If your office computer is stolen in a burglary, or if your patients’ records are hacked by a dishonest employee of your cloud service provider, can you afford a $400,000 fine?

If I ask nicely, will dentists heed my warnings about HIPAA? Probably not.

If like over 90% of dentists, you are a HIPAA-covered entity, you may recall that I have often recommended that you perform a breach risk assessment BEFORE a breach occurs. It’s no secret that it is the very first item an investigating agent for the OCR will request from a hapless dentist whose patients’ identities have been fumbled. And considering the fine for non-compliance can be hundreds of thousands of dollars – if not millions – a dentist’s practice will be much safer from bankruptcy if the risk assessment is not be dated the night before the OCR pays a visit. Just look what happened to Idaho State University.

“ISU to pay $400K after medical records breach” THE ASSOCIATED PRESS, May 22, 2013.

http://www.therepublic.com/view/story/b5f6a708621e47d3be488bdffa302a2b/ID–HIPAA-Penalty

“A subsequent investigation by the federal agency determined the school in Pocatello hadn’t adequately assessed potential risks to medical information shielded from release by the federal law known as the Health Insurance Portability and Accountability Act, or HIPAA.”

If your office computer is stolen in a burglary, or if your patients’ records are hacked by a dishonest employee of your cloud service provider, can you afford a $400,000 fine?

Arguably, I am the ONLY dentist in the nation willing to publicly warn colleagues about the risk of bankruptcy level HIPAA fines, and I am well beyond avoiding confrontations with shy, unaccountable stakeholders who hide truth for personal power and/or profit.

As a result of bringing unpopular transparency to my profession, I have often been ignored and censored by untrustworthy leaders – including EDR vendors and consultants, online dental publications, the American Dental Association and most recently, Dr. Gordon Christensen’s CR Foundation. Nevertheless. I simply have no respect for deceitful, unaccountable people whose greed causes harm to befall innocent dentists and patients, and I will do whatever it takes to expose stakeholders’ lies. Regardless whether you get even more pissed at me every time I share discomforting information like this… you are still most welcome. My pleasure.

D. Kellus Pruitt DDS

cc: American Dental Association via Sharecare.com

http://www.sharecare.com/group/american-dental-association

http://kff.org/interactive/subsidy-calculator/

Editor’s Note: We bet that providers who sign provider agreements with UHC are not going to like their contracted fees exposed to the public.

For Immediate Release

UNITEDHEALTHCARE’S myHEALTHCARE COST ESTIMATOR™ NOW AVAILABLE IN VIRTUALLY ALL MARKETS NATIONWIDE

Expansion adds 70 markets, enabling more than 20 million consumers to comparison shop for health care services based on quality and cost

• Online and mobile tool provides personalized, integrated health care decision support with quality, cost, financial and educational information

• Cost estimates based on physicians’ and hospitals’ actual contracted rates

MINNETONKA, Minn. (May 15, 2013)

– UnitedHealthcare has made available to nearly all of its employer-sponsored plan participants nationwide myHealthcare Cost Estimator, an integrated online and mobile service that brings a retail shopping experience to health care that enables people to comparison shop for health care services based on quality and cost.

The tool – free to employers and plan participants at www.myuhc.com and through the Health4Me app – helps consumers find quality care while being able to estimate the cost of more than 450 common services with enhanced accuracy. Estimates are personalized to reflect an individual’s own health plan benefits, including their real-time account balances when applicable. myHealthcare Cost Estimator provides plan participants the ability to compare quality and cost information for more than 540,000 physicians and 4,500 hospitals.

There are significant price variations for health care services and procedures at hospitals and doctors’ offices nationwide. For example, the total cost for a colonoscopy at hospitals in the Phoenix area can be between $1,540 and $6,020. For a knee MRI in Seattle, the cost ranges from $460 to $2,470 at area health care facilities.

The online and mobile service is more precise than cost estimation tools that may rely only on historical claims data or provide estimates based on geographic average. myHealthcare Cost Estimator draws on the company’s actual contracted rates with physicians, hospitals, clinics and other health care providers, giving consumers more accurate pricing information.

If consumers have questions about the estimates, they can call the number on the back of their health benefits ID card, or use the click-to-call feature on their Health4me mobile app, to speak with a customer care professional. The tool is also integrated with additional information and resources, including nurse support.

Consumers and employers are looking for help to understand what it will cost to go to the doctor and have the confidence in making the best use of their benefits. In a recent survey of myHealthcare Cost Estimator users, 67 percent of the people surveyed said the tool gave them confidence to make better cost choices, and 84 percent said they would use it again. Employers have embraced the tool as an important capability to engage employees and more effectively manage health care costs. Some employers are taking steps to encourage employees to use the tool, featuring it through webinars, health fairs, mailing campaigns and other marketing efforts.

“Empowering our employees with tools and information that improve their health is key to Nationwide Insurance, and the myHealthcare Cost Estimator is a perfect example of that,” said Kathleen Herath, associate vice president of health and productivity at Nationwide Insurance. “We are taking specific and strategic steps to help our workforce use myHealthcare Cost Estimator, which encourages them to make more informed decisions about the quality and cost of health care services. As a result, we are helping to create happier, healthier and more productive employees.”

Since myHealthcare Cost Estimator launched last year, thousands of consumers have used the tool to compare the quality and cost of various treatments and services.

“Expanding the availability of myHealthcare Cost Estimator meets a longstanding consumer need for thorough but simple online comparison shopping for health care by putting personalized, relevant and accurate information right at people’s fingertips,” said Yasmine Winkler, chief product, marketing and innovation officer, UnitedHealthcare. “myHealthcare Cost Estimator enables people to make better care decisions, by better understanding their treatment options, comparing services and anticipating future costs.”

myHealthcare Cost Estimator provides pricing and quality information regarding about 170 “episodes of care,” which creates a comprehensive view of what consumers should expect throughout their course of treatment for any health issue, from the time they first visit the doctor to the test or procedure, and all the way through to physical therapy or any necessary follow-up care. Quality and cost information is directly connected to hospitals and physicians that participate in UnitedHealthcare’s care provider network, and alternate treatment options are provided so consumers can have an informed conversation with their physician.

Collaboration with care providers is critically important when building cost estimators and other consumer support tools to ensure they enhance the overall patient experience – and accurately portray expected costs and treatment options – rather than putting unnecessary focus on just costs.

UnitedHealthcare plan participants can access the tool online at www.myuhc.com. It is also integrated into Health4Me™, UnitedHealthcare’s mobile app for iPhone and Android smartphones that helps people with employer-sponsored benefits plans access important health care information on their mobile devices.

A Simple Yet Comprehensive Shopping Experience

myHealthcare Cost Estimator was created based on years of consumer, employer and care provider feedback to ensure a simple, intuitive experience. Key features include:

• cost estimates for more than 165 geographic areas covering more than 170 “episodes of care” that can include 450 individual services, such as surgeries, lab tests, radiology tests and office visits;

• cost estimates that are tailored to a plan participant’s specific benefits plan design that identify what will be owed out-of-pocket, costs that will be paid by their employer, and real-time account balances available in an eligible health care account to pay toward the expenses;

• ability to assemble cost estimates by matching physicians with the specific facilities where they practice;

• presentation of common alternate treatment options to educate patients on their choices; and

• educational information about how their benefits work and how costs are determined.

The tool provides estimates based on available fee schedules and actual contracted rates with care providers; if that information is not available, estimates are based on historical claims with the care provider. myHealthcare Cost Estimator builds on the success of UnitedHealthcare’s Treatment Cost Estimator, which was created six years ago to help consumers comparison shop for health services and understand how costs differ from doctor to doctor.

About UnitedHealthcare

UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers and Medicare and

Medicaid beneficiaries, and contracts directly with 780,000 physicians and care professionals and 5,900 hospitals and other care facilities nationwide. UnitedHealthcare serves more than 40 million people in health benefits and is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.

                   By Avik Roy – Contributor

History of the employer mandate

Poll after poll shows that Americans who have health insurance—most through their employers—are happy with the health coverage they have. According to Gallup, around 70 percent consider their coverage to be “excellent” or “good.” Democrats’ push to nationalize health care in the early 1990s, led by Hillary Clinton, failed largely because the vast majority of voters who have health insurance feared that it would be too disruptive to their existing arrangements.

That’s why President Obama, in his Obamacare pitch, repeatedly promised that “if you like your health care plan, you can keep your health care plan.” And it’s why the Affordable Care Act includes an employer mandate. Because Obamacare subsidizes private coverage for the uninsured, Democrats wanted to make sure that employers didn’t have an incentive to drop coverage for workers and send them onto the new subsidized exchanges.

So they put in an employer mandate to force employers to continue covering their workers; if workers ended up accepting exchange subsidies, employers would face significant fines.

However, due to some technicalities in the way that the employer mandate works, the actual consequence of the law will be to incentivize employers to offer de minimis coverage for their workers, coverage that some workers will then reject by seeking more favorable terms on the Obamacare exchanges.

The strong penalty vs. the weak penalty

The employer mandate actually consists of two different penalties, based on two different categories of employer behavior. These originate from Section 4980H of the Affordable Care Act. Subsection (a) requires steep penalties for employers who offer no coverage at all. Subection (b) requires modest penalties for employers who offer “minimum essential coverage under an eligible employer-sponsored plan.” This difference—between the strong penalty in 4980H(a) and the weak penalty in 4980H(b)—is crucial to understanding how things will play out in the future.

Under the strong penalty, in which an employer “fails to offer to its full-time employees…the opportunity to enroll in minimum essential coverage,” and “at least one full-time employee” enrolls in an exchange, the employer has to pay a fine of $2,000 times the total number of full-time-equivalent employees at the firm, minus 30. (The employer mandate only applies to firms with 50 or more full-time-equivalent workers.) So if you employ 50 workers, that’s a fine of 20 * $2,000 = $40,000. And the fine isn’t tax-deductible, adding to the pain.

Under the weak penalty, in which an employer does offer “the opportunity to enroll in minimum essential coverage,” but that coverage doesn’t meet Obamacare’s requirements for affordability or actuarial value, and at least one worker enrolls on an exchange instead, the fine is $3,000 times the number of workers who enroll on the exchanges. So, if you employ 50 workers, and three of them get coverage on the exchange instead, the fine is a much lower 3 * $3,000, or $9,000. (Technically, in subsection (b), employers pay the lesser of the weak penalty or the strong penalty, but this in most cases should be the weak penalty.)

So: Employers avoid the strong penalty and gain eligibility for the weak penalty by offering “minimum essential coverage.” So what is “minimum essential coverage?”

‘Minimum essential coverage’ is very broadly defined

The legal term “minimum essential coverage” is defined by Section 5000(A)(f) of the Internal Revenue Code. The IRC states that minimum essential coverage can consist of either (a) government-sponsored coverage, such as Medicare or Medicaid; (b) an “eligible employer-sponsored plan”; (c) a plan “offered in the individual market within a State”; (d) a “grandfathered health plan”; or (e) anything else that the Secretary of Health and Human Services deems appropriate.

So what is an “eligible employer-sponsored plan?” Paragraph 2 of Section 5000(A)(f) defines one as “a group health plan or group health insurance coverage offered by an employer to the employee which is [either a government-sponsored plan] or “any other plan or coverage offered in the small or large group market within a State.”

In other words, any health insurance plan that is legally sold within a state’s boundaries counts as an “eligible employer-sponsored plan.” In many states, insurers market inexpensive plans that cover a limited range of services. According to Obamacare, employers can offer these inexpensive plans to their workers and thereby avoid the employer mandate’s strong penalty.

This has significant ramifications for sectors of the economy that employ hourly-wage workers, such as restaurant chains McDonalds (NYSE:MCD); Burger King (NYSE:BKW); Dunkin Brands Group (NASDAQ:DNKN); Yum! Brands (NYSE:YUM), owners of Taco Bell, Pizza Hut, and KFC; and Darden Restaurants (NYSE:DRI), owners of Red Lobster, Olive Garden, and Capital Grille, among others.

These employee notices must be provided to existing employees no later than October 1, 2013. This deadline is intended to correspond to the open enrollment period for the Marketplace commencing October 1, 2013, for coverage through the Marketplace beginning January 1, 2014. The Release includes temporary guidance and two model employee notices of the Marketplace upon which employers may rely. Additionally, the Release provides an updated model election notice for group health plans for purposes of the continuation coverage provisions under the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) to include information of the health coverage options offered to individuals through the Marketplace for comparative purposes.

Employee Notice of the Marketplace. The Affordable Care Act amended the Fair Labor Standards Act (“FLSA”) to require employers to issue to employees a notice of the health coverage options available under the Marketplace. The FLSA requirement was supposed to have been satisfied on or before March 1, 2013; however, given the regulatory delays in establishing and approving the Marketplace, the DOL extended the deadline. The guidance under the Release is temporary through the applicability date of October 1, 2013, but may be relied upon until future guidance and regulations are issued.

Which Employers Are Required to Comply with the Notice Requirements?

Whether or not they are required to “pay or play” under the Affordable Care Act, all employers subject to the FLSA must provide their employees with notice. The FLSA generally applies to employers that employ one or more employees and are engaged in, or produce goods for, interstate commerce. The FLSA also covers, among other things, hospitals; schools; institutions of higher education; and federal, state, and local government agencies. To determine whether an employer is subject to the FLSA, the DOL provides an Internet assistance tool at http://www.dol.gov/elaws/esa/flsa/ scope/screen24.asp.

Which Employees Must Receive the Notice?

Employers must provide the employee notice to each of their employees, whether or not an employee has part-time or full-time status. It does not matter whether the employee is enrolled or eligible to enroll in a group health plan. A separate notice is not required for dependents or other individuals who may become eligible for coverage under the plan but are not employees.

What Information Must the Notice Contain?

The employee notice must contain the following information:

• the existence of the Marketplace;
• the contact information and description of services offered on the Marketplace;
• a statement that the individual may be eligible for a premium tax credit if the employee purchases a qualified plan on the Marketplace; and
• a statement that, if the employee purchases a qualified plan on the Marketplace, the employee may lose the employer contribution to any health benefit plan offered by the employer and all or a portion of employer contributions may be excluded from federal income.

What Are the DOL Model Notices?

The DOL has provided two model employee notices, which are available on its website, one for employers that do not offer a health plan and one for employers that offer a health plan to some or all employees. The Release provides that employers may use the model notice(s), provided that the notice(s) include(s) the information described above.

The model employee notice for employers that do not offer health coverage includes the information described above, as well as an explanation of the impact of the availability of employer health coverage on the employee’s eligibility for subsidies on the Marketplace. The model employee notice does not require the employer to provide specific contact information for the Marketplace in the state where the employee resides, but rather refers the employee to the healthcare.gov website for contact information for the Marketplace in the employee’s area. This model employee notice requires the employer to provide contact information for the employer, including the employer’s EIN (Employer Identification Number). This is the information that an employee will need to include in an application for a premium subsidy on a Marketplace.

The model employee notice for employers that do offer health coverage, while generally including the same information as the model employee notice for employers that do not offer health coverage, also requires the employer to provide contact information to obtain more information about the employer’s health care coverage. The disclosure section requires the employer to state whether the health care coverage is offered to all employees and, if not to all employees, a description of those employees eligible for health care coverage. This model employee notice further requires the employer to state whether it offers dependent coverage and which dependents are eligible. Finally, the employer is required to disclose whether the health care coverage offered meets the minimum value standard and that the cost of coverage is intended to be affordable. The Department of Treasury and Internal Revenue Service recently issued proposed guidance to assist employees in assessing whether the coverage offered provides minimum value. (For more information, see the Epstein Becker Green Health Employment And Labor blog post by Michelle Capezza entitled “New Proposed Guidance for Determining Whether Employer-Sponsored Health Plan Provides Minimum Value.”)

In addition, the model employee notice for employers that offer health coverage includes optional information that an employer may provide to employees based on the Marketplace Employer Coverage Tool to help them better understand their coverage choices, including whether an employee is eligible in the next three months for employer coverage, whether the employer offers a health plan that meets the minimum value standard, the premium for employee-only coverage under the lowest-cost plan that meets the minimum value standard if the employee received the maximum discount for any tobacco cessation program, and what changes the employer will make for the next plan year. Although this information is optional, it may be to an employer’s benefit to demonstrate, where appropriate, that its plan is providing minimum value and is affordable.

When Must the Employee Notice Be Provided, and What Are the Acceptable Delivery Methods?

Current employees who are employed before October 1, 2013, must be provided with the notice no later than October 1, 2013. Beginning October 1, 2013, the employer must provide each new employee with the notice at the time of hire, which will be considered timely in 2014 if it is provided within 14 days of the employee’s start date.

The employee notice must be provided free of charge, in writing, and in a manner calculated to be understood by the average employee. The employee notice may be provided by first class mail or electronically if done in accordance with the DOL’s electronic disclosure safe harbor.

What Is the COBRA Model Notice?

Under COBRA, an individual who was covered by a group health plan the day before a qualifying event occurred may be eligible to elect COBRA continuation coverage. These qualified beneficiaries must be provided with an election notice within 14 days after the plan administrator receives notice of a qualifying event. The COBRA election notice is required to include specific information.

The DOL updated its model COBRA election notice to provide information about the Marketplace for the purposes of informing qualified beneficiaries that they may also be eligible for a premium tax credit to pay for coverage offered through the Marketplace. The model COBRA election notice also includes a clarification on the limit on pre-existing condition exclusions beginning in 2014. Such information is not specifically required under the Affordable Care Act and should have no impact on whether an employer is subject to the employer responsibility penalties if, in fact, a former employee obtains coverage on the Marketplace.

The Release provides that the use of the model COBRA election notice, if completed appropriately, will be considered good faith compliance with the COBRA election requirements. The model COBRA election notice does not provide a specific deadline or compliance date. Employers may wish to review their existing COBRA election notices for changes relating to the Affordable Care Act.

Conclusion

Employers have long been waiting for specific guidance from the DOL on their employee notice requirements. Now that it is here, compliance should be addressed well before the October 1, 2013, deadline.

For more information about this Advisory, please contact:

Gretchen Harders New York 212-351-3784 gharders@ebglaw.com

Michelle Capezza New York 212-351-4774 mcapezza@ebglaw.com

]]> http://blog.riskmanagers.us/?feed=rss2&p=11581 0 http://blog.riskmanagers.us/?p=11569 http://blog.riskmanagers.us/?p=11569#comments Tue, 21 May 2013 01:35:31 +0000 admin http://blog.riskmanagers.us/?p=11569

Yet, as many of you know, the Medicaid eligibility rules of many states require them to do just that — surrender their policies just before the time they would most likely pay off.

The big winner under this rule is not the insured or the state, but rather the insurance companies that will not have to pay a death claim. To avoid this absurd result, a number of states (Florida, Kentucky, Louisiana, Maine, Texas) have considered or are considering Medicaid life settlements.

Although the laws differ in the details, here’s a brief summary of how the proposals work. Rather than surrendering a policy, an insured who is attempting to become eligible for Medicaid may enter into a life settlement and designate the proceeds to be used for his or her long-term care. As an incentive to enter into the transaction, the insured can designate a beneficiary for the lesser of $5,000 or 5 percent of the face amount. In addition, any unused settlement proceeds would also go to the insured’s beneficiary.

These proposals create a win-win situation. The states would get some relief from Medicaid long-term care outlays, and the insureds’ beneficiaries would receive some remaining death benefit. At a time when many states are hurting financially, these laws would offer some badly needed help. This idea is just another example of how life settlements are good for consumers.

For most of our clients, the thought of a life settlement at the time they need long-term care should be a last resort. It could be, however, one more opportunity to find money at a time when it is really needed.

http://www.lifehealthpro.com/?utm_source=LHPro_Daily_eNL_051613_FreeERISA&utm_medium=Email&utm_campaign=LifeHealthPro_Marketing_Campaign

     By Darrell Pruitt, DDS – darrelldk@tx.rr.com

“Court sides with Iowa dentists in key billing case” By RYAN J. FOLEY, Associated Press

http://www.chron.com/news/article/Iowa-court-to-decide-key-case-for-dental-billing-4524864.php

So families with “high deductibles” of $3,500 or less are “burdened” even though they would have to pay $7,190 in higher premiums to avoid the deductible. Keep in mind that the premium is lost money.

By Greg Scandlen Filed under Health Insurance on May 16, 2013 with 19 comments

The folks at Harvard really, really hate cost sharing (i.e., deductibles, coinsurance and co-pays) in health care. They are much less concerned about high premiums or taxes. At least that is the conclusion one might draw from a new article in Health Affairs.

The authors examined the fate of 393 families enrolled in high-deductible plans through Massachusetts’ Commonwealth Connector. The families were well off enough to be unsubsidized and enrolled in a Harvard Pilgrim health plan. These were compared to similar families in plans with no deductible. They were looking for –

…respondents’ reports of any financial burden, higher-than-expected out-of-pocket costs, or discussions of costs with doctors. To measure financial burden, we asked enrollees whether, in the prior twelve months in the Connector plan, they or a family member had had problems paying or had been unable to pay medical bills; had had to set up a payment plan with a hospital or doctor’s office; or had had trouble paying for other basic needs such as food, heat, and rent because of medical costs. An affirmative answer to any of these three questions was considered an indication of financial burden.

So right off the bat, the authors are judging that any discussion of costs with a doctor is a bad thing, and any “payment plan” is a “burden.” You can see where this is going. One might think that discussing costs with a doctor would be a good thing, but not to the folks at Harvard. And, by golly, using these criteria the researchers found that lots of folks are “burdened.” They write –

Among families in such plans, those with lower incomes, worse health, and more children were at greater risk for financial burden and higher-than-expected out-of-pocket costs. Families in high-deductible plans were also more likely to have higher-than-expected costs than were families in plans with no deductible.

The authors are remarkably unconcerned about what it would have cost these unsubsidized families to avoid such burdens. But they include a table that provides a hint ― if you compare the difference in annual premium to the annual deductible, as I do below. Gold plans have zero deductibles.

So families with “high deductibles” of $3,500 or less are “burdened” even though they would have to pay $7,190 in higher premiums to avoid the deductible. Keep in mind that the premium is lost money.

The family would have to pay that every year no matter how little health care they consume.  The deductible may not be paid at all in a given year, or a family may have to pay only a portion of it.

But our friends at Harvard have no trouble burdening families with very high premiums (or taxes) provided they don’t have to pay for any of the health care they actually consume or (heaven forbid) have a discussion with the doctor about the cost of the care he or she is providing.