraq and Afghanistan Veteran Health Care Needs

Dave Chase??is CEO of Avado, which provides patient relationship management systems for healthcare and is a member of White House Roundtable on Patient Access to Data. ? The biggest mega-trend in healthcare is a shift towards fee-for-value from what some call the ?do more, bill more? era of healthcare that is bankrupting governments??and impacting business? ...

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Pioneer Health Care Organizations Share Lessons Learned and Challenges Ahead

LOUISVILLE, Ky.--(BUSINESS WIRE)--

With a U.S. Supreme Court ruling on the Affordable Care Act also known as the federal health care reform law expected later this month, Humana Inc. (HUM) issued the following statement:

Humana has long said that all Americans deserve affordable, quality health care and that our nation needs a health care system that works for everyone. Regardless of how the U.S. Supreme Court rules on the federal health care reform law, Humana is committed to keeping in place important patient protections contained in the law, including health care reforms restrictions on lifetime limits, rescission standards, appeals and external review processes, coverage for dependents on family plans to age 26, and preventive services with no cost sharing.

Humana believes its health plan members should have the peace of mind of knowing the company embraces and will maintain these common-sense provisions that add stability and security to health care coverage.

Specifically, Humana will maintain these health care reform provisions:

Humanas pledge to preserve these protections applies to its fully insured commercial health insurance policies. The company will also work with its employer clients that self-insure their health benefits to emphasize the importance of the continuity of policies and coverage.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

More information regarding Humana is available to investors via the Investor Relations page of the companys web site at http://www.humana.com, including copies of:

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Humana to Voluntarily Preserve Key Health Care Reform Protections

UnitedHealthcare and Humana, two of the nation’s largest health insurance companies, will keep major and popular parts of President Obama’s health care initiative regardless of how the U.S. Supreme Court rules.

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Health Insurers Will Keep Parts of 'Obamacare,' Regardless of Court Ruling

UnitedHealthcare, the nation's largest health care insurer, commits to keeping some key mandates regardless of Supreme Court's impending ruling on health reform.

NEW YORK (CNNMoney) -- The nation's largest health insurer promises to continue offering some key mandates of health care reform -- such as coverage of adult dependents up to age 26 -- regardless of how the Supreme Court rules on the health care law.

The Supreme Court, which is currently debating health care reform, is expected to announce its ruling later this month. Industry experts say the Court could uphold the law, overturn the law completely or overturn just some provisions of the law.

Ahead of the Court's decision, UnitedHealth Group (UNH, Fortune 500) said it will uphold several mandated provisions that have already gone into effect since health reform passed in 2010.

Among them, the insurer said it won't charge co-pays for preventive services, won't impose lifetime dollar limits on members' policies and will allow members to add their adult children up to age 26 to their plans.

The company -- which covers 38 million people -- also said it won't rescind insurance coverage of individuals who become ill, except in cases of fraud.

"The protections promote broader access to quality care and contribute to helping control rising health care costs," Stephen Hemsley, CEO of UnitedHealth Group, said in a statement.

"These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue," he said.

UnitedHealthcare's decision, though, does not apply to large employers that self-insure and use the company only to manage their health plans. Most Americans are insured in such plans. In those cases, it's up to the employer whether to abide by the mandates.

Also, UnitedHealthcare did not commit yet to standing by another key mandate which has gone into effect -- offering coverage for children up to age 19 with pre-existing conditions.

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UnitedHealthcare to keep some health care mandates