Monthly Archives: May 2012

Fast and slow lanes in passing fraud legislation

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howard_bill_signingA supposed truism of government affairs is that legislation can take up to three years to go from a great idea to introduction, then to passage and finally being signed into law.

Maryland and Alabama disprove this notion at its extremes.

I just returned from Annapolis, where I was invited to see Maryland Gov. Martin O’Malley sign two fraud bills into law.

One gives the insurance department the authority to seek civil penalties against insurance fraud suspects. The second bill allows more exchange of case information among insurers, law enforcement, regulators and organizations like NICB. Fraud fighters thus gain better ability to jointly unravel large fraud schemes such as medical mills that steal from multiple insurers.

The idea for these bills came from the Coalition’s government affairs committee just last year, then introduced early in the 2012 session. They then took all of 90 days to become law, just as the brief session closed. That’s a far cry from the three-year “truism.”

Alabama sits at the other extreme. Fully 17 years ago, legislators started talking about making insurance fraud a specific crime, and creating a fraud bureau. The Coalition assisted in drafting the measure.

Essentially the same measure passed this spring. Yes, 17 years later. That’s nearly Biblical in proportion, and longer than it took the United States to build the Panama Canal.

For a variety of reasons, fraud bills didn’t gain any traction year after year after year. But there were several near misses along the way. One year a bill died while waiting for a final vote that would’ve sent it to governor.

The governor is expected to sign the current measure into law. But since we’ve waited all these years for it to pass, I think we can we wait a few more days for the final act.

Should we be upset about that Alabama took 17 years to pass a fraud bill when Maryland finishes the job with two bills in just 90 days?

CARTOON_howardI don’t think so. There is a new movie with a line that should sum up our thoughts about Alabama, Maryland and every other state as they consider insurance fraud laws: “Everything will be alright in the end. If it is not alright, then it is not the end.”

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Good results in curbing Medicare fraud — so far

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blogChartDon’t like Obama? Hate Obamacare? Fine.

But even the President’s harshest detractors should recognize that this administration is on the verge of accomplishing something no other President has done — effectively combat medical fraud.

Fraud by medical providers is the most costliest form of insurance fraud and a huge drain on federal taxpayers, at least $60 billion a year.

So the latest statistics on the success of the government’s attack on Medicare fraud are welcome news. In just two years, arrests have spiked 75 percent. More than $4 billion has been recovered from fraudsters. And nearly 5,000 medical providers have been kicked out Medicare. And it looks like the 2012 stats will be even better.

Healthcare reform legislation gave federal fraud fighters a bevy of new tools — and gobs of money for new anti-fraud programs. And while some initiatives are slow out of the starting gate, others are quickly gaining traction and are producing solid results in just two years.

Medicare now can stop the flow of bad claims before real money goes out the door. Like many others, I was leery that Medicare would really abandon its pay-and-chase model of fraud fighting for more proactive initiatives. But the federal government seems to have an honest commitment to do just that, starting with better screening of medical providers and embracing predictive modeling technology.

All the new anti-fraud tools are great, but they won’t have much impact without a willingness to use them effectively, plus a conducive and lasting anti-fraud culture in the federal government.

One sign the culture is changing is the new level of cooperation among federal agencies. Enhanced collaboration among Health & Human Services, the Office of Inspector General and the Department of Justice already is paying dividends — as evidenced by the recent nationwide fraud sweep of 107 suspect medical providers.

But collaborative efforts are going even farther. Federal agencies are now beginning to reach out to state fraud bureaus and private insurers to even better leverage their new anti-fraud tools.

The U.S. Government Accountability Office and several members of Congress have been critical that some anti-fraud programs are too slow off the mark or are not producing good enough results. That’s legitimate criticism, but major structural and cultural deficiencies that took 50 years to create aren’t going to improve in just two or three.
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Still, the progress of the last two years will need to continue ― and then some ― for many years before taxpayers finally get relief from this enormous fraud tax.

If the Supreme Court tosses out Obamacare, it’ll be a shame if anti-fraud efforts are lost as well, because this is one area in healthcare that has the most promise to succeed.

About the author: Dennis Jay is executive director for the Coalition Against Insurance Fraud.

A brief history of analgesic’s holy grail

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holygrail75 Americans will die today from a prescription drug overdose. In fact, prescription drug overdose is rated as the second most frequent cause of accidental death. It’s not just a problem for adults — every hour a baby is born in the U.S. with symptoms of withdrawal from opiates — meaning 13,500 babies a year.

How did we get here?

Nowadays, almost all prescription drugs that are misused come from doctors’ prescriptions, and end up in the wrong hands through theft or sale. Insurance companies often pay for prescriptions.

But painkillers have existed long before prescriptions or insurance companies have. In 5000 B.C., Sumerian tablets named opium poppies HulGil, or “joy plant”. Egyptian Papyrus from 1550 B.C, archives instructions on using grains of poppy plant as medicine.

With pain relief came the drug’s euphoric feelings, and an onset of steady addiction. Non-addictive painkillers became the holy grail of chemists, who set about toying with molecular structures of opioids to get the perfect combination of maximum benefit with minimum risk. In time, they developed several close calls.

Codeine (1830), heroin (1874), and oxycodone (1916) were all advertised immediately after their discoveries as the perfect painkillers, noted for their ‘non-addictive’ properties, and ability to replace their antecedents in the painkiller world.

Morphine, developed in the early 1800s, remains the gold standard for treating severe pain, and is given to cancer patients to this day. The first civil war (1861 – 1865) in America largely depended on the availability of morphine, with one general quoted saying “You can’t fight wars without morphine.”

As the problem of addiction became a growing concern, the Bureau of Social Hygiene created a Committee on Drug Addiction. In 1929, the committee decided upon a research plan that involved three components — chemical, pharmacological, and clinical. After the first decade of research, 500 compounds were ready for testing in animals. Three were tested on humans for pain relief and dependence liability.

Seeking to help existing addicts and understand the root of the problem, the narcotic farm (U.S. Public Health Service Hospital) in Lexington, Ky. was opened in 1935. Prisons that had been flooded with addicts now sent drug-addicted criminals to Lexington for treatment. The Addiction Research Center (ARC) inside the farm was open until 1970 and is today known for accomplishing many of the landmark studies in the field of drug abuse.

Hundreds of prisoners were recruited to volunteer in the ARC as guinea pigs for groundbreaking drug experiments. Scientists would administer heroin, morphine, and other drugs, and take note of what effects it had on the addict. In other experiments, they abruptly stopped dispensing heroin to cause withdrawal symptoms, and then introduce dan experimental drug to see if it would effectively relieve withdrawal symptoms.

Then, Analgesic Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) was established as a “public-private partnership with the United States Food and Drug Administration (FDA) to identify, prioritize, sponsor, coordinate, and promote innovative activities — with a special interest in optimizing clinical trials — that will expedite the discovery and development of improved analgesic treatments for the benefit of the public health.”

In the 1940s, the opiate program at the National Institutes of Health (NIH) began, and has resulted in more than 750 research papers and patents. Some 59 drugs identified as painkillers were introduced from 1960 to 2009, and remain in use today. From 1960 to 2009, pain-related publications grew exponentially: The number of articles almost tripled during the first and second decades, and then doubled during each of the next three decades until 2009. Intensive research has produced thousands of publications, but none of these efforts has yielded new painkillers that can significantly change the scope of the opioid addiction problem.

Today, various laboratories are synthesizing different molecules in hope of finding the perfect cure. Though progress has been made, the answer has not yet been found. It will take a national database where researchers can share their results, more funding, and certainly more time before we may ever reach painkillers’ holy grail.
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About the author: Jennifer Tchinnosian is communications specialist for the Coalition Against Insurance Fraud.

JIFA reveals no-holds insight about fraud fight

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liar.png An angry child calls his convicted fraudster dad a liar…An executive dismisses a job applicant after learning she has a fraud record…A wife is outraged that her hubby lied to their auto insurer that someone stole their car.

Sounds like the fraud version of a daytime soap ― “As the Stomach Turns.” But these are TV ads by an astute Pennsylvania anti-fraud agency. It uses science to create the ads, and measure results.

In fact, the ads show that public outreach can measurably convince people not to commit fraud. We need more science like this to get all of our anti-fraud messages right.

How measurably? Why is shame and humiliation such a good fraud deterrent? The secrets are amply detailed in lead article of the newest issue of the Journal of Insurance Fraud in America, or JIFA for short.

JIFA is the Coalition’s leadership quarterly. It’s a compelling read ― a no-holds arena with articles by many of the best minds in the anti-fraud business. JIFA doesn’t aim to please. It aims to enlighten and sharpen our grasp of trends and issues that affect the fraud fight for better or worse.

There’s better and worse for state fraud bureaus, another article reveals. Some budgets are taking their lumps. Many of these agencies must work harder to stay on top of schemes. But fraud bureaus still are churning out solid fraud-busting numbers. This shows a great deal of resilience despite dollar-squeezing pressure ― true pros at work.

Many forms of fraud still appear on the rise, these agencies also told the Coalition in a survey. Agent scams such as stealing client premiums are especially big, the fraud bureaus say. Fake health plans also may still be spreading, creating more victims who must pay hospital bills from their own pockets.

One possible upshot: The stagnant economy still may be hard at work, creating more fraud cheaters and victims.

In another trend…staged-crash gangs and medical mills increasingly are trying to recruit real crash victims into fake-injury scams. Recruiters are scarfing police crash reports and hounding often-bewildered crash victims to get treatment at shady clinics.

But fraud fighters are firing back with clever legislation in the latest rounds of cat-and-mouse, JIFA reveals. Even so, some very surprising opponents are trying to keep crash reports flowing despite their high value to swindlers.

There’s a lot of engaging reading in JIFA…because there’s a lot of fraud.
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About the author: James Quiggle is director of communications for the Coalition Against Insurance Fraud.