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By Amanda Seitz – Jan 30, 2023

WASHINGTON (AP) — The Biden administration estimated Monday that it could collect as much as $4.7 billion from insurance companies with newer and tougher penalties for submitting improper charges on the taxpayers’ tab for Medicare Advantage care.

Federal watchdogs have been sounding the alarm for years about questionable charges on the government’s private version of the Medicare program, with investigators raising the possibility that insurance companies may be bilking taxpayers of billions of dollars every year by claiming members are sicker than they really are to receive inflated payments.

The Department of Health and Human Services said it will begin collecting payments from insurers when an audit turns up that they charged for diagnoses that are not reflected in the patient’s medical records. The government has not sought refunds for those payments in over a decade, the agency said.

“Today, we are taking some long overdue steps to move us in the direction of accountability,” HHS Secretary Xavier Becerra said Monday during a phone call with reporters.

The penalties are expected to return $4.7 billion over the next decade, the agency estimated.

The questionable payments are submitted through Medicare Advantage, a booming program that nearly half of the 60 million people enrolled in Medicare sign up for. Medicare Advantage is different from traditional Medicare, with private companies offering plans that are reimbursed by the government for care. The government spent $900 billion last year overall on Medicare.

With the rise in popularity has come growing concern that insurers are ripping off taxpayers by overstating how sick a patient is to unlock higher reimbursements from the government. The HHS Office of the Inspector General raised red flags about $6.7 billion worth of payments for patients whose diagnoses were not supported by medical records in 2017, for example.

Insurers have been gearing up for a fight against the long-awaited final rule, with company leaders raising concerns about the accuracy of the audits. The move will raise insurance rates, warned Matt Eyles, the president of America’s Health Insurance Plans, the lobbying arm for health insurance companies.

“Our view remains unchanged: This rule is unlawful and fatally flawed, and it should have been withdrawn instead of finalized,” Eyles said.

‘Greg Says‘ agrees that increased oversight of the insurance carriers offering Medicare Advantage plans is warranted.  The carriers need to be held accountable when they file fraudulent reports regarding the health condition of their plan members in order to increase the payments they receive from Medicare to insure Medicare beneficiaries.

Many people prescribed antibiotics in the U.S. don’t need them, and a study suggests this is particularly true for Black and Hispanic individuals.

By Lisa Rapapor – April 28, 2022

Two-thirds of antibiotics prescribed to Black people are unnecessary, as are more than half of such prescriptions for Hispanic individuals, according to preliminary results from a recent study.

Three in four antibiotics prescriptions for patients 65 and older aren’t needed, a recent study found. Two-thirds of antibiotics prescribed to Black people are unnecessary, as are more than half of such prescriptions for Hispanic individuals, according to preliminary results from a study presented at the European Congress of Clinical Microbiology and Infectious Diseases in Lisbon.

“Our results suggest that Black and Hispanic/Latinx patients may not be properly treated and are receiving antibiotic prescriptions even when not indicated,” said an author of the study, Eric Young, of University of Texas Health Science Center in San Antonio, in a statement.

Particularly for elderly patients, the stakes of these unnecessary prescriptions are high, Young said. “In older adults, inappropriate prescribing in primary care is associated with a wide range of adverse outcomes, including emergency hospital attendances and admissions, adverse drug events, and poorer quality of life,” Young said.

For the study, researchers examined data from the Centers for Disease Control and Prevention (CDC) on prescriptions written during outpatient visits for more than 5.7 billion adults and 1.3 billion children between 2009 and 2016. Overall, 11 percent of these patient visits resulted in antibiotics prescriptions, the analysis found.

Antibiotics should be prescribed only for bacterial infections, which can include strep throat, bloodstream infections, bacterial pneumonia, urinary tract infections, and some types of ear infections. Antibiotics are ineffective against viral infections, such as the flu, and shouldn’t be used for viral illnesses.

Most often, when antibiotics were used inappropriately in the study, doctors offered these medicines to treat viral infections, bronchitis, or skin conditions unrelated to bacterial infections, the analysis found.

One limitation of the study is that it looked only at outpatient visits, not at antibiotic use inside hospitals. Another drawback is that researchers lacked some data that might have influenced prescribing decisions, such as patient allergies or certain diagnoses that might warrant use of antibiotics. The results have not been published in a peer-reviewed medical journal, a process that typically involves an independent verification of the findings.

While the study wasn’t designed to determine why so many patients got antibiotics they didn’t need, it’s possible that clinicians made decisions based at least in part on whether they thought people might be able to return to the doctor if their condition took a turn for the worse, Young said.

“We know that physicians typically send patients home with antibiotics if they suspect their symptoms may lead to an infection,” Young said. “This practice becomes more common when patients are unlikely to return for a follow-up visit or have no established care within a clinic or hospital system, which more frequently happens in minority populations.”

Yes, broken heart syndrome (also known as takotsubo cardiomyopathy or stress induced cardiomyopathy) is a real heart condition. Broken heart syndrome is a temporary and reversible heart condition whose symptoms mimic those of a heart attack. Unlike heart attacks, broken heart syndrome occurs when sudden emotional or physical stress causes a weakening of the heart muscle.

Risk Factors For Broken Heart Syndrome

Broken heart syndrome usually affects women more so than men, as well as people over the age of 50. Another factor that may increase your risk of developing broken heart syndrome is whether you’ve been diagnosed with a current or previous mental health disorder, such as anxiety and depression.

Causes Of Broken Heart Syndrome

Broken heart syndrome is brought on by physical or emotional stress. Physical stressors that may cause this condition include severe pain, exhausting physical activity, and a variety of health issues such as asthma attacks, difficulty breathing (dyspnea), seizure, stroke, high fever, low blood sugar, intense blood loss, or surgery.

Emotional stressors that may cause broken heart syndrome include intense good news (surprise party or winning the lottery), intense bad news, grief from the death of a loved one or other meaningful loss (divorce, loss of home, loss of job, loss of money, loss of pet, etc.), intense fear, and extreme anger.

This condition is thought to be brought on by a sudden surge of stress hormones such as adrenaline, epinephrine, noradrenaline, and norepinephrine, which might temporarily cause a decrease in heart health. These hormones interfere with your heart’s ability to function properly by disrupting your heart’s normal rhythm, temporarily enlarging part of your heart (the lower portion of the left ventricle) and creating more forceful contractions in other areas of your heart. These changes lead to temporary heart failure.

In rare cases, use of certain drugs may lead to the development of broken heart syndrome, such as emergency medications used to treat severe allergic reactions or asthma attacks, anxiety medications, nasal decongestants, or illegal stimulants such as methamphetamine or cocaine.

Symptoms Of Broken Heart Syndrome

With broken heart syndrome, the release of stress hormones temporarily stuns your heart muscle and produces symptoms that are similar to the experience of a heart attack. These symptoms include sudden and severe chest pain, shortness of breath, weakening of the left ventricle of your heart, fluid in your lungs, irregular heartbeat (arrhythmias), and low blood pressure.

Complications Of Broken Heart Syndrome

Although complications arising from this condition are rare, they can sometimes occur. Possible complications due to broken heart syndrome include a rupture in the left ventricle of the heart, blockage of blood flow from the left ventricle, blood clots in the wall of the left ventricle, left ventricular outflow tract obstruction, cardiogenic shock, complete atrioventricular block, congestive heart failure, and even death.

Prevention Of Broken Heart Syndrome

While there are no known treatment options for the prevention of this condition, stress management and relaxation techniques can help to reduce the physical and emotional stress that can lead to the development of broken heart syndrome. These methods include relaxation techniques such as yoga, meditation, journaling, or taking a warm bath. Stress management techniques include eating a healthy diet, getting regular physical exercise, getting seven to nine hours of sleep each night, reducing alcohol and tobacco consumption, and keeping up with medical appointments.

Testing For Broken Heart Syndrome

To determine whether you are experiencing broken heart syndrome, your doctor will first conduct a physical examination and review your medical history. After this, a series of tests will be ordered, including an electrocardiogram (EKG), coronary angiography, echocardiogram, chest X-ray, cardiac MRI, and a ventriculogram. These tests will help rule out any other possible causes of your symptoms and properly diagnose your condition.

Treatment For Broken Heart Syndrome

Treatment for this condition depends on the severity of the symptoms. Typically, your doctor will prescribe medications for either short term or long-term use. Long term medications include ACE inhibitors to lower blood pressure and anti-anxiety medications to manage stress. Short term medications include beta blockers to slow your heart rate and diuretics to decrease fluid buildup.

Depending on the extent to which your heart muscle was weakened, your doctor may also recommend cardiac rehabilitation, a program which strengthens your heart muscle by helping you receive regular physical activity, along with education about healthy lifestyle changes such as quitting smoking, reducing alcohol consumption, and switching to a healthy diet. The program also offers counseling to relieve stress and improve mental health.

By – Andrea Atkins

February 15, 2023

Jokes about “senior moments” may seem harmless, but such negative stereotypes and ageist attitudes are stressful to the people they’re aimed at. Combating ageism, however, may help you stay healthier longer.

You might find yourself chuckling uncomfortably when your grown daughter says your penchant for losing your glasses is just part of the “joy of aging.” Or when a friend teases you, saying that “your advanced age” is the reason you sometimes can’t remember why you got up to walk into the other room. And then, of course, there are endless jibes about the ill effects of advanced age from talk show hosts and all-over social media.

“These stereotypes are funny, they’re self-deprecating, but they may have serious consequences for health,” says Julie Ober Allen, PhD, assistant professor at the University of Oklahoma and co-author of a recent study in JAMA Network Open. The study shows that more than 90 percent of older people report having experienced ageism on a regular basis. In fact, according to Alana Officer, the unit head for Demographic Change and Healthy Aging at the World Health Organization (WHO), 50 percent of the world’s population has moderate to high levels of ageist attitudes against older people.

What exactly is ageism? According to the WHO, ageism is prejudice and discrimination towards others – and even ourselves – based on age. Ageism may adversely affect people’s status at the workplace, in health care policies and with interpersonal interactions.

How does ageism affect your health?

“When you hear those types of comments over and over and over again, from health care providers, from service providers, from friends and family and even from yourself, it can become a major source of stress,” Ober Allen says. “Over time, it may start to wear the body down. And that really increases people’s risk for a variety of adverse health outcomes, both physical and mental.”

We absorb these ageist stereotypes sometimes as early as three years old, according to research, and by the time we are old ourselves, may accept them as truth. These negative beliefs “can become scripts we begin acting out,” says Becca Levy, PhD, a Yale University professor of public health and psychology and author of Breaking the Age Code: How Your Beliefs About Aging Determine How Long and Well You Live.

Levy identifies three pathways for ageism’s effect on health.

Biological

Levy’s research has found that negative health beliefs are correlated with higher levels of cortisol and C-reactive protein in the blood, which may be indicators of stress, she says. Increased stress can lead to inflammation, which is linked to heart disease and stroke.

Behavioral

If you take in the negative age belief from our society – that aging is a time of decline and think there’s nothing you can do to combat this – then you’re less likely to be proactive, Levy says. That might include abandoning good health practices, like getting exercise and eating a nutritious diet, and may lead you to believe that medication or other medical advice will make no difference.

Psychological

Your self-esteem takes a hit after repeatedly hearing messages that suggest you can’t contribute to society, and that, according to Levy’s research, can lead to depression and other mental health problems. Her research has also found that negative stereotypes may adversely affect memory and cognition.

Positive beliefs about aging can improve your health and may even help buffer you against diseases like dementia.

How to combat ageism

So how can you combat the negative beliefs associated with ageism when they are so pervasive? Levy suggests the ABC approach to improve your beliefs about aging and, ultimately, your health:

1. Be AWARE of these negative messages and the power that they have. Notice when you hear them in conversation or on TV or when you read them in a publication.
2. BLAME ageism not aging. If you misplaced your keys, ageism suggests it’s because you’re old and forgetful. But you might have misplaced your keys when you were in your thirties, too. Your absentmindedness may be a symptom of a distracted moment in your day not of aging, Levy says.
3. CHALLENGE the stereotypes. Levy’s research has found that older people who actively confront ageism are less likely to develop depression and anxiety. It may seem awkward to point out ageism when someone levels it at you, but it’s important to fight back against this practice. If you don’t, you can begin to “think yourself old,” says Barbara Waxman, MS, MPA, PCC, a life-stage coach, gerontologist, and member of the Stanford Center on Longevity Advisory Council.

“We no longer have to be defined by a chronological number,” Waxman says. “We’ve added roughly 30 years to life expectancy over the past 120 years. Those years don’t show up as more years of being frail; they show up as years in the middle of our lives. We’ve expanded not just our life expectancy but our health span, too.”

As a result, those of us who are older can be the ones who get the last laugh.

By Nihal Krishan
JAN 18, 2023 | FEDSCOOP

The Department of Health and Human Services has launched a pilot program to tackle Medicare fraud using tree-based artificial intelligence models and deep learning approaches, HHS Chief Information Officer Karl Mathias said Wednesday.

The program has so far helped streamline fraud identification within the more than one million transactions processed each day by the Centers for Medicare & Medicaid Services (CMS), according to the IT leader.

“They’re using tree-based models and deep learning approaches and then they go and look at the Medicare administrative claims data,” said Mathias during a AFCEA Bethesda Health IT event Wednesday.

“It’s still in a pilot phase but they’ve seen some success with this, and they intend to keep growing it.”  The IT executive added that the AI systems being tested have an edge over current fraud detection systems because tree-based models allow faster identification of new types of criminal activity.

“As Medicare fraud criminals figure out what’s being spotted by law enforcement, they keep changing their techniques, then this AI system figures that out and drops obsolete models based on that,” said Mathias.

Tree-based AI models use a decision tree to represent how different input variables can be used to predict a target value. Machine learning systems use tree-based models both for classification and regression problems.

Mathias said that HHS has also started using new AI technology to speed up counterfeit drug detection at the Food and Drug Administration (FDA) by using computer vision AI to tell whether a drug is authentic or fake. The technology can do so within seconds by evaluating wavelengths, which mitigates the need for a human to carry out a physical inspection.

Another branch of HHS, the National Institutes of Health (NIH), has also begun using AI automation when it comes to research grant proposal analysis and auditing. According to Mathias, the AI system has a 92% accuracy rate when it comes to accepting the appropriate grant proposals, thereby eliminating a key bottleneck for innovative research approval. The CIO added that the use of AI systems at NIH would ensure taxpayer dollars are used more efficiently.

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Greg Says encourages the use of artificial intelligence and any new tools that can stem the growth of Medicare fraud which is estimated to cost taxpayers more than $65 Billion per year.

Medicare fraud can result in higher out-of-pocket costs, including co-pays and co-insurance for services. A beneficiary may have to pay for services that weren’t provided, were excessive, or were medically unnecessary. Additionally, they may be responsible for 100% of costs if the service was denied by Medicare.