Onward

The Ultrasound and the mammogram results were it.  The surgeon confirmed there was ‘something’ there; it, the tumor, might be benign or might be malignant. So, after insurance approval, next up comes the biopsy. Then he had also ordered a bone scan, for base line reading as breast cancer so often morphs to the bone. Ultimately he ordered the MRI of the both breasts. Whew, but it is good to make certain of what’s there! Also good to determine the size of the tumor, and make the correct decisions regarding if a  lumpectomy or mastectomy was going to be the surgery of choice.

Biopsy results are in. Another appointment with the surgeon. I brought a friend of mine from church who has had both breasts removed due to two different kinds of breast cancer. Always bring another set of ears with you! Also, bring paper and pen to take notes, or have your friend take notes!

My surgeon is terrific. He began by saying that it was cancer, those words you just really don’t want to hear….especially when there is no cancer of any kind in my family! He said that he doesn’t believe in shrinking (via chemo) the tumor just to do a lumpectomy. There may be leftover cancer cells someplace  around. All his explanations were clear, all questions answered including those of my friend. So he will see me after the MRI to determine which surgery was appropriate. Currently my tumor was sized out at about 5 mm..kinda big..oh crap.

So here are some of the facts to consider: if the lumpectomy is done, I will need radiation as a tumor will re-appear in same area in 70% of cases (what a stat!); If the mastectomy, there is no radiation, but then you have all the re-constructive surgery to consider, as well as more pain, more tubes and drains, more time “off” for healing. So I turned it over to God asking just to be clear of any cancer, no matter which surgery was going to happen. Obviously there was surgery in my future.

Next installment: the MRI results and the decisions about surgery and what it may mean for time away from my work.

To connect with Linda call her at 310-831-4400 or Linda@theidentityadvocate

Always a good reminder as things continue to evolve in the healthcare world. Very good article by Richard E. Mackey, Jr., Contributor. As compliance becomes key, always continue learning.

http://searchsecurity.techtarget.com/tip/Key-elements-of-a-HIPAA-compliance-checklist?track=NL-102&ad=777444&asrc=EM_NLN_12122780

Owner of Doraville Medical Clinic Indicted for Health Care Fraud
Atlanta Hope Medical Group Billed Medicare for Doctor Services Never Performed
U.S. Attorney’s Office January 18, 2012

Northern District of Georgia (404) 581-6000

ATLANTA—DAVID SONG SEN CUI, 43, of Duluth, Georgia, has been indicted by a federal grand jury on charges of health care fraud.

United States Attorney Sally Quillian Yates said of the case, “Medicare dollars provide critical medical services for elderly and disabled persons. This defendant is charged with defrauding Medicare by repeatedly billing for ‘physical therapy’ that in truth was only massages given by unlicensed massage therapists. Medicare and our taxpayers cannot afford such criminal abuse of health care dollars.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “The FBI, in conjunction with its various law enforcement partners, is committed to the protection of such federally funded programs. Individuals engaged in such fraudulent acts, as is alleged in this indictment, demonstrate a lack of compassion and greed that simply cannot and will not be tolerated. The FBI urges anyone with information regarding healthcare fraud activity to contact its nearest FBI field office.”

According to United States Attorney Yates, the charges, and other information presented in court: From November 2008 through August 2011, CUI operated the Atlanta Hope Medical Group, Inc., a clinic located in Doraville, Georgia. The clinic purported to provide physical therapy services for elderly patients. However, the clinic actually offered massage services, which were performed by unlicensed massage therapists. CUI allegedly billed the massages fraudulently to Medicare as “physical therapy” under a doctor’s name who did not render the services and was not even present at the clinic. As part of the scheme, Atlanta Hope employed a doctor who was present at the clinic only two days a week. The indictment alleges that, during the operation of the clinic, CUI fraudulently billed over $5.5 million in false claims to Medicare.

The indictment charges 11 counts of health care fraud. Each count carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.

Members of the public are reminded that the indictment contains only allegations. A defendant is presumed innocent of the charges and it will be the government’s burden to prove a defendant’s guilt beyond a reasonable doubt at trial.

This case is being investigated by special agents of the Federal Bureau of Investigation.

Assistant United States Attorney Shanya J. Dingle is prosecuting the case.

For further information, please contact Sally Q. Yates, United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney’s Office, at (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.

Preventing Medical ID Theft: Are You At Risk ?

Preventing medical ID theft has become a hot topic as Americans increasingly hear about the safety of their private medical records as more medical breeches continue to be discovered. Medical ID theft happens when a person uses someone’s identity to obtain medical services or steal money by falsifying claims for medical services. Identity thieves use a person’s Social Security number, insurance information, or other forms of identification to commit the medical ID theft.

Medical ID theft can have a devastating effect on victims, causing collections issues, credit problems, and even bankruptcy. But that’s not all. The type of medical treatment obtained by the identity thief can also prevent the victim from getting medical insurance or medical services themselves because, as far as the insurance company is concerned, the victim now has a “pre-existing” condition.

According to the FTC, medical ID theft accounts for three percent of all ID theft cases, or approximately 250,000 cases per year. Unfortunately, these medical ID theft statistics are expected to grow, especially with the shift to electronic medical records.

Preventing Medical ID Theft: The Unemployed and Uninsured
Due to their difficult circumstances, some groups are at a higher risk for becoming identity thieves. The unemployed and uninsured may use another person’s identity because of a belief that it’s the only way they can receive quality medical care. Since they’re unemployed, they don’t have access to an employer’s healthcare benefits, and they can’t afford to buy medical insurance because they don’t have a job. It’s a vicious cycle, and it can make good people do bad things.

Preventing Medical ID Theft: Illegal Immigration
Illegal immigration also poses a serious threat as medical ID theft continues to rise. When an illegal immigrant steals private information such as an individual’s Social Security number, he or she can obtain identification and numerous services reserved for legal residents. If precautions aren’t taken to prevent medical ID theft, an illegal immigrant can get a passport, driver’s license, bank account, credit card, loan, mortgage, insurance, medical treatment, and many other services.

Preventing Medical ID Theft in Five Steps
Begin preventing medical ID theft by following these five easy steps:
1. Have your Social Security number removed from your insurance records. If your Social Security number is currently on your insurance card, don’t carry your card with you. Keep it in a safe place and only carry a photocopy with all but the last four digits of your Social Security number blacked out.
2. Obtain copies of your credit reports, insurance claims, and medical records. Lock them in a safe or safety deposit box, or place them on a CD or flash drive.
3. Next, regularly review your credit reports, insurance claims, and medical records for suspicious entries, such as a medical treatment that was never performed on you.
4. Immediately address disputes on your explanation of benefits, bills for medical services you never received, or any other charges that could be sent to collections and damage your credit. These need to be investigated and removed from your records.
5. Don’t leave a paper trail. Destroying sensitive information you no longer need is another critical step in preventing medical ID theft, so shred claims that are more than seven years old. Also, ask if your provider’s office performs background checks employees to prevent medical ID theft rings and stolen medical information.

Preventing medical ID theft takes vigilance. Medical ID thieves are doing everything to stay one step ahead of you and the authorities, so use medical ID theft prevention strategies to protect your private information.

Want to learn more about preventing medical ID theft? Contact The Identity Advocate at 310.831.4400 or via email at info@theidentityadvocate.com.
Visit us online at www.theidentityadvocate.com.

Despite the law stating medical breaches involving more than 500 people must be listed on the Health and Human Services (HHS) breach list, the Identity Theft Resource Center recorded medical breaches which never made the list. Do you know why? The HHS list allows the loophole of “risk of harm” without requiring federal law enforcement verification. One state has reported more than 200 breaches. Most are not included in the Identity Theft Resource Center Breach Report because they did not include sufficient pertinent details regarding the event. Some states now harbor a protected breach list which is not made public at all, or is only accessible by exercising the Freedom of Information Act. Doesn’t this make you wonder why is it all so protected? Read the entire article from the Office of Inadequate Security
http://www.databreaches.net/?p=12436

It is happening again, a large corporation has the potential loss of data due to a security breech. this means medical records, social security numbers even credit card information may have been exposed. The threat of Medical Identity Theft is even greater in a a case like this. Read California Health Line article at: http://www.californiahealthline.org/articles/2010/6/30/wellpoint-breach-could-have-exposed-enrollees-medical-financial-data.aspx

Earlier this year, HHS and the Department of Justice created a new Health Care Fraud Preventing and Enforcement Action Team (HEAT). The program expands existing DOJ-HHS Medicare Fraud Strike Force teams that focus on data analysis to track fraud. Also new is a requirement that DME suppliers except pharmacies be certified by CMS in order to reduce fraud.

The OIG has also launched an online consumer program, http://www.StopMedicareFraud.gov/, to combat medical identity theft. The website and printed materials offer tips on how to recognize medical identity theft and what to do if it happens. Common scams include offering free services, groceries, transportation, or other items in exchange for Medicare numbers, as well as telephone surveyors or marketers who ask for Medicare numbers as an identifier.

Depart of Justice is making Health Care Fraud a top priority with settlements and judgments added up to $1.6 billion, $867 million of which came from settlements with the pharmaceutical and medical device industries.
Read more at Fierce Healthcare Daily News: http://www.fiercehealthcare.com/story/false-claims-prosecutions-focused-healthcare/2009-12-14?utm_medium=nl&utm_source=internal

The advent of Electronic Health Records may mean the rise of Medical Identity Theft and the fears attached such as credit misinformation; errors in health records including allergies, blood types; loss of lifetime coverage or even becoming uninsurable. Read the informative article at ihealthbeat and take note of how to reduce your risk.
http://www.ihealthbeat.org/articles/2009/11/30/growth-of-ehrs-could-lead-to-rise-in-medical-identity-theft.aspx