Viveka Health Automates Medical Provider-Payer Communications with New Amazon Alexa Skill, “Vive Health”

NEW YORK -- September 05, 2018Viveka Health, a leader in healthcare payer automation and intelligence technology solutions, today announced the release of a new skill for Amazon Alexa designed to enable health plans to automate eligibility and payment inquiries. The Vive Health skill for Amazon Alexa supplies members, patients and providers with real-time answers to their most pressing questions about benefit coverage and adjudication decisions.

By utilizing the Vive Health skill for Amazon Alexa, Viveka Health’s payer customers are able give their member and provider customers very specific information, all without the exchange of any personal health information (PHI). These payers now have access to information that is the same across the entire platform, including core claims, membership, provider, payments and mobile.

“They key is in utilizing Amazon Web Services (AWS) and Amazon Alexa for a single source of truth, so our customers don’t have to rely on expensive call centers or interactive voice response (IVR) systems that quickly become outdated,” explained Laurent Laor, a founder and product manager at Viveka Health. “This greatly improves value for both payers and patients.”

About Viveka Health

Viveka Health reduces healthcare expenditures and improves outcomes for payers through a complete portfolio of technology-enabled solutions created to support the full spectrum of back-office processes. The company’s intuitive and powerful software expertly manages employee enrollment and eligibility, medical claims processing and adjudication and remittances and overpayment recovery for the approximately 350,000 lives it services in California and the New York metro area. For more information, please visit http://www.vivekahealth.com.

Two Members of Dockworkers Union Charged in Scheme that Bilked Health Care Plan by Fraudulently Billing for Chiropractic Services

Department of Justice                      U.S. Attorney’s Office          Central District of California

 

FOR IMMEDIATE RELEASE

Tuesday, December 8, 2015

Two Members of Dockworkers Union Charged in Scheme that Bilked Health Care Plan by Fraudulently Billing for Chiropractic Services

LOS ANGELES – Two members of the International Longshore and Warehouse Union (ILWU), Local 13, have been arrested on federal fraud charges that allege they caused two medical clinics to bill the union’s health care plan for chiropractic services that either were not provided or were not medically necessary.

Sergio Amador, 49, of Downey, and David Gomez, 52, of San Pedro, were arrested yesterday without incident by federal authorities.

At arraignments yesterday afternoon, Amador and Gomez pleaded not guilty to mail fraud charges contained in an indictment that was returned by a federal grand jury on November 18. Both men were freed on bond and were ordered to stand trial on February 2, 2016.

The ILWU represents dockworkers at the ports of Los Angeles and Long Beach. Members of the union receive benefits, including health care benefits, through the International Longshoremen’s and Warehousemen’s Union – Pacific Maritime Association Welfare Plan.

In 2009, Amador and Gomez opened a clinic in Long Beach operating under the name Port Medical that purported to provide general medical and chiropractic care. The next year, they opened a second clinic operating under the same name in San Pedro.

According to the indictment, Amador and Gomez also created medical management companies that they used to receive funds generated by the medical clinics, which were then used to pay themselves and to pay incentives to Welfare Plan members to use the Port Medical clinics and to encourage other Welfare Plan members to use them. The incentives allegedly included cash payments and sponsorships of sports teams.

The indictment alleges that when some Welfare Plan members went to the Port Medical clinics to receive chiropractic treatment, they were asked to sign their names on multiple sign-in stickers, while on other occasions Welfare Plan members’ signatures on sign-in stickers were forged. According to the indictment, Amador and Gomez then caused the sign-in stickers to be used to create chart entries that falsely indicated the Welfare Plan members had received chiropractic services on dates when no such services had been provided.

The indictment also alleges that Amador and Gomez encouraged Welfare Plan members to go to the Port Medical clinics to receive massages, heat and ice treatments and other services that were not medically necessary – while the patients’ medical charts falsely showed “that the services provided were medically necessary, addressed specific conditions of patients that had been properly diagnosed, and were used to support and facilitate chiropractic care.” Those services – and others never provided – then allegedly were billed to the Welfare Plan. Those bills also concealed that patients had been recruited through the use of cash payments or other incentives.

As a result of the fraudulent scheme, the indictment alleges that Port Medical received at least $225,000 from the Welfare Plan.

What Is a Trauma Team and Why Is Its Activation So Expensive? - themedicalbag.com

Recently, a doctor writing in the Wall Street Journal highlighted a $10,000 charge for a trauma team activation that apparently never took place. In apost on my personal blog, I addressed some of the problems with the piece, but a $10,000 trauma team activation charge for an 11-day-old bruise on the head of a toddler seems excessive, even if the team had attended to the patient.

A trauma team consists of several members depending upon the resources of the hospital and its level of trauma center designation. Here are some of the people who may be involved:

Trauma surgeon (sometimes in-house 24/7), emergency physician, residents, or mid-level providers

Anesthesiologist or nurse anesthetist

OR tech and circulating nurse

Emergency or ICU nurses

Nursing supervisor

X-ray and CT techs

Lab, blood bank

Respiratory therapy

Social worker, chaplain

When the trauma team is activated, the clinicians rush to the emergency department and the support personnel prepare for the worst. The doctors and nurses are usually assigned specific roles during patient resuscitation and evaluation that are gone over during drills and simulations. The idea is that the patient should be assessed as rapidly and thoroughly as possible so that appropriate treatment can be delivered in a timely way.

In discussing the expense, you must understand the difference between what a hospital charges (ie, the bill) and its costs, which are determined in mysterious ways. What a hospital charges for a trauma team activation is not related to the actual cost. An exposé by the Tampa Bay Times was revealing. Here are some quotes [emphasis added]:

“None of the hospital officials who spoke to the Times would itemize the expenses that go into their trauma fees. Some said they didn't even have that kind of a document.

"‘It's not based on our cost,’ Robyn Farrington, a trauma administrator at Broward Health, told the Times in a 2013 interview.”

“Farrington said her hospital's average fee of $4,473 was based more on ‘the market,’ or what other hospitals charged.”

“Recently, a hospital spokeswoman said the fee was based on actual costs,but these costs could not be separated line-by-line. I would like to have their accountant do my taxes next year.”

The investigation found that the average trauma team activation fee in Florida was $10,800, up from $2555 in 2006, with the most expensive hospital charging $33,000.

Similarly disparate hospital charges exist in Texas, where doctors are cashing in too. The Statesman of Austin reported that some surgeons receive as much as $7000 per day for being on call. Those are salary numbers even a hospital or insurance company CEO might envy.

According to a 2009 paper in the Journal of Trauma,“ there are no widely available data on the actual costs of readiness and standby that can be applied to determine ‘reasonable’ individual patient charges.”

That study said that the fee was established to help trauma centers recoup some of the losses they suffer when taking care of uninsured patients. Also, the team is often mobilized for what turns out to be insignificant injuries. The cost of a trauma team response may not be recovered for such injuries.

Note also that many of the trauma team (ED MDs, ED RNs, ancillary personnel, and others) are already present and not really costing the hospital extra money. Centers for Medicare and Medicare Services rules state that only activations for outpatients are reimbursable. Activations for admitted patients come under the admission DRG and thus are not paid for.

Yes, hospitals deserve something for all the free care they give to trauma patients, but there must be a better way than simply allowing whatever the market will bear.

You're paying 130% more for health care than a decade ago - New York Post

Employees of midsize and large companies in 2015 paid an average of $4,700 for their health insurance, up from $2,001 in 2005, according to recent analysis from Aon Hewitt.

Because they are looking for solutions to high costs, companies are changing the design of their benefit programs, Aon Hewitt Senior Vice President Mike Morrow said, moving toward leaner plans. In fact, 38% of employers have increased their participants’ deductibles and/or copays in the last year, and another 46% may do so in the future, the report from Aon said.

Companies are also beginning to offer high-deductible health plans (HDHPs) more frequently, an option that didn’t really exist for employers until the last decade, said Gerald Kominski, the director of the UCLA Center for Health Policy Research; they are now the second-most popular plan choice, surpassing health-maintenance organization plans (HMOs).

Employers are making cutbacks in health coverage in other ways, too. Some 18% of companies are reducing subsidies for covered dependents, and 17% are adding a surcharge for adult dependents who have access to other health coverage. Plus, 43% of companies are considering using unitized pricing, in which employees pay per person instead of individual versus family.

“It comes down to a fairness-and-equity point of view,” Morrow said. “If you are covering many more members of your family than another employee, is it fair that your contributions are the same?”

These types of increases in health-care costs do make a significant impact on workers’ purchasing power, since they happen faster than increases in wages, Kominski said.

Still, health-care rate increases are showing some signs of slowing down. In 2015, the average health-care rate increase for employees was 3.2%, the lowest increase since Aon started tracking this data in 1996. Although this increase was comparatively low, it was still higher than the consumer-price index and overall inflation, which remained basically unchanged in the 12 months ending with September 2015, and the overall compensation budgets of Aon’s clients, Morrow said.