Thomas Hamilton Live on February 16th, March 4th, and March 25th.

Presenting:

“Taking Control in a Perfect Storm” 

Recession, Mandates, Regulations, Scrambling for Business, Uncertainty, Health Care Reform (all over the place), Rising Cost and Out of Control Spending.
 
The Perfect Storm is upon you and your clients.
 
It is time for businesses to take back control.   
 
In 2010, Employers will fall into one of three categories:
Employers with a group health plan that are looking for a broker with a new solution
Employers who have a group health plan that can no longer afford it
Employers who do not have or want to offer health benefits

On Tuesday I will discuss each category of employers in more detail.  One of the ways to take control is through your health benefits program.
March 1st, 2010, Zane Benefits will have a solution for each type of employer: 
Please join us Tuesday February 16th, March 4th, or March 25th 11:30 to 1pm,  when our Lunch & Learn Summit presents “Taking Control in a Perfect Storm!”   It is an hour and half of pure solid info to help you and your client’s business.   We hope you can attend.  If you can’t attend, please pass this information along to someone who may benefit from this Seminar.

You can Register on line at www.e2BeneFlex.com or reply to this email.    

 Looking forward to seeing you there!
 
In Your Service
 
Employee Choice    Employer Control     Better Benefits
 
Thomas E. Hamilton
Thomas (Tom) E.  Hamilton
President, Carolina Benefit Designs, Inc.
5960 Fairview Rd, Suite 400
Charlotte, NC 28210
Office: (704)375-1112 I Fax: (704)375-1113 I Mobile: (704) 453-6429
thamilton@e2beneflex.com
www.beneflexhra.com

Many of you have asked me what I thought was going to happen with the Healthcare Reform Bill now that Scott Brown was elected.  Below, is an update that I just received from a very reliable source (William R. Boyles, Interpro/HPM) out of Washington D.C.  As we all know things can change in Washington.  Nothing is definite, but it looks promising that at a minimum, this will get everyone hopefully to rethink what is truly needed for healthcare reform for our country.

In the meantime, there are still many businesses, especially the smaller ones, which are faced with continued increases in their health insurance plans along with pressures from taxes, laws and the economy.  Our goal at CBD will continue to bring businesses an innovative and exciting alternative with our e2BeneFLEX program.  In the coming months we will be making a big push to make an impact.

I hope you will join me in making a big difference for employers and their employees in having control in just one area of their business.

In Your Service,

Tom Hamilton

HealthPlanMarkets       January 21, 2010

Update: All Reform Dead For 4 Years

All health reform legislation appears to be delayed by at least four years following the failure of Democrats to take a final vote on the Obama Administration proposal that passed both House and Senate, HPM is now predicting based on events in the past 24 hours. The political window which allowed reform to proceed has closed.

This amounts to the third time since the late 1970s that liberal Democrats have killed national health reform. But the dramatic last-minute failure in 2010 is totally different because there is not much debate over which last-minute objections delayed final passage: the tax on Cadillac plans and abortion. If the White House had brokered a deal Obama would be signing a bill this week.

In yesterday’s email alert we suggested a compromise was still a possibility in 2011 after the mid-term election. We are now revising that to predict that no health reform will pass during the entire first term of the Obama Administration. Discussions continue on Capitol Hill over two very unlikely options: reconciliation and scaling down the bill and going through the process all over again.

© Interpro Publications Inc. 2010

January 13, 2010

The IRS Should Fix Itself First

By Steven Malanga

I nearly fell out of my chair laughing when I read the dozens of news stories that appeared recently describing the Internal Revenue Service’s new effort to cut down on errors and fraud by clamping down on tax preparation services. With their typical credulity, reporters at newspapers across the country, quoting IRS statistics and the agency’s aggressive new commissioner, Doug Shulman, painted a portrait of taxpayers victimized by ill-informed tax preparers whose mistakes cost ordinary folks big-time penalties and interest payments.

What none of these gullible stories mentioned is that the IRS itself answered incorrectly about 2.5 million tax and account queries last year, according to the Government Accountability Office (the number would have been even higher except that only 70 percent of those who called the IRS looking for tax advice managed to get through to a real person). Nor did any of the stories note that the agency annually sends out probably millions of incorrect notices and assessments, or that the IRS has significant administrative problems that affect its performance, such as the one uncovered by a GAO study in December which found that in 78 percent of cases the agency awarded Individual Taxpayer Identification Numbers (issued to those who don’t qualify for Social Security numbers) to people who weren’t eligible for them. And then of course there was the report last October from the Treasury Department’s Inspector General noting that more than 100,000 people who applied for the first-time home buyers tax credit were ineligible and probably scammed the IRS out of as much as $500 million, which the agency would have to go try and chase down.

Most of these facts rarely make it into the press (the housing credit fraud was one of the most underreported stories of 2009 in my humble opinion), which is one reason why when the IRS outlined how it plans eventually to license the nation’s tax preparers, no one in the press seemed to pause and wonder whether there aren’t underlying problems with our tax code and the politicians who design it which have created the mess that the IRS is now trying to solve with its heavy hand.

Shulman’s aggressive stance is reflective of a default position in Washington which holds that there is massive tax noncompliance among Americans which, if we can just stamp it out, will yield hundreds of billions of dollars in new revenues. It’s a position that ignores the role that the extraordinary (and still growing) complexity of our tax system plays in what the IRS and others view as noncompliance, which is often just confusion or disagreement about what Congress intended. And it’s a position which consistently ignores the inability of even the IRS to deal with that complexity and with the many tasks that Congress keeps assigning to it. Indeed, there’s no greater indication of how clueless Congress is in this respect than that current health reform legislation assigns the IRS responsibility for monitoring who has, and doesn’t have, insurance, and for assessing penalties. As questions mount from taxpayers, who have become ever more confused about our tax code, just look at how difficult it has become to get through to the IRS now and imagine what nightmares the new health care law will present.

There’s little question that our tax code is now far too complex. Some 80 percent of households now use tax preparers or tax software to figure out their returns, and collectively we spend 7.6 billion hours on tax compliance, according to the IRS Taxpayer Advocate, at a cost of nearly $200 billion annually. From 2001 through April of last year, Washington initiated 3,125 changes to the tax code, or more than one a day.

None of this is par for the course. Around the rest of the world, countries have been simplifying their tax code by flattening out rates, eliminating deductions and ending tax credits. One recent study ranked the U.S. tax code 122nd in complexity among 175 nations worldwide.
Our politicians have created this mess because rather than use our tax code for what it was designed, that is, to raise revenues, they now wield it as an instrument of social policy. Every politician whose campaign platform includes goals like increasing home ownership or lessening the financial burden of college tuition or encouraging more energy efficiency wants to do it through the tax code. Tax credits are also a way to reward donors and lobbyists for friendly causes.

But ultimately the complexity of this approach befuddles not only taxpayers and preparers, but even the IRS. One example is the mess created by the alternative minimum tax, which eliminates deductions for some filers as their income rises. Originally intended just to apply to the richest Americans when Congress enacted it in 1969, the tax, which for years wasn’t indexed to inflation, now hits a few million households and is so complex that it has proved a nightmare even to the IRS. Several years ago, for instance, the IRS erroneously tried dunning thousands of people for additional taxes under the AMT because the agency miscalculated the complex interplay between the tax and state taxes. Accountants noticed a pattern and reported it to the IRS, which admitted to at least 21,000 letters sent mistakenly requesting additional taxes.

Given the complexity of the code, it was with a special amount of hubris that only Washington could display that Congress enacted something called an “accuracy-related penalty” provision in the IRS code. Under this provision filers must pay a penalty for mistakes on their returns for in addition to interest penalties on back taxes they owe. Of course, the government pays no such penalty when it mistakenly duns you for taxes that you don’t really owe.

But the situation will only get worse because Americans both inside and outside of Washington and across the political spectrum now seem to accept as inevitable increasing tax complexity and the cost it brings. And so, for instance, in its 2009 audit, the GAO actually deemed it a ‘highlight’ of the IRS performance that the agency answered correctly nearly 93 percent of tax queries, as if it’s acceptable that the agency which is supposed to be the ultimate arbiter of our tax laws gets more than 7 percent of questions about its own code wrong. And of course, much of what the Obama administration and Congress are now proposing in the way of fiscal policy, from energy tax credits to health reform legislation, will only make the code even more complex because this Congress and this administration seem even fonder than recent ones of using the tax code as a vehicle for social policy.

As a result, to fix a problem that is largely its own creation, the government will now add a layer of licensing and oversight to the tax preparation business, the cost of which the IRS commissioner naively says will be borne by the preparers. Not surprisingly, many of the stories I read about his proposal quoted local tax preparers who approved of the commissioner’s move, which alone should make journalists skeptical. (Memo to newspaper reporters: The next time someone tells you he supports more regulation of his industry, Google the term “rent seeker.”)

Unfortunately, there is not much of an ‘tax simplification” constituency out there, so that even when the winds of political change blow again, it’s likely we’ll just get a whole new set of politicians looking to use the code to advance their causes. Even the so-called Tea-Party movement, with its strong anti-tax bias, is heavily focused on cutting taxes when, in truth, simplifying our tax code would probably produce the same benefits as knocking a few points off tax rates.

 Steven Malanga is an editor for RealClearMarkets and a senior fellow at the Manhattan Institute

http://www.realclearmarkets.com/articles/2010/01/13/the_irs_should_fix_itself_first_97588.html

Provisions that take effect immediately upon enactment:

2010

 Insurance Regulations

• Prohibition on pre-existing condition exclusions for private insurance on the individual market.
• Prohibition on revoking insurance for patients who falsify applications to fraudulently obtain private insurance coverage (however, penalties for fraud against federal health programs are increased).

 Taxes

• “Annual Fee” tax on prescription drugs of $2.3 billion, allocated according to market share.
• New 10% tax on indoor tanning services effective July 1, 2010.

Other  

• New restrictions on not-for-profit hospitals.

 Special Favors

• Special tax benefit for BCBS organizations that maintain medical loss ratios of at least 85%.

 Medicare

• Physician payments decrease 21% effective March 1, 2010.

 Provisions that take effect six months after enactment

 Insurance Regulations

• Group and Individual policies issued after this date may not contain lifetime coverage limits, must provide first-dollar coverage for preventive care as defined by the U.S. Preventive Services Task Force, and must cover “children” of primary policyholders up to age 26.

 2011

 Taxes

• FSA plans limited to $2,500 per year (currently no limit).
• New limits on what health care can be paid for with FSA, HAS, and HRA funds.
• Deduction for Part D eliminated.
• “Annual Fee” tax on medical devices of $2.0 billion, allocated according to market share (rises to $3.0 billion after 2017).
• “Annual Fee” tax on health insurance, allocated according to share of total premiums. Begins at $2 billion in 2011, then increases to $4 billion in 2012, $7 billion in 2013, $9 billion in the years 2014, 2015, and 2016, and eventually $10 billion for 2017 and every year thereafter. Two insurers in Nebraska and one in Michigan are exempt from this tax.

 Medicare

• 10% Bonus for primary care physicians and general surgeons.
• Restrictions and substantial cuts to Medicare Advantage plans.

Medicaid

• Allows states to expand eligibility to 133% of the federal poverty line (FPL) for childless adults.

Other

• Private health plans must maintain a “medical loss ratio” of at least 85%. Failing that, they may rebate policyholders or increase medical expenditures. “Annual fee” tax does not count toward this ratio.
• First phase of small business tax credit for certain qualified small employers.

 2012

 Taxes

• “Annual Fee” tax on health insurance increases to $4 billion.

 Medicare

• Payment penalties for hospitals with the highest readmission rates for selected conditions.

 Other

• Health insurance company employees may not be paid more than $500,000 per year.

 2013

 Tax Increases

• “Annual Fee” tax on health insurance increases to $7 billion (does not count toward the required 85% medical loss ratio).
• 40% excise tax on health insurance premiums above $8,500 (individual plans) or $23,000 (family plans). Higher thresholds apply to the 17 highest-cost states until 2015, and indefinitely to retirees over age 55, and employer-provided plans for certain professions. This tax does not count toward the required 85% medical loss ratio.
• Itemized deduction for out-of-pocket medical expenses is limited to expenses over 10% of AGI (currently 7.5%); those over age 65 can use the 7.5% rate until 2016.
• Medicare tax increased from 2.9% to 3.8% for incomes over $250,000 (joint filers) or $200,000 (all others). (This is stated as an increase of 0.9 percentage points, to only the employee’s share of the FICA tax.)

 2014

 Primary health reform takes effect:

 Tax Increases

• “Annual Fee” tax on health insurance increases to $9 billion (does not count toward the required 85% medical loss ratio).
• Individual mandate begins: Tax penalties for not having insurance begin at $95 or 0.5% of income, whichever is higher, rising to $495 or 1% of income in 2015 and $750 or 2% of income thereafter (indexed for inflation after 2016). These penalties are per adult, half that amount per child, to a maximum of three times the per-adult amount per family. The penalty is capped at the national average premium for the “bronze” plan.
• Employer mandate begins:

Other

• Strict federal regulation of health plan benefit packages, premiums, and rating rules for both Exchange-participating and employer-sponsored group health plans.
• Imposition of actuarial value restrictions (in addition to restriction on medical loss ratio in effect since 2011).
• Health Insurance Exchanges.
• OPM-managed plans for the general public (in lieu of public option).
• “Affordability Credits” to those with family income under four times FPL who do not qualify for Medicaid in their state.

 Medicaid

• Medicaid eligibility expanded to 133% of FPL for everyone under age 65 in participating states (such as Nebraska).
• All states except Nebraska must pay a share of the cost or drop Medicaid.

 2015

 Tax Increases

• Individual mandate penalty rises to $495 per adult ($247.50 per child), maximum $1,485 per family, or 1% of family income, whichever is higher (capped at the national average premium for the “bronze” plan).

 Insurance Regulations

• Limits on deductibles and copayments imposed on Exchange-participating and employer-sponsored group health plans ($2,000 for single plans, $4,000 for family plans, indexed for inflation in health insurance premiums).

 Medicare

• Establishment of Independent Medicare Advisory Board (IMAB) to recommend cuts in Medicare benefits; these cuts will go into effect automatically unless Congress passes, and the President signs, an override bill.

 Other

• Second phase of small business tax credit for certain qualified small employers.

 2016

Tax Increases

• 40% excise tax on health insurance premiums above $8,500 (individual plans) or $23,000 (family plans) applied to remaining 17 states.
• Individual mandate penalty rises to $750 per adult ($375 per child), maximum $2,250 per family, or 2% of family income, whichever is higher (capped at the national average premium for the “bronze” plan). After 2016, the penalty will be increased each year to adjust for inflation.

2017

 Tax Increases

• “Annual Fee” tax on health insurance increases to $10 billion (does not count toward the required 85% medical loss ratio).
• Itemized deduction for out-of-pocket medical expenses is limited to expenses over 10% of AGI for those over age 65.

 heritage.org

Thomas Hamilton Live on Dec. 16th.

Presenting

The New Way to Health Plan Freedom

Come see and learn for yourself at our corporate office located at: 

5960 Fairview Rd

 Ste. 400

Charlotte, NC 28210

704-375-1112

The New Way to Health Plan Freedom

Lunch and Learn Summit

from 11:30-1:00 pm.

This session is limited to the first 15 who register!

Reserve your seat today, have lunch on us and learn about the biggest Health Insurance breakthrough in the last 20 years.

Testimonials:

“We were captivated by this alternative after hearing about it.”

Jennifer Morgan – MGI, Inc.

“This may be the future of health insurance.”

Nick Trickolas – CEO, Ilios Parnters

“The biggest thing for us : No More increases!”

Helen Griffin – IT Pros

“After hearing about this program, I signed on.  With the plans to double the size of my company, I expect to still save at least $360,000 this year with the new program.”…”I had to worry about healthcare costs every year.  We are no longer in the Healthcare Business!”

Bret Berneche - Cardinal Homes

To register for this event please visit www.e2beneflex.com

Posted:

MINNEAPOLIS, Minnesota – Insurer UnitedHealthcare is trying to encourage people with diabetes to take better care – and to save themselves, and eventually their employers and the insurer, a lot of money.  
 
The Diabetes Health Plan goes beyond traditional diabetes wellness programs by giving patients financial rewards for taking routine preventive-care steps, such as having regular blood sugar checks, routine exams and preventive screenings, according to the Minneapolis health care insurer.  
 
These steps are aimed at improving patients’ management of their disease, which cost the U.S. economy $175 billion in 2007, according to the American Diabetes Association. The steps also get diabetic patients involved in their own care, which costs an average of more than $22,000 per person a year, according to the insurer’s data.  
 
“One of the best ways to control escalating health care costs is to encourage people to adopt healthier behaviors and take preventive steps,” said Dr. Deneen Vojta, senior vice president of UnitedHealth Group. But it’s impossible for people to live healthier — with the goal of managing or avoiding diabetes — if they don’t know they have the disease.  
 
While nearly 24 million people in the United States had diabetes in 2007, only one-in-four knew they had the disease, the association said. Another 57 million people were considered pre-diabetic –having higher-than-normal blood sugar but not high enough to count as diabetes. Again, about a fourth of pre-diabetics were unaware of their condition.  
 
The Diabetes Health Plan promises to identify people who have diabetes or pre-diabetes and then equip those who are identified to manage or avoid the disease, Vojta said.  
 
To get an idea of where to go with its benefits, UnitedHealthcare piloted its Diabetes Health Plan among three big employers — General Electric, Hewlett-Packard and Affinia Group this year. The employers liked the plan so much, they’ve renewed or expanded their participation for next year. UnitedHealthcare is rolling out the plan for employees of other large, self-insured employers on Jan. 1.  
 
“We’re definitely keeping it,” said Keith Clark, health and safety director for the Gastonia, N.C.-based Global Filtration Division of Affinia, a maker of after-market automotive parts and supplies.  
 
Diabetes Health Plan benefits vary by employer and can include some free diabetes supplies and prescription drugs, as well as lower co-payments for related doctor visits. The benefits could save patients up to $500 a year, UnitedHealthcare said. The plan also requires people with diabetes and pre-diabetes to be educated about the disease and its management.  
 
In addition to the cost savings offered by UnitedHealthcare, Affinia contributes $200 to a health reimbursement arrangement account (HRA) when an employee signs an agreement to work with a doctor to manage their diabetes, Clark said. The company contributes another $200 to the HRA account when the employee completes an educational program about the disease and its management. Another $200 is contributed if the employee complies with a schedule for tests, exams and other measures.  
 
“So that’s up to $600 you can get in your HRA account” per year, Clark said. Spouses of employees can earn another $600 for a total of $1,200 in contributions per couple, he said. Employees can pay medical expenses not covered by employers’ insurance with tax-free contributions to their HRA accounts.  
 
Money may not be the best way to encourage people with diabetes to live healthier, said Dr. Paul Robertson, president of Medicine & Science, the research arm of the diabetes association. “In my experience, the patients I work with typically are turned off if they’re offered money,” said Robertson, who does clinical research with patients who have diabetes. “They would rather do it because they would rather do it. Money spoils that.”  
 
Even pregnant women who develop gestational diabetes may not be motivated by money, Robertson said. But healthy people who have adult-onset diabetes in their families might take cash to change some behaviors to avoid developing the disease, he said.  
 
Dr. Randy Cebul, director of Better Health Greater Cleveland, applauded the health plan because it gets diabetic patients engaged with their doctors and their care. Better Health Greater Cleveland is an alliance of hospitals, doctors and health care organizations, agencies and insurers in Northeast Ohio committed to improving the health and care of people in the region who are living with chronic diseases, starting with diabetes.  
 
“Is this a novel idea? Yes,” said Cebul, who has several appointments in Greater Cleveland, including professor of medicine and director of the Center for Health Care Research and Policy. “I think it’s a good idea. I think physicians would like it. It makes patients part of the picture.”  
 
Cebul said there’s little research evidence to indicate that financial incentives motivate people who have diabetes. But the idea of using clever incentives to require patients to do better for themselves — and for things that the doctor can’t fix — is a good one, he said.

The United States Preventive Services Task Force (USPSTF) recently released new guidelines for mammography screening based on a review of the medical literature. As a result, the USPSTF is recommending that regular screening for breast cancer in women begin at age 50. The previously recommended age to begin routine screening was age 40.

Our coverage for mammography and cervical cancer screening is unchanged.

Mammograms

We consider mammography an important screening procedure, one that has resulted in the ability to detect and treat breast cancer at earlier stages of the disease and save lives:

UnitedHealthcare will continue to offer coverage of mammograms for women covered by a UnitedHealthcare insured plan when recommended by their physicians.  

Customers with a self-funded plan may modify coverage based on the recently reissued guidance but must provide us with specific instructions prior to the implementation of any coverage changes. However, we strongly recommend customers follow our policy and continue with the coverage for mammography unchanged. 

Cervical Cancer Screening

In addition, the American College of Obstetricians and Gynecologists (ACOG) recently changed its recommendations for cervical cancer screening, advocating less frequent screening for women in their 20s. However, UnitedHealthcare is not changing its coverage policy on cervical cancer screening. As is true for mammography, we recommend that women discuss with their physicians how frequently they should undergo cervical cancer screening.

An employee communication template outlining this issue is included for you to use with your employees, as appropriate. If you have questions, please contact your UnitedHealthcare representative.

Check Your Annual Medical Report

Health and life insurance companies have access to powerful technologies for evaluating whether to cover individual consumers: “medical report” files.  Consumer medical report files, sold by the Medical Information Bureau, Inc. (MIB), Ingenix, Inc., and Milliman, Inc. enable health and life insurance companies to charge higher premiums and powered the technology behind rescission of coverage.  Most dangerously, medical report files may include both medical and non-medical information about consumers.  For instance, data collected by the Medical Information Bureau (MIB) may include medical conditions, credit report history, driving records, criminal activity, drug use, participation in hazardous sports, and personal or family genetic history.

Under Federal law, all consumers are entitled to free annual medical reports from the Medical Information Bureau, Inc. (MIB), Ingenix, Inc., and Milliman, Inc. No consumer should pay for health or life insurance without first checking their free annual medical report files.  However, all consumers should be aware that the Medical Information Bureau, Inc. (MIB), Ingenix, Inc., and Milliman, Inc. do not offer a single, secure website to request, review, or dispute your medical report file.  To obtain a copy of your free annual medical report file, you must contact the Medical Information Bureau, Inc. (MIB), Ingenix, Inc., and Milliman, Inc. individually, by telephone or postal mail.

(1) INSTRUCTIONS ONLINE: Contact the Medical Information Bureau, Inc. (MIB) to request your medical report file.

(2) INSTRUCTIONS ONLINE: Contact Ingenix, Inc. to request your medical report file from the MedPoint prescription profiling database.

(3) INSTRUCTIONS ONLINE: Contact Milliman, Inc. to request your medical report file from the IntelliScript prescription profiling database.

On behalf of families, workers, and businesses, the Medical Information Reporting Standards Trust (mirst.org) is advocating for privacy protections in medical records and improved online access to the “medical report” files that are kept on more than 250 million American consumers.  Please help us TAKE ACTION to provide secure, online access to your free medical report.  Tell a friend, send an e-mail, write a letter, or update your status on Twitter!

Just as AnnualCreditReport.com is the ONLY authorized source to get your free annual credit report under Federal law, the goal of AnnualMedicalReport.com is to provide a secure, modern, and free centralized source for consumers to get free access to the free annual medical report guaranteed under the Fair Credit Reporting Act.  The Medical Information Reporting Standards Trust (mirst.org) is committed to providing every consumer with a secure and free online option to request, review, and dispute the contents of his or her medical report file maintained by the Medical Information Bureau, Inc. (MIB), Ingenix, Inc., and Milliman, Inc.

As consumers, we would never apply for credit cards or mortgages without checking our “annual credit reports” to ensure accuracy and fair pricing.  However, there is virtually no awareness among consumers that a few, large corporations collect, store, and sell their most intimate medical information!  Surprisingly, these organizations have managed to stay under the radar, even during the current health care reform debate.  Whereas the New York Times first reported on the Medical Information Bureau in 1932, the last time the newspaper mentioned MIB, Inc. was in 1990.

Under Federal Law, the activities of the Medical Information Bureau, Inc. (MIB), Ingenix, Inc., and Milliman, Inc. qualify them as “credit reporting agencies” and thus are required to provide free annual medical reports to consumers.  To enforce compliance on providing annual “medical reports” as required by the Fair Credit Reporting Act (FCRA), the Federal Trade Commission reached an agreement with the Medical Information Bureau, Inc. (FTC Press Release, June 21, 1995  “Nation’s Largest Insurance Reporting Agency Agrees To Expand Consumer Rights – Fair Credit Reporting Act requirements to apply to insurance investigations under new policy accepted by Medical Information Bureau.”); Ingenix, Inc. (FTC Press Release, Febraury 12, 2008;In the Matter of Ingenix, Inc.); and Milliman, Inc. (FTC Press Release, Febraury 12, 2008; In the Matter of Milliman, Inc.)  Have you ever checked your free annual medical report from the Medical Information Bureau, Inc. (MIB), Ingenix, Inc., and Milliman, Inc.?

AnnualMedicalReport.com is a project of the Medical Information Reporting Standards Trust (mirst.org), a non-profit entity that represents millions of consumers of health-care services and life insurance products.  On behalf of families, workers, and businesses, the Medical Information Reporting Standards Trust (mirst.org) is dedicated to improving privacy protections for personal medical information, establishing technological standards for insurance company use of consumer reporting data, and reducing out-of-pocket costs for consumers by detecting and deterring insurance company fraud and discrimination.

OutOfPocket.com is a social-networking portal to help consumers find the best value for routine health care services in their neighborhood. The site includes a directory of true prices for common services based on actual visits by individual consumers. The website is free and everyone is invited to participate, including the insured and under-insured, by anonymously posting prices they paid for routine health care services (such as MRIs, mammograms, x-rays, CT scans, vaccinations, office visits, dental and vision), along with their personal recommendations on the provider.

To all those who say that health care reform with the “public option” is the way to reduce medical cost through competitiveness and better controls in the health care marketplace, I say bunk!  The sad part is; those who want the “public option” to offer more government control on health care, coverage for all with better savings, better quality and on and on, can’t show historically how that is possible.  

The “programs” implemented by our government have never stayed with in the beginning estimates of budget.  In fact, their ending costs have gone as high as 10 times the initially projected cost.  I would love for anyone to find me wrong!  Please tell the American, realistically, how this can be done?

“With cost savings through reduction of waste, fraud, and abuse in the Medicare system being offered as a key funding source for health care reform currently under consideration on Capitol Hill, eliminating this corruption could require Medicare to adopt private-sector reforms, “ says Thomas Cheplick, with The Heartland Institute. 

The proposal, authored by Sen. Max Baucus (D-MT), currently pending in the Senate relies on such reductions of more than $400 billion in funding over the coming decade.

“Officials estimate that Medicare is annually cheated out of some $60 billion in improper claims payments—an eighth of its entire budget,” said Kevin Wrege, regional state affairs director for the Council for Affordable Health Insurance in Alexandria, Virginia.

 Private Firms Can Do Better

Fraud is rampant and unchecked throughout the Medicare system, while private carriers do a much better job of preventing it.

“Private carriers spend a lot on efforts [to prevent fraud], raising their administrative expenses in the process,” stated Wrege.  “By contrast, the Medicare program does not regularly review bills for accuracy and to prevent fraud.”

Medicare typically pays claims in full, and the Department of Health and Human Services’ Office of Inspector General (OIG) operates as a post-claim payment cop, flagging and investigating only those that appear suspicious.

“Recovered funds, if any, are often only a fraction of the often millions of dollars taken,” Wrege added.

 Scrutiny Advocated

Many Medicare abuses happen in the market for durable medical equipment (DME), such as wheelchairs and oxygen equipment. A draft OIG audit released in August 2008 flagged almost a third of the 2006 DME claims, as having been improperly reimbursed.

“A July report by the Government Accountability Office found that Medicare paid as much as $92 million since 2000 for equipment purportedly prescribed by doctors who were dead,” said Wrege. “Claimants have submitted counterfeit documents, forged doctors’ signatures, and filed bills on behalf of patients who were dead or had never been seen by the prescribing physician.”

In 2008 a single Florida businessman was convicted of submitting more than $5.5 million in fake Medicare claims. He had operated for months, using some of the money to purchase a Rolls-Royce, despite giving the agency an address that was actually a utility closet.

For more information…

“Medicare’s Hidden Administrative Costs,” Council for Affordable Health Insurance: http://www.heartland.org/policybot/results/26241/

“Improper Payments: Responses to Posthearing Questions,” Government Accountability Office: http://www.heartland.org/policybot/results/26242/

“Medical Review of Claims for the Fiscal Year 2006 Comprehensive Error Rate,” Office of Inspector General, U.S. Department of Health and Human Services: http://www.heartland.org/policybot/results/26243/