Monday, July 3, 2017

Democrats and Republicans Have So Much in Common!

Dear Friends,

It has been utterly shocking to me to discover that Republicans and Democrats share virtually identical beliefs!

Liberals believe that they play fair and conduct themselves with decorum and that Republicans don’t. Republicans believe – well, you can guess!

Republicans believe that Democrats value nothing but power and winning – and Democrats view Republicans the same way. Amazing!

Liberals don't believe that Republican positions are legitimate. And, vice versa!

Republicans want to shut up Democrats and make them go away. And… you guessed it!

Democrats view Republicans as racists, sexist, homophobic, and xenophobic because they do not speak out against racism, oppose access to birth control and OB-GYN care for women, oppose same sex marriage, and oppose immigration.

Republicans view Democrats as “bleeding heart liberals” who choose these positions because they are fashionable.

Republicans and Democrats both believe that, “These people are not arguing in good faith. I'm convinced that many of them don't even really believe their own crap.”

They both believe that the "other side" is destroying our country!

Liberals and Conservatives both believe that they are “Going to have to come to terms with this reality (the lack of good faith and good will) and start playing hardball back.”

Both sides believe that going low is “a coordinated strategy” on the part of the other side. So much in common!

 Each side sees the other as “vicious.” Evidently, the viciousness of the other side explains one’s own viciousness.

Liberals and Conservatives both believe that the other side is evil.

Many on both sides seem to believe that “the ends justify the means.”

Republicans seem to be aware of every insult to their side and their politicians and completely unaware of negative behavior on their own part. And, vice versa!

Democrats think that Republicans “never turn their backs” on one of their own and…Surprise! Republicans believe that to be true of Dems!

With so much in common, it would seem that everyone could put the welfare of country first and work toward solutions!

Nah… Not gonna happen.  But, I can hope, can't I?



Hoping for reconciliation, 
VLL
















Monday, June 26, 2017

A Love Letter about Health Care

Dear Republicans:

I am going to hold you responsible for every single death that results from lack of health care if your catastrophe of a bill passes.

Remember facts? Those pesky things! Read on. You can do it!

I really love health care! And, life. Life.
V

FACT SHEET ON THE HEALTH CARE DELIMMA

Health care is a moral issue:

 “The issue of universal coverage is not a matter of economics. Little more than 1% of GDP assigned to health could cover all. It is a matter of soul.” (amsa.org)

There are 18,000 excess deaths for people between age 25-64 per year because of lack of insurance and health care.  (amsa.org)

Our friends, neighbors, and family are suffering:  emotionally and financially.  (amsa.org)

The United States of America is the only developed country in the world that sees health care as a privilege and not a right. (amsa.org)

The US treats health care as a product – an economic product – and, not as a social good.
(amsa.org)

Who are the uninsured?

80% of the 45 million who don’t have insurance and health care – or it isn’t adequate – are employed or from working families.  (pbs.org)

How does lack of insurance or under-insurance affect the lives of our fellow Americans?

The uninsured are more likely not to fill their prescriptions. (amsa.org)

They are more likely to pay more. (amsa.org)

The uninsured are more likely to have difficulty getting medical care. (amsa.org)

More than half of the uninsured postpone medical care for financial reasons.  (amsa.org)

Over 1/3 do not have recommended medical tests or treatments because they cannot afford it.

40% of our uninsured do not have a regular source for medical care. (amsa.org)

20% of those without insurance get their care from and ER while only 3% of those with insurance use an emergency room for regular care. (amsa.org)

The uninsured are 50% less likely to receive preventive care.  (amsa.org)

The uninsured are far more likely to be diagnosed late and begin treatment late.  (amsa.org)


Health insurance and health care have become unaffordable for Americans.

Health insurance premiums have been rising at a rate of increase that is 2-3 times the rate of inflation. (amsa.org)

These costs have led to a large increase in the number of people without health insurance and without health care. (amsa.org)

Before the ACA, 45 million people were without health insurance and millions more had insufficient insurance. (amsa.org)

More and more middle class Americans are unable to afford insurance and have no access to health care. (amsa.org)

Fewer and fewer employers provide insurance to their employees. (amsa.org)

There is a trend for employers to provide insurance with higher deductibles that cover fewer and fewer medical expenses.  (amsa.org)

As fewer employers provide insurance, more people turn to Medicaid – the safety net – but there are constant cuts to Medicaid funding.  (amsa.org)

There is vast room for improvement in quality of health care, in delivery, and in cost cutting in the USA.

The USA spends $8,233 per person per year. (pbs.org)

Our health care budget eats up 17.6 percent of our GDP.  (pbs.org)

We spend more than 2 ½ times what most other developed countries spend.
(pbs.org)

According to the Organization for Economic Co-operation and Development:

The USA has fewer practicing doctors/population than most other OECD countries.

We have fewer hospital beds/person than other developed nations.

Our hospital stays are shorter – yet, our costs are much higher.

Our life expectancy is one year less than other OECD countries.

Life expectancy in the USA increased by almost nine years between 1960 and 2010. There was an increase of over 15 years in Japan.

Other countries use a common fee schedule, but in the USA how much a health care clinic or hospital gets paid depends on the kind of insurance a patient has. 
(pbs.org)

Providers can choose which patients they will and won’t see based on insurance.

U.S. payment rates are less flexible than those in other countries: They can address increases in costs easier and faster.

The USA has fewer methods for cost containment because our for-profit insurance companies find it easier to pass on the costs than to negotiate with providers – doctors and clinics. (pbs.org)

We spend three times as much on administrative costs than France does.

Our hospital costs are higher than other countries – it isn’t that we deliver more hospital services. (pbs.org)

The quality of care in hospitals in other countries is a good as in the US and they are still able to attract people to health care professions. (pbs.org)

Many common procedures cost far more in the US than in other countries with comparable quality of care. (pbs.org)

Why does the health care cost so much more in the US?

U.S. doctors make far more money than in other countries.

We use more expensive diagnostic procedures.

No organization has a motivation to cut waste – from insurance companies to clinics to doctors: this is a for-profit industry.

The US does more testing and more expensive testing than other countries and performs more of some procedures.

Providers make more money the more that they test, treat, prescribe, etc.

“The uninsured are more likely to receive poor care for chronic diseases.” Living and dying thus are determined by financial status. (pbs.org)


The Case for Universal Health Care

There are costs of not having UHC:

Fewer years of participation in the workforce. (amsa.org)

“The annual cost of diminished health and shorter life spans of Americans without insurance is $65-$130 billion. People who do not live as long do not work and contribute to the economy as long.” (amsa.org)

Developmental delays for children without health care. (amsa.org)

“Medicare, Social Security Disability Insurance (SSDI), and the criminal justice system have higher costs than they would if there were universal coverage.” (amsa.org)  (amsa.org)

There is a cost to communities that have more uninsured people (poor communities): Providers leave, reduce staff, or relocate and there is less availability of health care. (amsa.org)

Emergency rooms are over-burdened and the insured and uninsured suffer from lack of availability Some ER’s shut down. Some reduce capacity. (amsa.org)

Lack of health care facilities in areas with high uninsurance rates weakens the local economy. (amsa.org)

“Communities with high rates of uninsurance have less effective control of communicable disease (e.g. less vaccinations, less surveillance of TB) and an overall greater disease burden in general.” (amsa.org)

Unnecessary use of ER’s is a financial burden. It is estimated that over 10% of ER visits are for non-emergencies, costing the health care system billions of dollars. (amsa.org)

The under-insured and uninsured don’t get the preventative and maintenance care that they need are more likely to need more expensive care later. (amsa.org)

Lack of Universal Health Care results in “job-lock” (people who have insurance through a job cannot afford to leave) and people may not be able to retire because they cannot get or cannot afford insurance. (amsa.org)

Lack of health insurance and health care stops people from opening their own businesses. There is an “entrepreneur” cost. (amsa.org)

The employer based health insurance system in the USA puts tremendous strain on businesses. (amsa.org)

And, the costs of insuring employees is added in to the cost of products making USA made products more expensive. (amsa.org)



 “In summary, the cost of universal health care would be at least $34-$69 billion, plus whatever costs are associated with covering out-of-pocket expenses and uncompensated care for the uninsured. Specific solutions may entail additional expenses as well, depending on their design parameters.” (amsa.org)

But, “The issue of universal coverage is not a matter of economics. Little more than 1% of GDP assigned to health could cover all. It is a matter of soul.” (amsa.org)


SOURCES:

https://www.amsa.org/wp-content/uploads/2015/03/CaseForUHC.pdf



http://kff.org/uninsured/fact-sheet/ke

Wednesday, June 14, 2017

Dear Liberals, Progressives, Democrats: Join the 21st Century!

My dear liberals...  Oh, how I love you! But... Well... Something is wrong!

Liberals, progressives, and Democratic Party organizations – formal and informal - need to get organized to meet the demands and challenges of these times using 21st century means.

Many of us are using tactics that are outdated and ultimately destined to continued failure.

Political organizations must use social media.

Every political party unit should have an updated easy to navigate web-page, a Twitter account, a Facebook Group, and a Facebook Page.

Then, get to work connecting with other groups, sharing your info and events, and promoting your message!

What about live-streaming a meeting, a speaker, a portion of a meeting, an event…? Using Twitter during a meeting? Taking pix and sharing them on FB & Twitter?

Social media is a very powerful tool that cannot be ignored. It may not be the answer to everything but it has to be a part of the plan.

A look around social networks reveals that many groups, including local Democratic political parties, are not using social media effectively, if at all.

The boards of directors or the executive committees of some groups purposely refuse to support the use of social media: to allocate resources (money and time), to learn to use social media as individuals, to hire consultants to train board members and members, etc.

Why? They believe that it is a waste of time.

County Democratic Parties and other progressive groups often don’t have Twitter accounts or don’t use them and may rarely even post on their own FB pages and groups.

Board or committee members of liberal organizations often do not “Like” or “Share” the posts on their own pages/groups to increase their own Facebook visibility.

Chairs or other leaders of liberal groups refuse to share their events on other FB pages or on Twitter.

This means that other people and organizations using social media have to check numerous other groups and pages to collect info that should be shared by the groups themselves. Whew!


It's 2017! Get crackin'!

Love,

VLL

Friday, June 9, 2017

Dear Anti-Abortion Rights Friends

Ah, friends

There will never come a time when we all have the exact same values and beliefs. But, I hope that we can always have the same facts - from a diversity of sources and with citations, of course!

Even if you believe that blastocysts have souls or you don't believe that people have souls, can we all agree with science has to say?

Many abortion restrictions are not based on sound science. (Guttmacher Institute)

Scientists have found no link between abortion and cancer. (American Cancer Society)

A large study by the New England Journal of Medicine found no link between abortion and later pregnancy complications including miscarriage. (VeryWell)

The American Psychological Association found no evidence that the termination of a single pregnancy caused psychological problems. (APA)

95% of women do not regret their decision to terminate a pregnancy. (Time)

It is a myth that infants capable of independent life are “ripped from the uterus.” All states have term limits on abortion. (The Atlantic)

The fetus does not suffer during abortion: They do not feel pain until about the 27th week of pregnancy.

“Indeed, the American College of Obstetricians and Gynecologists (ACOG) said it considers the case to be closed as to whether a fetus can feel pain at that stage (20 weeks) in development.”

“The science shows that based on gestational age, the fetus is not capable of feeling pain until the third trimester," said Kate Connors, a spokesperson for ACOG. The third trimester begins at about 27 weeks of pregnancy.” (American College of Obstetrics and Gynecology.)


Many religious and ethical groups support or allow abortion. (Christian Life Resources)

The vast majority of abortions in the US take place in the first trimester – 90%.  (Guttmacher Institute)

A Southern Christian doctor came to believe that he had a duty to perform abortions because he saw the suffering of pregnant women and girls as young as 12. (Newsweek)

Most people do not appreciate the desperation that women and girls seeking abortion are experiencing and that has lead them to risk (and lose) their lives. (Newsweek)

Abortion is not a new issue: “Abortion has been performed for thousands of years, and in every society that has been studied. It was legal in the United States from the time the earliest settlers arrived. At the time the Constitution was adopted, abortions before “quickening” were openly advertised and commonly performed.” 
(National Abortion Federation)

The cost of unintentional pregnancy and childbirth is enormous: about 12 billion dollars annually for medical care for mothers and infants. (Brookings Inst.)

Among women and girls who are least prepared financially, socially, emotionally… the unintended pregnancy rate exceeds 60 percent. (Brookings Inst.)

Anti-abortion laws prioritize the life of a fetus over that of a fully sentient human woman. (Center for Reproductive Rights)

This is what happens when the rights of a fetus are more important than that of a fully sentient adult woman: A young beautiful Hindu woman died tragically when denied an abortion of a pregnancy (that was in miscarriage) that had become septic. (The Guardian)

“Birth control is not controversial: 99 percent of sexually active women use it at some point in their lives.”  (Guttmaker Institute)

“Making birth control accessible and affordable is the quickest way to reduce the number of unintended pregnancies.” (Naral)

 Peace, Vivian
















https://www.verywell.com/abortion-future-miscarriage-risk-2371749

Thursday, June 1, 2017

My Dear Soul Mates

Liberals. Progressives. Democrats - from the far left to more conservative than most Republicans: 

Once again: There is not a day that goes by that I do not read posts from you using derogatory language that stereotypes poor and working class people.

People who would never utter a derogatory racist term or make a homophobic comment feel completely free to make negative assumptions about huge groups of diverse people and huge regions of the country.

And, they feel completely entitled to deride the poor and the working class without knowing one damn thing about the people that they are trash talking.

In the last 2 days, it was comments about the "ignorant toothless hillbillies that elected Trump," and the "redneck racists" that were at a rally. These are not useful descriptive terms. These are classist terms. Classist.

One comment was on how terrible the "redneck racists" at a rally looked and dressed. Fashion reviews from a rally?

Dearest Liberal Friends: THEY CAN SEE YOU! THEY CAN HEAR YOU! Yes. Poor people. Working class people. Toothless people. Hillbillies. They do have computers. And, smart phones. And, TV. Cable! Who knew?

Do you really think that you have 2,000 friends and not one of them is from a poor or working class background?

When I chastised the commenter for stereotyping, she kindly let me know that "most rednecks are racists." Another stereotype. I will let the admissions committee at the Country Club know that they have competition.

Remember the lessons on how stereotyping is just lazy thinking? It applies to your thinking about poor and working class people, too. Who knew?!?

Oh, and those huge blocks of the country that liberals love to hate (Texas, "The South," Appalachia, etc. etc. etc? They are not a monolithic group. Stereotyping, again.

Here are some convos that I have had: Stereotyper: Wow, there are some hilbillies there.
Vivian: I am a hillbilly.
S: No, you're not.
V: Yes, I am.
S: You are not like "them."
Now, substitute the word "Jew" or the word "African American."

Shocking though it may be:
My father in rural Eastern KY had cable 25 years ago. I live 3 miles from the Janesville city limits and have none.

My mother was a school teacher and my red neck father was a union construction worker that sent 3 girls to college.

They were "yeller dog Democrats" who told me that they wouldn't sent me to college unless I registered to vote as a Democrat.

My mother worked to organize a union.

My little town had doctors and lawyers and teachers and writers and police officers and builders and ... poor people.

Oh, having no teeth is not a fashion statement. People have no teeth because a dental implant can cost $2,000 but it just costs a few bucks to have your teeth pulled.

So... how's the "winning hearts and minds" thing going?

I will never believe that you are pure of racism and homphobia as long as you despise poor people.

Why some of my best friends are poor redneck toothless hillbillies.

We need more love in the world, less judgment and no name calling or stereotyping.

V









Thursday, May 4, 2017

Dear Friends on the Crazy Left - Yes! You!

Dear Crazy Left:

You are my tribe. My people. The place where I feel most comfy. My soul mates!

But, you are costing me my sanity - any shred of sanity that I had left.

I remember the Vietnam War. The Civil Rights Movement. Sh!t! I remember George Wallace! Gulf 1. Iraq - oops, wrong country. Who knew? AF. 

But, you know what is killing my soul. YOU, my dear soul mates. YOU!

Stop fighting! Stop SHOUTING! at both friend and enemy. Stop with the fake news and Republican talking points! Stop name calling! Were you raised by wolves? No. That's an insult to wolves. 

Shhhhh... 

"Come together right now." Or, else.

Love, love, love is all there is,

VLL

Friday, April 7, 2017

Dear Trump Voters

Happy now? 

We certainly got something new and different.

For those who voted for Trump because:  
We have do to something different; (We didn’t.)    
We need someone who isn’t a political elite; (We got a financial elite.)    
We need someone with business acumen. (We got the bankruptcy king.)    

Here is a comparison: 
Let’s hire the CEO of Frito-Lay to be principle of our high school!
Let him choose people for the department heads:
English Dept:  CEO of bank!
Math Dept: CEO of restaurant chain!
Social Studies Dept: CEO of landscaping/nursery business!
Art Dept: Hmmmm… CEO of local hospital!
….

Wow! Look at all that business savvy we now have!

But... Oh, dear... They are in charge of something that they know nothing about. 

Isn't that refreshing? New perspectives! A business approach!

Now, let them start firing people and eliminating budgets! Let’s improve the English department by firing half the teachers! Yeah!

Let’s improve the math department by… firing 30% of the teachers and cutting the budget!

Art? We don't need no art! Eliminate the art department.

Etc. Ad nauseum.


But, let’s double the security force! And, double the security budget! Hire a private security firm! 

Put up a wall around our schools! Have ICE officials at the doors! 

Who knew that health care is complicated? Every single thinking person in the USA. And, every single person who doesn't or hasn't had health care.

Who knew that there is a history of effort and diplomacy with North Korea?  Career State Department Officials. And, any informed American. And, everyone over the age of 50.

Who knows all about the Middle East? What has succeeded and what has failed? Not me. Not Trump. Not the new Secretary of State.

Well, I am going to apply for a job teaching physics and nano-technology at MIT! Hope I get the job!

Love, love, love is all there is,

VLL

Thursday, April 6, 2017

Dear Hypocrites

Don't worry! Some of my best friends are hypocrites. Is it the human condition or a passing fad?

The word of the day: HYPOCRITE
noun
1.
a person who pretends to have virtues, moral or religious beliefs, principles, etc., that he or she does not actually possess, especially a person whose actions belie stated beliefs.
2.
a person who feigns some desirable or publicly approved attitude, especially one whose private life, opinions, or statements belie his or her public statements.


Republicans, remember how enraged you were when President Obama issued an executive order? Hypocrisy much?

Oh, remember what a slacker President Obama was – He played golf sometimes. I’m listening for the outrage about #45’s weekend trips to Mar-a-lago.

You didn’t like Mrs. Obama revealing her arms? But, Mrs. T can reveal it all? Oh! She’s a Republican?!? Maybe. Maybe not.

Lordy, remember the fake stories about how much money President Obama’s trips cost? Where are the (real) stories about how much money #45 and his spawn are spending on travel?

You judged President Obama not a Christian but President T can talk openly about grabbing women by the pu$$y and that is OK? Because he began to claim to be a Christian in order to run for president? Because it is OK for Christian men to grab women by the pu$$y? Because he is a Republican? All of the above?


Remember way way way back when Republicans were all outraged by the TV show “Murphy Brown” and living in terror that teen girls were going to follow in her footsteps – by which they meant get pregnant. 

I was hoping that teens would follow in her footsteps and became the best and most daring investigative reporters in the US

I digress. Why aren’t you worried that your teen sons are going to follow in Mr. T’s footsteps and just start kissing every beautiful woman they see and grabbing them by the pu$$y? Hypocrisy much?

Honestly, I have a vision of masses of hypocrites wearing the letter "H" on their clothing. It would be so much fun!

Well, someone has to love hypocrites but it doesn't have to be me! You can all love each other!

VLL

http://www.dictionary.com/browse/hypocrite

Tuesday, March 28, 2017

DEAR DEM PARTY POOPERS

Party Poopers, sit down and listen up.

With nothing but loving kindness in my heart, I say to you, “Get over it already!” Buck up! Quit yer whining! And, for Gawd’s sake, grow up!

While you are at it, quit with the fake news sites already!

You don’t like how the Democratic Party operates? Oh, boo hoo! Those lazy-assed volunteers don’t get around to everything you think that they should do? Bummer. The entire 20 paid staff members for the entire state of Wisco don’t do enough? Lazy slobs.

Why don’t you do it? Yes, you! For free. In your spare time. While you hold down a full-time job, raise a family, and keep your car in running condition.

Wait… You don’t belong ? What!?! You have never belonged!?! Uhhh? You never paid fees. You never donated. You never volunteered.

And, they don’t listen to you? Imagine that. I assume that you have called, written letters, and sent emails outlining your vastly superior ideas. I know that I have – many, many, many times.

You don’t like fund-raisers? You didn’t get an invite? You can’t afford it? They are just for the elite of the Democratic Party?

Why, yes, they are. That is why they are called “FUND raisers.” They are not free. They are not charity. It does take money to run for office, to run the party, to elect Democrats.

Did the country club to invite you to their next shin-dig? No, they didn’t because you don’t belong. I cannot afford the country club. I hate the concept of country clubs. But, I am not asking them to invite me and then getting angry because they didn’t.

Have your own party. Make it a pot-luck. Have a keg. Invite anyone you please.

Oh, wait! You didn’t even know about the event?  Yes, people used to ask me all they time why they didn’t know about events. The answer: Read a newspaper. Check the Facebook page every day. Check the web-page. Join and get on the mailing list.

To the best of my very limited knowledge, The Democratic Party and the DNC is a private club. It operates for the sole purpose of electing Democrats and perhaps even sometimes supporting the Democratic Party Platform.

It is not a democracy. The majority does not rule. It isn’t even a constitutional republic.

The purpose is to elect Democrats to the top of the ticket. Whatever other programs exist, I haven’t seen in operation.

As in all such organizations, people seek power, influence, and money even when there is very little to be had – or, none at all. People fight like cats and dogs for county Dem Party offices that pay nothing but a generous headache.


It is a bureaucracy. Doing anything at all requires navigating 5,000 levels of hierarchy. The “We have never done it that way before” crowd wins most decisions.

I am sure that there are county parties that engage in a lot of activism – but, I haven’t seen it.

It isn’t fair and doesn’t claim to be.  I am from a small county and I wouldn’t get to go to a convention if I donated a million dollars. So, if you are new to politics, get used to it.

Or, do what I am doing. Start your own f’ing group of awesome activists! No elections. No bureaucracy.  

Do I love the Dem Party? No. I f’ing hate it. But, I will be voting Democratic till the day I die.

Warmly, 
VLL


Saturday, March 25, 2017

Dear Medical Fraudsters

As people die from lack of health care here in the USA - and, that's ought to be a crime - I am especially incensed by health care fraud including bill padding. Please share your experience!

PERSONAL EXPERIENCE:

Ø     After my aunt’s death, my sister received receipts for medical services rendered after her death.
Ø     Some MD’s keep a list of all Medicare patients being seen by PA’s or MSN’s. Then, they look into the room, ask a brief question and bill Medicare for both the PA or the MSN and a physician consultation.
Ø     A clinic advertises a “Headache Clinic.” This consists of a neurologist and a “float nurse” – not even a HA specialist. The float nurse spends about an hour and 45 mins administering a questionnaire that could be filled out by the patient alone. The neurologist spends about 10 ministering administering a very simple neuro check – and, they bill $700.00. No technology involved. I challenged this bill, even though my insurance was paying, and got it reduced.
Ø     Doctors who prescribe antibiotics for viruses and then have patients come back for follow up – for the common cold.
Ø     Clinics have “quotas” – they want their doctors to see a certain number of patients/week.
Ø     Clinics give bonuses for doctors seeing the highest numbers of patients.
Ø     Clinics encouraging doctors to prescribe medication that require follow-up visits – such as narcotics.
Ø     Hip replacement patients were not purchasing the optional personal care items (which were unnecessary or could be bought less expensively at local stores) so the items were added to the room charge.
Ø     Patients are required to be seen by a PA or nurse who is unable to answer basic questions and must then also be seen by an MD. This should be a cost savings, but is used to “double book” or bad bills instead.
Ø     Doctors bill for every second of your time – even the time spent standing in the hall way.
Ø     Patients cannot compare costs between clinics because the billing is so complicated. Even when you are seeing a doctor for a simple reason and there will be no testing or technology involved, clinics claim that they cannot tell you in advance how much you will be charge.



What Does Health Care Fraud Look Like?

The majority of health care fraud is committed by a very small minority of dishonest health care providers. Sadly, the actions of these deceitful few ultimately serve to sully the reputation of perhaps the most trusted and respected members of our society-our physicians.

The most common types of fraud committed by dishonest providers include:

Ø      Billing for services that were never rendered-either by using genuine patient information, sometimes obtained through identity theft, to fabricate entire claims or by padding claims with charges for procedures or services that did not take place.

Ø      Billing for more expensive services or procedures than were actually provided or performed, commonly known as "upcoding"-i.e., falsely billing for a higher-priced treatment than was actually provided (which often requires the accompanying "inflation" of the patient's diagnosis code to a more serious condition consistent with the false procedure code).

Ø      Performing medically unnecessary services solely for the purpose of generating insurance payments-seen very often in nerve-conduction and other diagnostic-testing schemes.

Ø      Misrepresenting non-covered treatments as medically necessary covered treatments for purposes of obtaining insurance payments-widely seen in cosmetic-surgery schemes, in which non-covered cosmetic procedures such as "nose jobs" are billed to patients' insurers as deviated-septum repairs.

Ø      Falsifying a patient's diagnosis to justify tests, surgeries or other procedures that aren't medically necessary.

Ø      Unbundling - billing each step of a procedure as if it were a separate procedure.

Ø      Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care contract.

Ø      Accepting kickbacks for patient referrals.

Ø      Waiving patient co-pays or deductibles for medical or dental care and over-billing the insurance carrier or benefit plan (insurers often set the policy with regard to the waiver of co-pays through its provider contracting process; while, under Medicare, routinely waiving co-pays is prohibited and may only be waived due to "financial hardship").

https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx

 

Medicare Funds Totaling $60 Billion Improperly Paid, Report Finds:  http://abcnews.go.com/Politics/medicare-funds-totaling-60-billion-improperly-paid-report/story?id=32604330


What's the Problem?

Health care fraud perpetrators steal billions of dollars each year from Federal and State governments, from American taxpayers, and some of our country’s most vulnerable citizens. Fraud drives up the costs for everyone in the health care system, in addition to hurting the long term solvency of the Federal health care programs, like Medicare and Medicaid, upon which millions of Americans depend.
Health care fraud can occur in many ways. One example is when an insurer (e.g., Medicare or a private health care insurance company) is intentionally billed for services or supplies that were never provided. Other examples of fraud include, but are not limited to the following:
·                     A health care provider bills for services or supplies (e.g., home health services, diabetic supplies, hospital visits, exams) that were never provided
·                     A health care provider bills an insurer for services or treatments that are medically unnecessary and, in some cases, potentially even harmful to the patient (e.g. power wheelchairs, therapy sessions, ambulance transports)
·                     Patients’ insurance numbers are stolen and sold to criminal organizations and then used to bill for health care services, supplies, or equipment that were not necessary or never provided
·                     A health care provider is paid bribes to refer patients for services and treatments which may be medically unnecessary or substandard (e.g. mental health services, physical therapy)
·                     An insured individual sharing their health insurance information with someone else so that the uninsured person can obtain health care services under the insured’s name.



TEN COMMON HEALTH CARE PROVIDER FRAUD SCHEMES  

Ø     Billing for services not rendered.
Ø     Billing for a non-covered service as a covered service.
Ø     Misrepresenting dates of service.
Ø     Misrepresenting locations of service.
Ø     Misrepresenting provider of service.
Ø     Waiving of deductibles and/or co-payments.
Ø     Incorrect reporting of diagnoses or procedures (includes unbundling).
Ø     Overutilization of services.
Ø     Corruption (kickbacks and bribery).
Ø     False or unnecessary issuance of prescription drugs.



HEALTH CARE FRAUD:

When a health care fraud is perpetrated, the health care provider passes the costs along to its customers. Because of the pervasiveness of health care fraud, statistics now show that 10 cents of every dollar spent on health care goes toward paying for fraudulent health care claims.