Health Care Fraud – The Perfect Storm

Today, health                       care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or   touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

– “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

– The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

– The National Health Care Anti-Fraud Association   reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges.  web-site]  was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David  , professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from   – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated    and services rendered  . These codes are used when seeking compensation from   for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs   not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed,   of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased   and post-payment audits of selected providers to detect fraud, and have created  and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act   . It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse.  purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.


Overgrown Nails


Overgrown Nails

Long nails may mobile grooming be a fashion in females but when it comes your four legged companions it is totally opposite. Overgrown nails cause lots of discomfort and at times are quite painful. With the long nails growing in the paw pads, it causes infection. Along with this, long nails can cause your pet’s toes to bend and create a walking deformity.

Grass Seeds

If you are not up to the date with your pet grooming, it is not easy to detect grass seeds on your furry pal. Undetected grass seeds can cause abscesses and other severe skin problems. Many cases exist that prove that a pet loses an eye from a neglected grass seed.

Fleas, Tick and Mites

When not grooming timely, pets become the host to some of the most common parasites – fleas, ticks and mites. These blood sucking parasites can be fatal to your pet and they usually thrive on untreated and dirty bodies.

Dental Problems

Lack of dental care opens up different oral issues including bad breath, teeth loss, tartar formation, reduced appetite, and if not treated can even lead to organ damage to your pet’s heart, liver and kidneys.

All these health problems are mostly connected to lack of grooming regime in pets. They are quite detrimental to pet’s physical as well as mental health due to discomfort and pain. By inculcating grooming regime on the regular basis you can support your four-pawed companion to lead a physically fit and mentally strong life. Therefore, it is necessary that you start tending your pet’s grooming needs for their overall wellbeing.

Taking care of two spaniels and one bulldog, I have realized that lack of grooming brings in lot of issues and it is necessary to maintain pet health and hygiene. Learning how grooming is so essential for our furry pals, here I have shared my experience related to pet grooming.


check out the stores today

If your marketing team has suggested that you need to participate in an exhibition to order to create awareness of your company products and services then go ahead and grab this opportunity. It is an excellent way to create awareness amongst potential customers who in the long run can become your customers as well. In order to make the right impression, opt for trade show exhibit design so that you can display your company products and services in the most effective way. The best part about these items is that you can use images as well as texts of your choice. As these items are customizable, you can easily ask the graphic designer to create them as per your requirements. Say for example your company is into manufacturing of organic skin products. What do you think will attract the customers? Definitely the image of a flawless, beautiful woman who is promoting your products will be more alluring. If you merely use the image of your products do you think the same impact will be created? So you need to know what images to use and how to use them. It is here that the creativity of your marketing and designing team will come into effect. Just because you have the trade exhibits at disposal does not mean that you can use them in any way possible. Try to make the best possible use of the items so that the desired impact is achieved.

Many of these exhibits are available on rent while there are many that you can purchase as well. It is best if you buy these exhibits because it will be a onetime investment and you will be able to use it for several years down the line. Why take the hassle of hiring them on rent on every occasion? Opt for the portable trade show displays that you can easily fold and store it away when you don’t need it. Make sure that the material used is of high quality and that it will not develop cracks or chips on the long run. Otherwise, you will have to buy another one. High quality makes sure that the product will be long lasting and effective.

There are many online stores that deal in them. So why don’t you browse through them to find the one that you are looking for? They come in different shapes, sizes and rates. You can take your pick as per your requirement and specification. Take into account the cost involved as well. Don’t forget to check out several stores as you will be able to compare the rates and the varieties available. So what are you waiting for? Go ahead and check out the stores today only. Since, you have decided to purchase trade show display graphics there is no point in wasting time. After the exhibition is over, store these items in a proper place so that the next time another exhibition is round the corner, you can take them out and use them again. So store them properly till the next time.



Training Design, Facilitation and Evaluation

According to the Mastery Teaching Model designed by Dr. Madeline Hunter of UCLA, trainers make three decisions: (1) what content will be taught, (2) what the learners will do to learn and demonstrate their learning, and (3) what the trainer will do to create a positive and motivational learning environment.

The number six occurs during each of these decisions.

Within the content decision:


  • There are six basic steps in the design of a lesson plan for a training program:


(1) conduct a needs assessment to determine if training is needed and, if so, what needs to be covered and who needs to be in the target group.

(2) identify the learning goals: what general content will be covered in the program and what benefits of attending the training will accrue to the target group from their perspective.

(3) create the learning objectives, which identify in specific, observable and measurable language: what the participants will learn, what level of learning will be necessary, and how they will demonstrate that they have learned it.

(4) outline the agenda, which involves grouping contiguous learning objectives that share a commonality into discrete modules. The titles of these modules will comprise the training agenda.

(5) select the learning activities, making sure that they will achieve the desired learning levels, provide variety and meet the needs of different learning styles.

(6) plan how to evaluate if learning has occurred during the training. This may involve observing the results of learning activities during the training as well as any quiz at the end of the training session.



Physician Retention – Get a Plan!

Physician recruitment               and retention is becoming increasingly difficult each year. More hospitals, group practices, and managed care work harder to recruit and retain the best and brightest physicians. As competition continues to grow, we are seeing more aggressive physician relations programs to strengthen relations with physicians. With 84% of the hospitals and thousands of group practices and most managed care companies in America recruiting, many feel it has become a recruitment war. (In 1999, with 6000 physicians graduating from Residency programs, there were over 18,000 practice opportunities available.)

Direct recruitment costs average $30,000 per physician (This does not include relocation expenses). Additionally, the following costs associated with physician turnover should be considered:

Patient Access
Patient Turnover
Gross Billings Lost
Inpatient Revenue Lost
Referrals Lost
Average annual turnover was 6.4% for all medical groups responding to the survey conducted by the American Medial Group Association – 5.2% for medical groups with more than 500 physicians and 6.9% for those with less than 500 physicians.
Causes of Provider Turnover

It is rare for a provider to have experienced one catastrophic event that causes them to seek other employment. Most typically, it is a combination of several things that build over time.

Typical causes of turnover:

Lack of or “bad” chemistry with the partners (#1 reason nationwide)
The practice didn’t    their professional needs (i.e. multi vs. single   group, group too big or too small, etc.)
The practice was different than expected (i.e. longer hours, weekend hours, evening hours, outreach expected, in-patient duties expected, number of patients seen per day, etc.)
Absence of feedback during the critical time of the honeymoon
Desire to be closer to family
The physician and family never become a part of the community
The physician and/or spouse never became comfortable with the environment
Lack of control over their practice (i.e. Scheduling, referral   being excluded from the decision making process, etc.)
Lack of two-way communication
Lack of appreciation
The feeling of abandonment.
Physician Retention Begins During Recruitment
Physician retention really begins early in the recruitment process. Retention efforts that should be included during the recruitment/interview process include:

Screening candidates for the best all around “fit”
Establishing mutual expectations during the interview & reiterating these before an offer is made (i.e. Patient load, call schedule, committee time,  to a full practice, etc.)
Ensuring that candidates know exactly what to expect
Screening the Spouse for career objectives or requirements
Integrating “retention” into the interview process. Communicating to candidates upon interview that one of the primary goals of the recruitment process is retention
Justification for a Three Year Plan
The highest turnover is during the first three years on the job among well-paid professionals in all industries, including medicine, and is especially high during the first year. To retain the highest percentage of new physicians,   should plan to work with them for three years.

Continue to build relationships with the physicians
Help them adjust professionally & develop their practices
Help them adjust personally to their new environment
The key to physician retention is to maintain regular contact with physicians and their spouses to stay abreast of how they are adjusting, and to anticipate any problems that may develop. The most critical element in any retention plan is a mechanism to “check in” on the physician’s expectations.
Recruiting cannot be considered completely successful until the physician is on staff and productive to the point of providing a service to the community and producing enough revenue to pay back recruitment. Therefore, the recruitment function should include responsibility for seeing that the physician and his or her family are not only recruited, but are successfully acclimated to their new location.

At all times you should keep in mind the needs of the physicians’ spouses and families because frequently physicians’ satisfaction depends on their families’ adjustment.




Dental Marketing Online

There are numerous approaches to add internet advertising to your dental promoting plan. The web is the preeminent commercial center for a wide range of plans of action. It is critical to do probably some internet showcasing for your dental business. Here are a few hints for adding dental promoting on the web to your dental advertising plan.

Make Several Dental Websites

One thought for dental promoting on the web is to make a few sites to guarantee that you are getting however many guests as could be allowed. One fundamental webpage for your dental business is acceptable however you additionally need to incorporate subject explicit sites to stand out enough to be noticed for your particular dental administrations. This could incorporate separate destinations for corrective dentistry, oral medical procedure; everything relies upon what you offer. Departmentalize your dental administrations and make a different site containing data relating to each. At that point connect back to your principle dental business site from these more modest destinations.

Make Quality Dental Websites

It isn’t sufficient to simply slap up a dental site, let it proceed to believe that to be your dental showcasing on the web endeavors. It requires some investment and energy to acquire new patients from your online endeavors. You need to ensure that the entirety of your dental sites seem proficient and superior grade. On the off chance that they don’t, patients will be killed.


Learn SEO Techniques

Website design enhancement represents site improvement, and with regards to dental showcasing on the web, SEO is a fundamental fixing. Utilizing an assortment of SEO techniques will assist with guaranteeing high rankings for your dental sites on web search tool data sets. High rankings equivalent more patients. It is imperative that you become familiar with everything you can about SEO and you utilize this data to advance your dental site substance as well as could be expected.

Add Blogging to Your Dental Marketing

Making a blog to promote your dental site is a significant and consistently developing technique for getting patients for your dental business. You can make a dental blog and even get your own space name for about $20 per year. You can without much of a stretch source out the composition on the off chance that you are not a decent author. There are many independent locales that will assist you with finding gifted essayists who will accomplish this work at you at low costs.

Add Email to Your Dental Marketing

An email publicizing effort is an extraordinary method to advance your dental business. Start with current patients yet in addition attempt to acquire email addresses on your dental site for expected new patients. Make a bulletin and mail it out month to month, depicting every one of the dental administrations you offer and every one of the manners in which that your dental business is remarkable.

Dental Marketing Through Online Advertising

Publicizing is similarly as essential to the web for what it’s worth to this present reality. The most ideal approach to add internet publicizing to your dental showcasing plan is by getting connections to your sites from other high positioning locales. You can do this utilizing web-based media outlets, contributing to a blog, viral recordings, and even compensation per-click administrations. These are basically free except for pay-per-click administrations. Pay-per-click administrations will maintain your dental business promotion on high positioning sites yet possibly charge you when somebody really taps on the site.

To stay up with the present innovative world, it’s significant that you add web based advertising to your dental promoting plan. Utilize these straightforward tips and you’ll be promoting your dental business online in the blink of an eye.


Replace Your Conventional Lights

Many people have been trying to replace their old lightening systems with LED lights. LEDs are innovative that looks really stylish and upgraded when installed in different rooms of houses, apartments and offices

There are many houses and offices that have these LED lights installed. There is no comparison between LED lights and conventional lights because the efficiency of LEDs is proving very well. It has been proven that small amount of these LEDs can illuminate a place better than a huge quantity of conventional lights. Today, people care more about savings. They want to save money in any way they can and when it comes to saving money, then what is better than these LED lights. LED flood lamps are a type of these LED fluorescents that are designed excellently. These LEDs have solved a number of problems of different people. These are best for illuminating a house or an office without much consumption of electricity.

They are perfect for saving money and energy. These lights are more powerful than any other conventional lights and they do not result in increasing electricity bills. In fact, they help in reducing monthly bills by saving electricity and providing more functions. Their quality is better and remarkable, as they work for a long period of time. There is nothing better than these LED lamps. They are a perfect source of providing white light that very efficiently brightens up rooms. Most of these LED flood lamps are found installed in different theatres, warehouses, playground and stadiums. These places have these LED lights because bright white lights enhance beauty of such places and people enjoy more their during night time in these bright lights. As compared to conventional lights, there are many advantages of white LED lamps. Some prominent benefits of them are:

* Long Life: As compared to other typical lightening systems, life of LED lamps is long lasting. They do not need replacing because they work for years and if ever any disturbance is found, these lights can be fixed anytime, totally free of cost. This benefit has actually attracted many people towards LED lights. In other words, these LED lamps last for more than ten times of conventional bulbs and lamps. Moreover, LED lights do not stop working at once, they give warning that their time is over and replacement is must, when they get dim gradually. This is how people get to know when to buy a new LED bulb.

* Free Of Carbon, Mercury And Lead: Different lights contain different emissions that help in producing light. These compounds are very harmful for health of people. LED lights are totally free of lead and mercury; this is why people have been using LED bulbs in their homes for maintaining healthy environment in their house.


The Fourth Generation of Lighting

During the human history, the first generation of Lighting is very primitive oil lamp (candle), the second is the incandescence bulb invented by Edison, the third is fluorescent lamp. Now here comes the revolutionary fourth generation of lighting – white LED which is expected to dominate the lighting market in the next ten years

Since Nick Holonyak from GE invented the first visible LED(GaAsP), at the 60s of last century, red and green LED born, followed by yellow at 70s, green at 90s. Green LED plus yellow fluorescence material emits white light. Thus, LED applications are expanded from traditional display to most promising general lighting-to replace the incandescence and fluorescent lamp. With the unparalleled advantages of energy efficient, long longevity, fast response, LED is becoming more and more popular in the lighting market.


The semiconductor wafer can’t emit any lights before being packaged in a bullet form, so the market is composed of two parts , EPI-Wafer and packaging. According to statistic, in 2005 the value of encapsulation has increase 11.4% to $6.7 billion. Japan is the largest LED production country on the world, accounting for 46% of the world market, followed by China Taiwan with 17%. It’s estimated in 2008, the value of world packaging market will be up to USD 9. 1 billion, average increase rate 10.9%.

As another statistic’s anticipation, the global requirement of white LED is around 4.5billion pcs, as of 2008, the figure will increase to 9.8 billion which more than doubled, average increase rate closed to 30%. From that We can see how large the market potential is. The biggest application now is mobile phone, having 68% market share at 2005. Due to cell phone market is being saturated, growing slowly, it’s still the top application at 2008, but its market share fall down to 40%, while application for automobile and lighting achieve faster growth, from 10% to 22% and 2% to 15%, and for LCD TV and PC, up to 7% and 6%.

According the study of Nomura Research Institute, because the high demand for mobile phone in developed country have passed, the growth rate will slow down, along with the price of white LED decreased significantly result in the white LED market growth calculated by turnover is far less than by quantity, however its still expected in 2005~2010 there is 10% of average growth rate, from $1.74 billion to $2.84 billion. The driving force is from white LED back light source required for large dimension LCD screens and car equipments.

Manufacturing techniques of white LED are mainly held in the Japanese company which occupies 72% of whole market. Amidst of that, Nichia solely accounts for 41.2%, Citizen accounts for 17.8%, OSRAM OPTO 13.7%, Toyota Gosei 12.9%. Seeing the promising market, through research and development and production cooperation, many western companies including Fairchild, Agilent and Korean and Taiwan companies get involve in LED market make the competition fiercer. Not only will Nichia’s market shrink, but through all sort of rearrangement, some new manufacturing companies will arise.


In the recent two years, white LED is mostly applied for mobile phones, digital cameras, portable game consoles as the back light source. As per the stat of 2004, the application extent is very high, mobile phone 69%, digital camera 67%, digital camcorder 80%, portable game console even reach 100%. High end digital cameras and camcorders’ view fetcher and replay monitor require high quality images, so it is required to use as back light source.



LED TV Facts

LED TVs are a fast growing technology. There is a misconception regarding these TVs. Many people are led to believe that they are purely LED lit. However, these TVs are next generation LCD TVs with LED backlighting. If you want to buy an LED television, here is some advice for you infohatworld

The first thing you need to consider is the type of LED backlighting used on the TV. LED television’s employ two types of backlighting, edge lighting and full LED lighting. Edge lighting involves the use of LED lights along the screens outside edges. Full LED lighting on the other hand involves the use of LED lights placed behind the whole LCD screen.

Secondly consider the display factors you desire. LED televisions offer better display than ordinary LCDs and viewing angles that rival those of plasma TVs. Therefore, it is up to you to decide which between the edge lit and the full LED lit TV to buy. With regards to display, it all comes down to how bright or dark the picture can be. Edge lit LED televisions are at a disadvantage as they tend to be brighter along the edges and darker towards the center.

Thirdly, consider the size of the LED TV’s. These televisions are generally sleeker than ordinary flat screen TVs. However, the edge lit LED televisions can be three times thinner than LCD televisions. The use of edge lighting technology enables these TVs to be sleeker. Therefore if you don’t mind losing some control over how bright or dark your pictures should be, edge lit LEDs are the best option.

Also with regards to size, you should also consider the screen size of the LED. Apart from aesthetic purposes, you should also consider the size of the room where the TV will be placed. A large LED TV works best in large rooms. This is to create a balance as well as prevent eye strain.

The fourth thing to consider is the power consumption of the LED TV. The use of LED lighting makes these TVs energy efficient. However, you should shop around comparing the energy consumption among the different models.

Fifth, you need to look at different brands before making the buying decision. Brands of LED TV’s determine factors such as the cost and quality of the TV. It would help a lot if you take different brands and compare them. When comparing, consider some features like the size, viewing quality, extra features like wireless connectivity and price.

Sixth, consider your budget. The prices of LED televisions have been dropping since they were introduced in the market. As mentioned, there are many factors which determine the price tag on an LED television. With a little research, you are likely to find LED TV’s to match your budget.

Finally, consider the life expectancy of the LED TV. The life expectancy of LED TVs is calculated in hours. For these TVs, it means the time it takes for the LED lights to start dimming. If you expect to use your TV for long,



Hands Down The Best LED Light

LED light therapy (light emitting diode) is sky rocketing in popularity and only shows signs of exploding ever further due to the effectiveness and safety of this advanced technology. This therapy has been shown to significantly improve the skin and ease pain without drugs, downtime, or pain. It’s a viable alternative to more invasive treatments without the risk LED Display

There are a number of exceptional systems designed for home use that are FDA cleared and put the power of caring for you in your own hands making it convenient and affordable!

There are also a number of cheap versions on the market that use low quality LEDs and don’t produce the results expected with this technology.

You and your skin are priceless and purchasing a high quality LED light therapy system is an investment in your confidence and self-esteem. It’s an investment that will last for years and years to come and help you look and feel amazing!

When looking to purchase a unit for yourself or a loved one, you will want one that is FDA cleared and utilizes proven wavelengths measured in nanometers, high quality LEDs, along with a solid warranty.

I am extremely passionate about this therapy and have tried and currently use a variety of systems giving me a unique perspective as to which systems really work, are easy to use, and are worth the investment. The following units are, in my opinion, the best and most effective units I have tried.

1. DPL Therapy System

The DPL Therapy system is probably the most versatile system on the market as it has the ability to improve the skin as well as ease pain and accelerate healing. It’s FDA cleared, uses high quality LEDs, and the powerful wavelengths follow NASA protocol.

The removable large panels allow you to treat your entire face at one time as well as treating any pain issues on other parts of the body.

Facts about the DPL Therapy System


  • 2 large removable panels that can be used on a stand or separately
  • 154 infrared LEDs at 880 nanometers
  • 20 red LEDs at 660 nanometers
  • 1 year warranty


Treatment time:

The DPL Therapy System runs for 17 minutes and then shuts off automatically (it beeps once every minute)

2. Baby Quasar PLUS and Quasar MD

These two powerful handheld systems are designed with exceptional quality and have an unheard of lifetime warranty. It’s said that the Quasar light therapy systems are 4 times more powerful than other systems and utilize the same power as professional medical devices.

Both the Baby Quasar PLUS and the Quasar MD contain 4 wavelengths and use super luminous LEDs (the highest grade LED available.)