Dear Friends and Colleagues:
Attached you find an article from todays Miami Herald reporting that Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The callous abuse of the Medicare system, a vital lifeline of needed healthcare service for millions of senior patients, has reached new heights in South Florida. here are the facts for Dade county ALONE:
* Miami-Dade is home to 334 Medicare-certified home healthcare providers.
* All together, the top 10 home health providers were paid $139 million by Medicare in 2007.
* Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
* The agency's spending in Miami-Dade totals $1.3 billion out of a nationwide budget of $16.5 billion.
* Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
There are only two conclusions: either the demand for home health care service has increased by 13 x times the national rate OR (more likely) unscrupulous provides are defrauding the system.
As physicians we MUST work collaboratively with law enforcement and CMS to STOP this abbuse. Every dollar diverted for for fraud will further jeopardize our struggle for reimbursement of physicians services.
We should also NOT stop from reporting those physicians who receive hefty and lucrative referral fees from home health companies. Protecting those "colleagues" means acquiescing to fraud and abuse of the system.
Yours
Bernd
Posted on Sun, Nov. 23, 2008
Ruling halts Medicare payments to more Miami-Dade home healthcare providers
BY JAY WEAVER
Medicare will suspend millions of dollars in payments to dozens of additional home healthcare providers in Miami-Dade after a federal judge ruled it has the power to stop reimbursements to companies suspected of overcharging for diabetic and other services.
The government agency began the crackdown on the top 10 Miami-Dade home healthcare operators in October, citing potential fraud, but one of the providers sued in federal court claiming Medicare exceeded its authority.
This week, U.S. District Judge Paul Huck sided with Medicare, saying the taxpayer-funded program's suspension policy is ``reasonable and appropriate.''
His decision allows Medicare to continue halting payments to local companies suspected of submitting excessive claims for nurses treating homebound patients who either aren't diabetic or don't need help injecting insulin.
Miami-Dade is home to 334 Medicare-certified home healthcare providers. Many could be affected by the giant entitlement program's unprecedented suspensions.
''Because of the judge's decision, we will be able to expand our efforts to look at other home healthcare companies for payment suspensions and audits,'' Medicare spokesman Peter Ashkenaz said Friday. ``We just want to make sure the people getting home healthcare services are receiving them under the law.''
The judge's decision followed a Miami Herald story that detailed how the home healthcare company that sued Medicare over the suspension policy had billed the agency about $75,000 last year for a nurse to inject the insulin of a homebound diabetic patient.
But the patient, 92-year-old Maria C. Perez, who was living in a Westchester group home, told the Miami Herald that she has never been diabetic and didn't receive twice-a-day insulin injections from a visiting nurse in the latter half of 2007.
Her family doctor and medical records backed up her statement.
Home Care Services Provider, based in Kendall, said it did send a nurse twice daily to treat Perez for diabetes from June to November last year based on a prescribed referral by a Hialeah physician. It denied any wrongdoing.
MULLING AN APPEAL
As for the dispute over Medicare's suspension policy, the company's lawyer said it is considering an appeal of the judge's decision, filed Wednesday.
''We respectfully disagree with the court's ruling,'' attorney Anthony Vitale said in a statement. ``We believed then and we believe now that the Medicare payment suspension regulation is illegal.''
But that dispute with Medicare could be the least of Home Care Services Provider's problems.
The company's Miami-Dade owner, Maria Del Carmen Escarpio, 48, was charged in July with defrauding the Florida Medicaid program, which covers healthcare services for low-income people.
She's accused of using her Kendall home healthcare business to bill the state program $447,000 in wound care supplies and oxygen equipment that were never delivered to Medicaid patients in 2003-04. Moreover, the patients didn't have any wounds or need the oxygen, state authorities said.
''We're vigorously defending her in that case,'' said Escarpio's criminal attorney, Louis Martinez. ``It has nothing to do whatsoever with the current Medicare case [in federal court] nor does it have anything do with the suspension.''
In early October, Medicare suspended millions of dollars in payments to the top 10 home healthcare agencies in Miami-Dade County, citing a spike in questionable billing for diabetic and other services.
All together, the 10 providers were paid $139 million by Medicare in 2007.
The suspensions, which entail audits of claims and payments dating back to 2004, are in effect for at least six months.
FIRST TARGETS
Among the first targets: Home Care Services Provider, which received $12 million in Medicare payments last year.
About 72 percent of its income came from treating mostly homebound diabetic patients, records show.
Medicare issued the suspensions after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade.
The agency's spending in Miami-Dade totals $1.3 billion. Its nationwide budget is $16.5 billion.
Since 2001, Medicare's Miami-Dade payments for home healthcare has grown at a pace 13 times the national rate.
What Medicare officials have found is that the massive health insurance program for the elderly and disabled is losing potentially hundreds of millions of dollars a year in Miami-Dade to fraud, abuse and waste in home healthcare.
The first round of Medicare suspensions in Miami-Dade were based on ''reliable information'' that home care claims submitted last year ''may have involved an overpayment, fraud or misrepresentation,'' according to an Oct. 3 Medicare letter sent to the targeted companies.
DIFFERENT SIGNATURES
The letter noted that certain physicians had told Medicare that their signatures didn't match those on prescribed patient care plans submitted to home care providers.
But one Miami-Dade operator, Patient Care, Inc., fired back a letter, saying it was ``being unfairly herded into the slaughterhouse as a result of its success and not a single shred of evidence.''
Sunday, November 23, 2008
Tuesday, November 18, 2008
Home Health Care Fraud
DADE COUNTY: THE HOME HEALTH CARE FRAUD CAPITOL OF THE NATION
The Miami Herald ran another excellent investigative report about the rampant fraud and abuse committed by Home Health Care Service agencies. http://www.miamiherald.com/living/health/v-fullstory/story/773538.html
Some facts.
• Medicare spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.
• Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.
• Medicare was billed roughly $75,000 by a Home Health Care Service provider for twice-daily nursing visits to inject her with insulin to control diabetes during the latter half of 2007.
• According to federal records, Medicare paid one company about $12.6 million last year. A little more than 70 percent of its income was for treating homebound diabetic patients, records show.
What can we do:
1. Report any attempt by home health company representatives offering financial “incentives” for patient referrals.
2. Report any physicians that you know have accepted such arrangements
3. Carefully scrutinize orders to be signed by the physician for inconsistencies and blatantly false medical services allegedly ordered by you.
4. Periodically review “routine” home health service requests.
5. Deny services that include for example “ twice daily insulin injections administered by a nurse. Ask why the patient is unable to learn the self-administration of insulin injections.
6. Do not hesitate calling the local US attorneys office and/or your local medical society to report any suspicious activities.
Remember, that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Miami Herald ran another excellent investigative report about the rampant fraud and abuse committed by Home Health Care Service agencies. http://www.miamiherald.com/living/health/v-fullstory/story/773538.html
Some facts.
• Medicare spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.
• Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.
• Medicare was billed roughly $75,000 by a Home Health Care Service provider for twice-daily nursing visits to inject her with insulin to control diabetes during the latter half of 2007.
• According to federal records, Medicare paid one company about $12.6 million last year. A little more than 70 percent of its income was for treating homebound diabetic patients, records show.
What can we do:
1. Report any attempt by home health company representatives offering financial “incentives” for patient referrals.
2. Report any physicians that you know have accepted such arrangements
3. Carefully scrutinize orders to be signed by the physician for inconsistencies and blatantly false medical services allegedly ordered by you.
4. Periodically review “routine” home health service requests.
5. Deny services that include for example “ twice daily insulin injections administered by a nurse. Ask why the patient is unable to learn the self-administration of insulin injections.
6. Do not hesitate calling the local US attorneys office and/or your local medical society to report any suspicious activities.
Remember, that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
Monday, November 17, 2008
Fight Medicare Fraud
WE HAVE TO FIGHT AGAINST MEDICARE FRAUD!
The Miami Herald reported again several troubling cases of Medicare fraud
The stories are very familiar:
• A family-run enterprise of medical equipment and billing companies submitted more than $17 million in false claims to Medicare, they admitted in court. Their haul: $5 million. The family's scheme was launched in 1999, when David and Laura Hernandez opened their first medical equipment company, said Assistant U.S. Attorney Ryan Stumphauzer.In a statement filed in court, the three admitted opening a string of equipment suppliers in Miami-Dade and starting a billing company to file false claims with Medicare. The billing company was owned by Laura Hernandez. David Hernandez, in the lead role, recruited four people to register as the official owners of four equipment-supply companies to conceal his participation in the scam, according to the court statement. Those ''nominee'' owners, members of another family, were charged in a separate Medicare fraud indictment. Husband and wife Jose Echevarria and Magaly Martinez, along with their son, Yuniel Echevarria, and his wife, Suyima Torres, pleaded guilty earlier this year. To fuel the racket, David Hernandez and his brother, Jose, paid kickbacks to patients for the use of their Medicare numbers. In turn, the brothers billed the federal insurance program for products, such as beds, catheters and pumps, that were never delivered to anyone. Proceeds of the fraud were deposited in the corporate bank accounts of the family's medical equipment companies. Hernandez also laundered some of the Medicare reimbursements through shell companies with ''medical-sounding'' names that were set up to cash checks at banks so his family could pocket the proceeds, according to the statement filed in court. Some of that taxpayer money enabled the Hernandezes to pay $331,000 to buy the Pembroke Pines home in 2002.
• A Miami doctor and nurse have been convicted of billing Medicare for millions of dollars in false claims for obsolete HIV therapy at a local clinic owned by three brothers who fled to Cuba to avoid prosecution. Dr. Ana Alvarez-Jacinto and Sandra Mateos, found guilty by a Miami federal jury Friday, played key roles in an $11 million scam involving HIV-positive patients who received kickbacks in exchange for letting the clinic use their Medicare numbers to bill the federal program. The two women who opened St. Jude Rehab Center as partners with Carlos, Jose and Luis Benitez -- fugitives charged in a separate indictment -- had already pleaded guilty to fraud this year. Mariela Rodriguez and Aisa Perera, who ran St. Jude from June to November 2003, collected $8 million from the false Medicare claims.
• A local physician convicted of Medicare fraud for his role in a massive HIV therapy racket run by three Miami-Dade brothers was sentenced to seven years in prison on Tuesday. Ronald Harris, 58, wrote prescriptions to bill Medicare for an obsolete treatment that was not provided to patients with the virus that causes AIDS, according to court records. The patients received cash kickbacks in exchange for letting the Miami physician bill the federal health insurance program with their Medicare numbers.In August, Harris pleaded guilty to a conspiracy charge as the medical director for Physicians Med-Care in Miami and Physicians Health Med-Care in Hallandale Beach. The two HIV clinics submitted $26.2 million in false claims to Medicare between 2002 and 2004.
Lets be reminded that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Miami Herald reported again several troubling cases of Medicare fraud
The stories are very familiar:
• A family-run enterprise of medical equipment and billing companies submitted more than $17 million in false claims to Medicare, they admitted in court. Their haul: $5 million. The family's scheme was launched in 1999, when David and Laura Hernandez opened their first medical equipment company, said Assistant U.S. Attorney Ryan Stumphauzer.In a statement filed in court, the three admitted opening a string of equipment suppliers in Miami-Dade and starting a billing company to file false claims with Medicare. The billing company was owned by Laura Hernandez. David Hernandez, in the lead role, recruited four people to register as the official owners of four equipment-supply companies to conceal his participation in the scam, according to the court statement. Those ''nominee'' owners, members of another family, were charged in a separate Medicare fraud indictment. Husband and wife Jose Echevarria and Magaly Martinez, along with their son, Yuniel Echevarria, and his wife, Suyima Torres, pleaded guilty earlier this year. To fuel the racket, David Hernandez and his brother, Jose, paid kickbacks to patients for the use of their Medicare numbers. In turn, the brothers billed the federal insurance program for products, such as beds, catheters and pumps, that were never delivered to anyone. Proceeds of the fraud were deposited in the corporate bank accounts of the family's medical equipment companies. Hernandez also laundered some of the Medicare reimbursements through shell companies with ''medical-sounding'' names that were set up to cash checks at banks so his family could pocket the proceeds, according to the statement filed in court. Some of that taxpayer money enabled the Hernandezes to pay $331,000 to buy the Pembroke Pines home in 2002.
• A Miami doctor and nurse have been convicted of billing Medicare for millions of dollars in false claims for obsolete HIV therapy at a local clinic owned by three brothers who fled to Cuba to avoid prosecution. Dr. Ana Alvarez-Jacinto and Sandra Mateos, found guilty by a Miami federal jury Friday, played key roles in an $11 million scam involving HIV-positive patients who received kickbacks in exchange for letting the clinic use their Medicare numbers to bill the federal program. The two women who opened St. Jude Rehab Center as partners with Carlos, Jose and Luis Benitez -- fugitives charged in a separate indictment -- had already pleaded guilty to fraud this year. Mariela Rodriguez and Aisa Perera, who ran St. Jude from June to November 2003, collected $8 million from the false Medicare claims.
• A local physician convicted of Medicare fraud for his role in a massive HIV therapy racket run by three Miami-Dade brothers was sentenced to seven years in prison on Tuesday. Ronald Harris, 58, wrote prescriptions to bill Medicare for an obsolete treatment that was not provided to patients with the virus that causes AIDS, according to court records. The patients received cash kickbacks in exchange for letting the Miami physician bill the federal health insurance program with their Medicare numbers.In August, Harris pleaded guilty to a conspiracy charge as the medical director for Physicians Med-Care in Miami and Physicians Health Med-Care in Hallandale Beach. The two HIV clinics submitted $26.2 million in false claims to Medicare between 2002 and 2004.
Lets be reminded that EVERY DOLLAR embezzled by this crooks is one dollar less paying for legitimate medical services rendered by had-working honest doctors!
Therefore, we need to be on alert pointing out fraud and abuse whenever it occurs in our community. No, we are not snitches but responsible members of our community who care for the viability of the Medicare program.
We need to work together on that and other issues. Together we are stronger. Together we can address this challenge.
The Election Is Over. What Shall We Do Now?
MESSAGE FROM YOUR PRESIDENT:
The Election Is Over. What Shall We Do Now?
The two year long presidential election session is over. Before our President - Elect can get down to business the political pundits are already preparing for the 2012 presidential elections. Furthermore, those who are unhappy with the outcome of the election are vowing to “resist” any changes to be promised by the new administration. During the recent Interim Meeting of the American Medical Association in Orlando some attendees even went a step further. A current member of the United States House of Representatives called upon doctors to carry - hopefully in a figurative manner - a loaded shotgun to fight for their freedom. A former AMA President even dared to compare the status of doctors in the US to that of Jews in Nazi Germany!
This kind of hyperbolic rhetoric is not only unacceptable but also misses the mark!
I am confident that the majority of AMA delegates do not support these positions.
What we need are pragmatic solutions to the problems we are facing: stagnating reimbursement, increasing practice costs, third-party control of our practices and unnecessary regulatory burden.
This requires the ability to reach out to all parties involved in the healthcare delivery process, listen to arguments, tolerate other opinions and reach a compromise. Collaboration and not confrontation will help us to achieve our goals. As I said many times before: we need to sit at the table, otherwise we are going to be the menu item on the table.
Therefore, I will remain focused on assisting our members to continue practicing medicine. But I will also remind each of you that there is no way back to the “good old days of medicine.” The only constant in life is change! We have to adapt to the rapidly changing economic environment and find the best solutions that suit us.
Verbal radicalism and defiance will only lead us into a political dead end street.
Many of you are helping me to identify the problems and we try our best to resolve them. One of the issues pertains to the sluggish Medicare reimbursement for services rendered and the onerous prepayment chart review requirements.
Therefore, on 10/22/08 I traveled to Jacksonville and met with the CEO and President Mrs. Sandy Coston and the Vice Chairman Mr. Curtis Lord of FIRST COAST, the regional Medicare administrator. I also had the opportunity to meet and speak with all department heads including claims processing support, claims processing center, provider customers service, provider enrollment, program integrity and Medicare Education and Performance Solution. We discussed ONE single topic: how to improve the claims processing and reimbursement process. We agreed to ease the prepayment review process thereby reducing the chart review requirements. I will depend on your feedback to monitor the promised improvements. On the evening preceding my trip I received a call from a physician reporting that he has not received ANY Medicare reimbursement in the last 6 months and that ALL of his claims were rejected. I was able to resolve the problem within 24-hours and he will receive all payments due.
You need you to join our DCMA to support these and other projects, which help you to practice medicine and to provide quality care to your patients.
What are you waiting for? Join today!
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
The Election Is Over. What Shall We Do Now?
The two year long presidential election session is over. Before our President - Elect can get down to business the political pundits are already preparing for the 2012 presidential elections. Furthermore, those who are unhappy with the outcome of the election are vowing to “resist” any changes to be promised by the new administration. During the recent Interim Meeting of the American Medical Association in Orlando some attendees even went a step further. A current member of the United States House of Representatives called upon doctors to carry - hopefully in a figurative manner - a loaded shotgun to fight for their freedom. A former AMA President even dared to compare the status of doctors in the US to that of Jews in Nazi Germany!
This kind of hyperbolic rhetoric is not only unacceptable but also misses the mark!
I am confident that the majority of AMA delegates do not support these positions.
What we need are pragmatic solutions to the problems we are facing: stagnating reimbursement, increasing practice costs, third-party control of our practices and unnecessary regulatory burden.
This requires the ability to reach out to all parties involved in the healthcare delivery process, listen to arguments, tolerate other opinions and reach a compromise. Collaboration and not confrontation will help us to achieve our goals. As I said many times before: we need to sit at the table, otherwise we are going to be the menu item on the table.
Therefore, I will remain focused on assisting our members to continue practicing medicine. But I will also remind each of you that there is no way back to the “good old days of medicine.” The only constant in life is change! We have to adapt to the rapidly changing economic environment and find the best solutions that suit us.
Verbal radicalism and defiance will only lead us into a political dead end street.
Many of you are helping me to identify the problems and we try our best to resolve them. One of the issues pertains to the sluggish Medicare reimbursement for services rendered and the onerous prepayment chart review requirements.
Therefore, on 10/22/08 I traveled to Jacksonville and met with the CEO and President Mrs. Sandy Coston and the Vice Chairman Mr. Curtis Lord of FIRST COAST, the regional Medicare administrator. I also had the opportunity to meet and speak with all department heads including claims processing support, claims processing center, provider customers service, provider enrollment, program integrity and Medicare Education and Performance Solution. We discussed ONE single topic: how to improve the claims processing and reimbursement process. We agreed to ease the prepayment review process thereby reducing the chart review requirements. I will depend on your feedback to monitor the promised improvements. On the evening preceding my trip I received a call from a physician reporting that he has not received ANY Medicare reimbursement in the last 6 months and that ALL of his claims were rejected. I was able to resolve the problem within 24-hours and he will receive all payments due.
You need you to join our DCMA to support these and other projects, which help you to practice medicine and to provide quality care to your patients.
What are you waiting for? Join today!
Yours
Bernd Wollschlaeger,MD,FAAFP,FASAM
President, Dade County Medical Association
Tuesday, November 04, 2008
Women and Health Insurance
A recent study revealed a scandalous phenomenon: that women pay more than do men of the same age for identical healthcare coverage provided by individual insurance policies! This "gender rating" is discriminatory and MUST stop! We have to regulate the insurance market to guarantee that all insurance companies follow the same rules. No, this is not socialism, but smart government policy to stop discrimination and to introduce fairness into the health insurance system.
Yours
Bernd
Posted on Mon, Nov. 03, 2008
Women pay more for insurance -- why?
It is an unpleasant fact that life sometimes can be an uneven experience, delivering different results for the same effort, or producing failure when success is warranted. In a well-organized society such as ours, insurance is designed to even out the rough spots somewhat by spreading risk broadly.
Which is why it should come as a surprise that women pay more than do men of the same age for identical healthcare coverage provided by individual-insurance policies. What is worse, men and women are finding it exceedingly expensive, if not impossible, to find coverage for some illnesses through the individual-insurance market.
Revealing study
This is something Congress should look into, not with a mind-set of heavy-handed mandates, mind you, but with the idea of listening to healthcare consumers and insurance companies and finding common ground for new approaches. A recent study by the National Women's Law Center shed some light on the matter. See the study at www.nwlc.org/; click on the report, Nowhere to Turn . . .
The study found that the individual-insurance market -- unlike group insurance purchased through an employer -- uses ''gender rating.'' This allows an insurer to charge women higher premiums than men for the same coverage. More and more people are discovering these discrepancies thanks to the failing U.S. economy, which has resulted in job losses for hundreds of thousands of Americans, who find themselves looking for new insurance coverage.
Some recently laid-off people who had full healthcare coverage in their previous jobs are finding that they can't get coverage at any price with individual insurers for some ailments because of ''preexisting conditions.'' Moreover, many women are finding that they are paying 30 percent more for insurance than men because of their gender. Insurers say their claim experiences show that women use healthcare services more and, therefore, are charged more. In other words, women are more likely to get checkups and visit the doctor more because, well . . . they just do.
Illogical comparison
Some insurers say this is similar to auto-insurance rates that are higher for men than women because men have more accidents and file more claims. The comparison seems logical but, in fact, it really is not. Women who proactively monitor their health may identify problems earlier, get treatment sooner and ultimately cost an insurer less. A man who crashes his car isn't involved in proactive, preventive behavior.
Society's long-term interest should be to promote more of the former behavior than the latter. This should be the goal of insurers, too. Finding a nexus between affordable healthcare and a financially viable insurance market won't be easy. Congress can get closer to a solution by hearing from, and listening to, all parties.
Yours
Bernd
Posted on Mon, Nov. 03, 2008
Women pay more for insurance -- why?
It is an unpleasant fact that life sometimes can be an uneven experience, delivering different results for the same effort, or producing failure when success is warranted. In a well-organized society such as ours, insurance is designed to even out the rough spots somewhat by spreading risk broadly.
Which is why it should come as a surprise that women pay more than do men of the same age for identical healthcare coverage provided by individual-insurance policies. What is worse, men and women are finding it exceedingly expensive, if not impossible, to find coverage for some illnesses through the individual-insurance market.
Revealing study
This is something Congress should look into, not with a mind-set of heavy-handed mandates, mind you, but with the idea of listening to healthcare consumers and insurance companies and finding common ground for new approaches. A recent study by the National Women's Law Center shed some light on the matter. See the study at www.nwlc.org/; click on the report, Nowhere to Turn . . .
The study found that the individual-insurance market -- unlike group insurance purchased through an employer -- uses ''gender rating.'' This allows an insurer to charge women higher premiums than men for the same coverage. More and more people are discovering these discrepancies thanks to the failing U.S. economy, which has resulted in job losses for hundreds of thousands of Americans, who find themselves looking for new insurance coverage.
Some recently laid-off people who had full healthcare coverage in their previous jobs are finding that they can't get coverage at any price with individual insurers for some ailments because of ''preexisting conditions.'' Moreover, many women are finding that they are paying 30 percent more for insurance than men because of their gender. Insurers say their claim experiences show that women use healthcare services more and, therefore, are charged more. In other words, women are more likely to get checkups and visit the doctor more because, well . . . they just do.
Illogical comparison
Some insurers say this is similar to auto-insurance rates that are higher for men than women because men have more accidents and file more claims. The comparison seems logical but, in fact, it really is not. Women who proactively monitor their health may identify problems earlier, get treatment sooner and ultimately cost an insurer less. A man who crashes his car isn't involved in proactive, preventive behavior.
Society's long-term interest should be to promote more of the former behavior than the latter. This should be the goal of insurers, too. Finding a nexus between affordable healthcare and a financially viable insurance market won't be easy. Congress can get closer to a solution by hearing from, and listening to, all parties.
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