The Fraud Prevention & Investigation unit of Thomson Reuters has released a white paper that explores the growing presence of organized crime groups in healthcare fraud.

The paper offers an overview of the growing problem of healthcare fraud in the United States, the cost of which is estimated by Thomson Reuters to be $150 billion annually, and the disturbing trend of organized crime groups and gangs in perpetuating complex schemes to defraud Medicare and Medicaid.

The free, in-depth white paper, titled “From Drugs to Wheelchairs: New Technology Fights the Growing Menace of Organized Crime in Healthcare Fraud,” offers details about the fight against fraud being mounted by government agencies and federal, state and local law enforcement. It details their use of sophisticated technology such as data mining and predictive analysis using search tools like CLEAR for Healthcare Fraud Investigations to stop organized crime groups.

“Organized crime groups and gangs are turning from drugs to healthcare fraud, and taking with them billions of taxpayer dollars from the healthcare system. They’re lured by the vast amount of money flowing through Medicare and Medicaid, and the relatively low risk of violence,” said Steve Rubley, managing director, Government, Thomson Reuters. “This white paper sheds light on the fight our government is waging against this fraud, and the state-of-the-art technologies that are assisting investigators in this fight.”

To request a free copy of the white paper, please send an email to clear[at]thomsonreuters.com.

Today’s graphic looks at a the results of a recent Reuters/Ipsos poll on U.S. opinions on healthcare and the economy. If you were asked these same questions, what would your answers have been? Feel free to list them in the comments section.

For more graphics like these, check out the Reuters News Infographics page.

Contrary to Nintendo’s effort, video games won’t make your kids healthier, or at least that is what a recent study has shown.  Nintendo’s Wii video game system and its corresponding games have been marketed to children and parents alike as a way to get kids off the couch and exercising as the United States battles an obesity epidemic, plaguing adults and children alike.  In 2008, more than 1/3 of children and adolescents were overweight or obese and the Center for Disease Control estimates that childhood obesity has more than tripled in the past thirty years.

To get a clearer picture of how, or if,  the Wii system actually influenced the amount of exercise its child users get, the Baylor College of Medicine in Houston, Texas gave Wii consoles and games to 78 overweight children between the ages of 9 and 12 and then tracked their physical activity. Half of the children were given a choice of an active game like, Dance Dance Revolution, and the other half were given a choice of sedentary games like Super Mario. At the mid-point of the study, the children were offered a second game from the same category as the first-active or inactive.  Accelerometers were used to track the children’s physical activity levels for 13 weeks.  After the thirteen weeks of tracking, researchers found that the children playing active games got an average of 25 to 28 minutes of moderate or vigorous physical activity each day while children playing inactive games got an average of 26 to 29 minutes of moderate or vigorous physical activity each day, essentially disproving the theory that the Wii and its active games facilitate exercise.  According to the original Reuters article, Nintendo was unavailable for comment.

While this study may very well prove the old adage, “if it sounds too good to be true, it probably is”, exercise scientist, Jacob Barkley, told Reuters Health, “Maybe the Wii isn’t going to increase physical activity a whole heck of a lot, but it might increase caloric expenditure a bit more than a traditional sedentary video game, and if you do that on a daily basis that could have a cumulative effect that might be beneficial.”

Wal-Mart Stores Inc. announced a cut in health insurance benefits on Friday, October 21^st, according to by Reuters’ journalist, Jessica Wohl. Wal-Mart will be joining the ranks of Wells Fargo & Co. and General Electric, who have also announced upcoming cuts to their employee health care benefits in 2012.

As the United States largest private employer, Wal-Mart employs 1.4 million people in the United States and insures more than 1 million employees and their families. The benefit reduction as laid out in the original article on Reuters.com, will only affect new, part time employees (working less than 24 hours per week) and workers that admittedly use tobacco. Part time employees (working less than 24 hours per week) will no longer be eligible for corporate insurance benefits with Wal-Mart and tobacco users will be looking at higher costs (basic plans will cost tobacco users $25 per pay period while non-tobacco users would pay only $15 per pay period).

In light of a separate article published by Reuters from Entrepenaurer.com, corporate insurance hikes should come as no surprise. In late September, Reuters chronicled the results of an annual healthcare survey by the Kaiser Family Foundation and the Health Research and Education Trust. According to the survey, the average annual premium for family coverage sponsored by an employer rose 9% from 2010 to 2011 and individual plans of a similar nature rose by 8% from 2010 to 2011. Over the course of the last ten years, there has been a 134% increase in the cost of health care premiums.

In a statement from Wal-Mart spokesman Greg Rossiter, he looks to the United States government to ease the burden of increasing healthcare costs, “Our country needs to find a way to reduce the cost of healthcare, particularly in this economy.” However, according to some small business owners, some of the new health care laws are actually creating the dramatic increases in healthcare costs. According to the study by the Kaiser Foundation and the Health Research and Education Trust, 1.5 percentage points of the 9% increase in healthcare premiums can be retraced to elements of health care laws.

While it remains to be seen how many other businesses or corporations may or may not be cutting healthcare benefits in 2012, a survey conducted by Mercer projects only 5.4% increase in health benefits costs for 2012.

The latest Thomson Reuters-NPR Health Poll reveals that one in five households have at least one member with a food allergy or intolerance. Interestingly food allergies are more prevalent among respondents under 35 years. Why do you think that is?
In any case, the most common intolerance seems to be for milk and milk products. Find out what else people are intolerant to by reading the full story here.

 

 

In an unscheduled appearance, former US President Bill Clinton appeared at the Aspen Ideas Festival yesterday afternoon and talked about jobs, the debt ceiling, and Medicare.

On jobs, he pointed out that 3 million jobs are posted for hire, but are being filled at about half the rate of previous recessions.  It’s important to bring back construction and manufacturing, not just service jobs.  Banks need to lend and companies need to borrow to accelerate this.  IT was the job growth engine of the 1990s, but not now.  In the 2000s, jobs could have come from the energy sector but there was a lack of investment in alternative energy, and this was a lost opportunity.

In the 2010s, President Clinton seemed to feel that the US is even less well-placed.  Many people have swallowed the GOP message that government is the problem, while corporations feel no responsibility towards the state, only their shareholders.  Business schools have certainly followed Friedman in teaching this view, stressing the claims of fiduciary responsibility, while in the US and much of the Western World, corporations are increasingly treated as persons under the law.

The debt ceiling debate was clearly a source of ire.  Congress has already voted to incur debt by spending money, so how can it now refuse to raise the ceiling?  (more…)

Sidebar on Jean MacQuarrie of Thomson Reuters Testifying at the House Oversight & Government Reform Hearing

CLEAR for Healthcare Fraud: most comprehensive solution for fraud and abuse detection market

CLEAR, the powerful public and proprietary records service and investigative suite from Thomson Reuters, is well-regarded among law enforcement and government investigative professionals for helping nab criminals and recover missing children. Now, the business has introduced a new version of the service to aid in the recovery of the $60 billion that the National Health Care Anti-Fraud Association estimates is lost each year to fraud.

CLEAR for Healthcare Fraud takes specific industry data and key provider content such as NPI (National Provider Identifier) numbers, sanctions data and professional licensing information, and combines it with a deep collection of utility records, cell phone data and other public records, to provide a powerful search tool that can pinpoint not just minor data aberrations, but true inconsistencies warranting further investigation. The results of those investigations can help remove fraudulent healthcare providers from Medicare and Medicaid payrolls and recover billions of dollars in wasteful spending. 



CLEAR for Healthcare Fraud offers the fraud, waste and abuse detection market its most comprehensive solution to date, including more live gateways to real-time data as well as Web analytics that combine public records data with Web search capabilities.
The business is uniquely positioned to combine market expertise and unique content sets from across Thomson Reuters to provide customers with a new level of power in the healthcare fraud, waste and abuse mitigation space.

(more…)

Thomson Reuters Micromedex has just released a new iPhone® application that gives clinicians mobile access to clinical reference information for monitoring drug interactions. The new application, Micromedex Drug Interactions, enables clinicians to check up to 50 patient medications simultaneously for potentially harmful interactions. Severity ratings are assigned to each interaction ranging from contraindicated to minor. Additionally, users can see why the drugs in question interact, how the results of those interactions will present in the patient, and recommendations for monitoring patient outcomes.

“As the use of mobile devices increase in clinical settings, it becomes increasingly important for our applications to be accessible that way,” said Thomas Hegelund, executive vice president at Thomson Reuters.

Both the Micromedex Drug Interactions and Drug Information applications are currently available for iPhone, iPad®, and iPod® touch.  Releases for the Android operating system are planned for later this year. For more information and to download each application, clinicians can go to www.micromedex.com/mobile.

To help states navigate the changing landscape of health information exchange (HIE), Thomson Reuters has provided an overview of existing governance models and the benefits and challenges of each.

“No single template exists for a state health information exchange plan as states will ultimately select a governance model that is best for their unique characteristics,” said Matthew Bates, senior vice president of products and solutions at Thomson Reuters. “However, there are important factors to consider as each model has pros and cons.”

When choosing a model, states should consider:

- Geography – requirements for building the infrastructure will vary based on the size of the state and the urban/suburban/rural makeup.

- Trust Framework – the level of cooperation and consensus that can be obtained will affect the model chosen.

- Population size – the number of providers and hospitals, and the number of patients, can be complicating factors.

“States need to think long-term when considering a governance model,” Bates advised. “Careful planning is essential to the improvement of the quality, safety and efficiency of the healthcare in each state and, ultimately, nationwide.”

The white paper, Governance Models For Health Information Exchange, is the first of three reports on HIE from Thomson Reuters. Co-authored with eHealth Initiative, it provides a current snapshot of HIE governance plan stages and models of all 50 states.

To download a free copy of the white paper, please click here. Information will also be available Thomson Reuters booth # 5263 at HIMSS 2011 in Orlando.

Do you think it’s possible to predict the winner of the Nobel Prize? That’s exactly what researchers at Thomson Reuters are trying to do in an interesting experiment called the Citation Laureate Nobel Prize Predictions.

Brian Wilson, vice president and chief architect for Thomson Reuters’ Healthcare and Science business, talked about this project at the Strata Conference on Thursday, February 3^rd in a presentation titled Research Evaluation in the Age of Global Digital Scholarship. Wilson opened by stating, “Predictive analysis is the holy grail of this whole data thing,” and posed the question: How do you predict the progress of science? “We have thousands of scientists around the world that are working to predict the future of science,” said Wilson “And, we have more than 40 years of experience in this. So we do something kind of fun – we try to predict who’s going to win the Nobel Prize.”

(more…)