Category Archives: file note

complex adaptive systems, cool, data saving lives, entrepreneurship, file note, healthcare, healthy habits, management and leadership, meaning, musings, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology, startup, storytelling, technology

an idea of earth shattering significance

ok.

been looking for alignment between a significant industry sector and human health. it’s a surprisingly difficult alignment to find… go figure?

but I had lunch with joran laird from nab health today, and something amazing dawned on me, on the back of the AIA Vitality launch.

Life (not health) insurance is the vehicle. The longer you pay premiums, the more money they make.

AMAZING… AN ALIGNMENT!!!

This puts the pressure on prevention advocates to put their money where their mouth is.

If they can extend healthy life by a second, how many billions of dollars does that make for life insurers?

imagine, a health intervention that doesn’t actually involve the blundering health system!!?? PERFECT!!!

And Australia’s the perfect test bed given the opt out status of life insurance and superannuation.

Joran wants to introduce me to the MLC guys.

What could possibly go wrong??????

data saving lives, facts & data points, file note, healthcare, policy, politics, rapid learning health systems

Australian Medicare Fraud

The quoted estimate seems a bit under…

http://www.abc.net.au/news/2014-03-06/australians-defrauding-medicare-hundreds-of-thousands-of-dollars/5302584

Video: 

Australian Medicare fraud revealed in new figures, 1,116 tip-offs so far this financial year

By medical reporter Sophie Scott and Alison Branley

Updated Fri 7 Mar 2014, 1:23am AEDT

New figures show Medicare is being defrauded of hundreds of thousands of dollars each year.

Figures released to the ABC show the Federal Government has received more than 1,000 tip-offs of potential Medicare frauds to date this financial year.

It comes as debate continues over a proposal put to the Commission of Audit to charge a $6 co-payment for visits to the doctor, which would reduce costs to the health system.

The Department of Human Services says its hotline has received 1,116 Medicare-related tip-offs since July 1, 2013.

Officers have investigated 275 cases, which has translated into 34 cases submitted to the Commonwealth Department of Public Prosecutions and 12 convictions.

The value of those 12 cases adds up to an estimated $474,000, with fraudsters ripping off an average of almost $40,000 each.

Department figures suggest most of the frauds come from outside the doctor’s office.

Ten of the 12 prosecutions this year were members of the public. One involved a medical practice staff member and one a practice owner.

“The Department of Human Services takes all allegations of fraud seriously and seeks to investigate where sufficient information is provided to do so,” a spokeswoman said.

The annual review of doctors’ use of Medicare, the Professional Services Review, showed at least 19 doctors were required to repay more than $1 million between them in 2012-13.

One doctor billed Medicare for seeing more than 500 patients in a day, and more than 200 patients on several other days.

Other cases uncovered by the ABC include:

  • Former police officer Matthew James Bunning has been charged with 146 Medicare frauds between 2011 and 2013. Investigators allege the 46-year-old removed Medicare slips from rubbish bins behind Medicare offices around Melbourne to produce forged receipts and illegally claimed more than $98,000 from the Government.
  • In January last year Korean student Myung Ho Choi was sentenced in a NSW district court to five years in prison for a series of fraud and identity theft charges that included receiving at least five paper boxes filled with blank Medicare cards intended for use in identity fraud.
  • In August last year NSW man Bin Li was sentenced in district court to seven years in prison for charges that included possessing almost 400 blank cards, including high quality Medicare cards, and machines for embossing cards.

Nilay Patel, a former US-based certified specialist in healthcare compliance and law tutor at Swinburne University of Technology, says the fraud figures are the “tip of the iceberg”.

“There is a lot more that we do not know and that really comes from both camps from the patients and the medical service providers,” he said.

He says Australia is falling behind the United States at preventing, detecting and prosecuting healthcare frauds.

“The safeguards [in Australia] are quite inadequate, the detection is more reactive that proactive and whatever proactive mechanisms that are there I think they are woefully underdeveloped,” he said.

Relatively ‘smallish’ but unacceptable problem: Minister

Federal Government authorities say they do not think Medicare fraud is widespread.

Minister for Human Services Marise Payne says the number of Medicare frauds are low compared to the number of transactions.

“I think when you consider that we have 344 million Medicare transactions a year it is a relatively smallish [problem] but that doesn’t mean it’s acceptable,” she said.

“One person committing a fraud effectively against the Australian taxpayer is one person too many.”

Ms Payne says the department uses sophisticated data matching and analytics to pick up potential frauds as well as its tip-off hotline.

The merger of Medicare with Centrelink also allows the bureaucracies to better share information and leads.

“The work we have done in that area is paying dividends,” Ms Payne said.

“There is more to do. The use of analytical data and risk profiling is highly sophisticated in the Centrelink space and we want to make sure we achieve the same levels in the Medicare space.”

The Australian Federal Police says it does not routinely gather statistics on the number of fake or counterfeit Medicare cards.

However, a spokesman says detections of counterfeit Medicare cards are rare.

“Intelligence to date indicates that the majority of Medicare cards seized that are of sufficient quality, are used as a form of identity, not intentionally to defraud Medicare,” a spokesman said.

A Customs and Border Protection spokeswoman says blank or fraudulent Medicare cards are not controlled under the Customs regulations and it is unable to provide seizure statistics.

The federal Ombudsman says he has not conducted any review or investigations into Medicare but did contribute to a 2009 inquiry into compliance audits on benefits.

The Medicare complaints detailed in the Ombudsman’s annual report relate to customers disputing Medicare refunds, not frauds.

‘People are just looting the money’

Sydney man Tahir Abbas is sceptical about the Government’s claims that Medicare fraud is not widespread.

Mr Abbas detected at least 10 false bulk billing charges on his Medicare statement between November and January valued at almost $750.

He was not in the country when many of the charges were incurred.

The charges were from a western Sydney optometrist who told the ABC they were unable to explain the discrepancies.

They said while Mr Abbas was billed, they never received payment.

How many times do we go and check our statements for Medicare particularly. Maybe with credit cards, bank details but not with Medicare. These people are just looting the money.

Victim of Medicare fraud Tahir Abbas

 

The owner told the ABC the system would not allow them to receive bulk billing payments for more than one check-up in a two-year period.

Mr Abbas said he believed his card had been misused by others for their own benefit.

“I was very disgusted to be honest,” he said.

“It’s all bulk-billed and they are charging the Government. But in a way the Government is charging us so we are paying from our pocket – it’s all taxpayers’ money.”

He has urged people to check their Medicare statements.

“How many times do we go and check our statements for Medicare particularly. Maybe with credit cards, bank details but not with Medicare.

“These people are just looting the money.”

Medicare has told Mr Abbas they are investigating.

High-tech Medicare cards needed?

Technology and crime analyst Nigel Phair from the University of Canberra says the Medicare card is an easy to clone, low-tech card that has been around for three decades.

While it is low in value for identity check points, it is a well-respected document.

 

“The Medicare card carries no technology which gives it additional factors for verification or identification of users,” he said.

“It’s just a mag stripe on the back, very similar to a credit card from the 1990s without any chip or pin technologies, which are well known to be the way of the future.”

He says Medicare is vulnerable to abuse because people’s data is stored in many places such as doctors’ surgeries and pharmacies.

“It’s very easy to sail under the radar if you’re a fraudulent user. And like all good frauds you keep the value of the transactions low but your volume high,” he said.

“Because all we do have is anecdotal evidence and no hard statistics, we really don’t know how bad this issue is.”

Ms Payne does not support upgrading the quality of Medicare cards.

“The advice I have is that that is not really a large source of fraud and inappropriate practices,” she said.

Do you know more? Email investigations@abc.net.au

 

Topics: fraud-and-corporate-crime, health, health-administration, health-policy, government-and-politics, federal-government,law-crime-and-justice, australia

First posted Thu 6 Mar 2014, 12:00pm AEDT

cool, data saving lives, file note, healthcare, policy, politics, rapid learning health systems

NPR on health care price transparency

  • Very cool, very powerful
  • I+PLUS can do it already (excluding PHIs that aren’t on board)
  • Think we should go for it
  • Could potentially take it to the US

Audio: 

http://www.npr.org/blogs/health/2014/02/12/276001379/elusive-goal-a-transparent-price-list-for-health-care

Elusive Goal: A Transparent Price List For Health Care

by ERIC WHITNEY  3:36 AM

Some states are trying to make health care prices available to the public by collecting receipts from those who pay the bills: Medicare, Medicaid and private insurers. Some states’ efforts to make these prices available are in jeopardy.

Coffee is important to many of us, but let’s say your coffee maker breaks. Finding a new one is as easy as typing “shop coffee maker” into your browser. Voila — you’ve got models, prices and customer reviews at your fingertips. But say you need something less fun than a coffee maker — like a colonoscopy. Shopping for one of those is a lot harder. Actual prices for the procedure are almost impossible to find, and Bob Kershner says there’s huge variation in cost from one clinic to the next. “You see the range is from $2,800 down to just about $400,” he says, pointing to a computer screen displaying some colonoscopy prices in Denver. Kershner works for a nonprofit called CIVHC, which is starting to make health care prices publicly available in Colorado. His boss, Edie Sonn, says knowing prices can change the whole health care ball game. “Knowledge is power,” she says. “None of us have had much information about how much health care services actually cost, and how much we’re getting for our money.” A database that includes all health claims in a particular state, she says, “gives you that information, so you can become an empowered consumer.” Colorado is one of eleven states that are starting to make public a lot of health care prices. It’s taken years. An “all payer claims database” is the first step in Colorado. It’s basically a giant shoebox that aims to collect a copy of every receipt for a health care service in a given state. Since doctors and hospitals generally don’t tell people how much services cost beforehand, the best way to figure out the price is to get receipts from the parties that pay the bills: insurance companies, Medicaid and Medicare, mostly. The more such information is made public, Sonn says, the more people will “vote with their feet” and migrate away from high-cost providers. However, turning this information about price from eye-crossing rows in a spreadsheet into consumer-friendly formats is hard. Colorado’s effort has taken years. Laws had to be passed to get insurance companies to send in their claims data (the receipts for what they’re paying), and sorting through all the information is a lot tougher than organizing a pile of paper receipts in a shoebox. “Claims data is dirty,” says Sonn. “It’s really dirty. It takes a lot of scrubbing to make sense of it. It’s complicated, time consuming and expensive.” Colorado has had funding to do that from private grants, but those are drying up. In order to keep on making basic price information accessible to the public for free, the state wants to sell more complicated, custom data reports to businesses within the health industry. There is a growing market for those sorts of reports, says Dr. David Ehrenberger, the chief medical officer for Avista Adventist hospital, outside Denver. He would like to see reports that show not just how much his competitors are charging, but also whether their patients have more or fewer complications. That would give him better negotiating power with big insurance companies. “The insurance industry still has a dramatic advantage over, particularly, smaller physician groups and smaller health care organizations. There’s not a level playing field there,” Ehrenberger says. That’s because big insurance companies pay bills at hospitals all over the state, so they have a big picture view of how much everybody charges for procedures, and of details such as complication rates. Individual hospitals only know their own prices. It’s as if only customers could get a list of prices for different coffee makers, but Cuisinart and Mr. Coffee couldn’t, so they wouldn’t know if they were asking too much or too little for their coffee makers. The better view Ehrenberger can get of the entire marketplace for health care services, the better he can set prices. “What we want to do is be able to have the data that shows, unequivocally, that we can provide a better quality product — and [at] a cost they can afford,” he says. But there’s a glitch. In order to get the kinds of reports Ehrenberger and other health care providers want, they have to include price information from all payers, and one of the biggest is Medicare — it pays about a fifth of all health care bills in Colorado. At the moment, Edie Sonn explains, they cannot use that Medicare data in any of the custom reports they want to sell. “Current federal law restricts what we can do with that Medicare data,” she says. “The only thing you can use their data for is public reporting.” Sonn’s organization and others like it have found support on Capitol Hill to let them sell Medicare data. It turns out that Democrats and Republicans agree that price transparency is key to controlling costs. A measure that would make that change is now part of a bigger Medicare bill (find it in section 107) working its way through Congress. If it passes, Colorado will be one step closer to making shopping for health care as easy as shopping for a coffee maker. This story is part of a partnership between NPR and Kaiser Health News.

complex adaptive systems, cool, data saving lives, file note, musings, rapid learning health systems, technology

Andrew Ng: How to build your very own Skynet

Andrew Ng on Deep Machine Learning via Large Scale Brain Simulation

https://www.youtube.com/watch?v=5elcmFNRCWk

The key determinants of learning accuracy are accessing as much data as possible and being able to process.

Partnered with the Google speech team.

Deep learning works well in two different settings:

1. Learning from labeled data > speech recognition, streetview images

2. Learning from unlabeled data >

 

AndrewNg_LearningPerformance

 

AndrewNg_HumanVsMachineLearning

 

Up to now, humans have been driving performance due mainly to a lack of data and processing. With both of these now becoming available in abundance, machine learning will soon overtake human learning to become the dominant driver of performance.

Sky net.

business, facts & data points, file note, healthy habits, musings, nutrition, policy, politics, quotes & aphorisms

“There is no freedom in addiction”

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

PN: The fallacy in the rump of this discussion is that cigarettes are not that more harmful than a big mac. I’m just as likely to die from smoking a single cigarette in front of you, as I am if I were to eat a big mac in front of you. The problems arise when you smoke/eat these products every day of your life.

http://bigthink.com/21st-century-spirituality/should-big-food-pay-for-our-rising-obesity-costs

Should Big Food Pay For Our Rising Obesity Costs?

FEBRUARY 25, 2014, 4:29 PM
Bt-big-food

Paul McDonald didn’t expect his letter to go public. The Valorem Law Group partner had queried sixteen states, asking leaders to consider investigating Big Food’s potential role in paying for a percentage of the health system’s skyrocketing obesity costs. The Chamber of Commerce got wind of this letter and made it public, setting off a national debate over food marketing, ingredient manipulation and personal responsibility.

McDonald’s premise is simple enough: if large food companies are purposefully creating addictive foods to ensure consumer loyalty, adding to the rising obesity levels in this country, they should be responsible for covering costs associated with treatment. The backlash was immediate and biting.

Comparisons to the Big Tobacco companies came first to mind. In the 1998 Tobacco Masters Settlement Agreement, major players in the tobacco industry agreed to pay $246 billion to offset health risks and diseases associated with its product. Critics of McDonald’s idea believe there is no link between tobacco and food.

Advertising

On the face of it, this would appear true: you don’t need to smoke, but eating is a necessity. Smoking is a choice, and therefore if you choose to smoke, you pay the consequences. Eating falls into an entirely different category.

Yet the neural mechanisms might be similar. A 2010 study in Nature Neuroscience found that rats consumed well past their limits when offered high-calorie foods such as bacon, sausage and cake, speculating that humans, when faced with an equivalent scenario, also choose to overeat.

Harvard University Professor of Medicine, Emeritus David Blumenthal’s study, Neurobiology of Food Addiction, found a similar link between food and drug abuse. In the summary he writes

Work presented in this review strongly supports the notion that food addiction is a real phenomenon…although food and drugs of abuse act on the same central networks, food consumption is also regulated by peripheral signaling systems, which adds to the complexity of understanding how the body regulates eating, and of treating pathological eating habits.

The argument against food addiction is a tough one, waged by industry insiders who want to keep 60,000 products on American shelves. The real question, however, is: are food companies purposefully producing addictive foods that change our neurobiology? If so, should they be held economically accountable?

American obesity costs are currently $147 billion per year. The CDC estimates that 35.7% of adults and 17% of children ages 2-19 are obese—a number that has risen dramatically over the last two decades. A joint report between Trust for America’s Health and the Robert Wood Johnson Foundation estimates that 44% of American adults will be obese by 2030. The report predicts that will add between $48-66 billion to our costs, some of which is paid for by taxpayers.

Yet food is such an emotional topic. For example, when informing someone that I’m vegan, they immediately let me know why they could never do such a thing (I didn’t ask) or that it’s ‘wrong’ for them, and sometimes by extension, me (last week’s annual blood work shows me in perfect shape).

Michael Bloomberg was laughed at for suggesting that New York City businesses limit soda serving sizes. It was never a perfect plan, but his public shaming shows how closely we equate food with ‘freedom.’ The problem is, there is no freedom in addiction. As the Nature Neurosciencestudy showed above, rats and humans alike will overeat (or eat less healthy food options) even if they know better.

Hence the magic bullet at the center of McDonald’s letter: a precise combination of fat, sugar and salt that keeps us craving more. As NY Timesreporter and author of Salt Sugar Fat: How the Food Giants Hooked UsMichael Moss said in an interview

These are the pillars of processed foods, the three ingredients without which there would be no processed foods. Salt, sugar and fat drive consumption by adding flavor and allure. But surprisingly, they also mask bitter flavors that develop in the manufacturing process. They enable these foods to sit in warehouses or on the grocery shelf for months. And, most critically to the industry’s financial success, they are very inexpensive.

Inexpensive to companies, not to consumers. Paul McDonald is striking an important nerve in how we manufacture, distribute and consume food in our country. There will be a lot of resistance and debate from both industry and citizens. But if we don’t begin this conversation now, our national and mental health is only going to continue to decline.

Image: Aliwak/shutterstock.com

file note, healthy habits, musings, nutrition, policy, quantified self

Quantified-self harm..?

OK. This is purely a rant based on a shallow, n=1 observation.

I lost my fitbit down the toilet in December and chose not to replace it.

Since then, I’ve been maintaining my active habits (walking to work, training for a fun run) without the motivational air cover provided by the device.

Since then, I’ve been eating slightly healthier, primarly reducing meat consumption in favour of vegetables, and also increasing the depth and number of fasting days.

As a consequence, I’ve been losing more weight.

The interesting thing is that the only quantified self metric I’ve been looking at has been my weight.

It’s all a bit zero-sum, but I feel that by no longer monitoring my activity, I’m now focusing more on what matters – weight.

This isn’t to poo poo the tracker. I’m confident that it supported the development of activity habit. It’s just that now I’ve covered that, I need to focus on more salient measures.

It makes me think there’s change management a process that’s required to get healthy:

Firstly, get active using whatever motivational means necessary -trackers, fun runs etc.

Second, perhaps simultaneously, concentrate on diet… fasting, nutrition etc.

For further discussion, no doubt…

data saving lives, file note, healthcare, policy, politics

Senior Doctors rorting Queensland Health

  • double-billing
  • charging but not present
  • overtime while on holidays

Queensland auditor-general refers some public hospital doctors to CMC over possible fraud

By Melinda Howells

Updated Tue 11 Feb 2014, 7:15pm AEDT

The Crime and Misconduct Commission (CMC) has been asked to investigate whether some senior doctors have defrauded Queensland Health by claiming excess overtime and double-billing.

The auditor-general investigated 88 of the state’s 2,500 Senior Medical Officers.

He found that seven of them did not attend work during their rostered hours for more than 30 days, and that doctors who were on leave were paid $500,000 in overtime.

Health Minister Lawrence Springborg says the evidence gathered warrants further investigation.

Mr Springborg says the report shows systemic failings and ‘double-dipping’ by some doctors in the state’s public hospitals.

“The report highlights gaps in both rostering and attendance processes and treatment and billing practices, which have been open to exploitation,” he said.

He says some doctors were paid overtime while on holidays, turned up late but claimed overtime, or billed patients privately when they had no right of private practice.

“Inadequate oversight and administration, and we’ve had double dipping and we’ve had people that have taken advantage,” he said.

Mr Springborg admits better checks are needed.

“I’m talking here today about a small number of doctors – the majority of people are doing the right thing,” he said.

“Matters are going to be referred to the Crime and Misconduct Commission in Queensland.

“Also there are a number of recommendations which have been made to improve scrutiny and oversight in the system, which will all be implemented and adopted by the Government.”

Report a ‘smokescreen’ amid contract push

Alex Scott from the Together Union says the report comes as the State Government pushes for individual contracts with doctors.

“This Government is trying to use a smokescreen of this auditor-general’s report to completely misrepresent the true state of affairs in relation to the hours of work for doctors, the private practice arrangement for doctors,” he said.

Dr Shaun Rudd from the Australian Medical Association says it is an attack on the profession.

He says only a small percentage of Senior Medical Officers appear to be involved.

“If that’s correct that’s very worrying,” he said.

“However again it’s usually a system problem in the fact they’re probably working somewhere else in the public system, or it’s not been recorded what they’re actually doing.

“The problem with the Queensland Health system has been that it is a system which has been very difficult.

“It’s had its problems as well with the payroll system etcetera.

“The vast majority of doctors in the public system work long and hard.”

The report comes amid a dispute between the State Government and unions about putting senior doctors onto individual work contracts.

cool, file note

Bill & Melinda on Why We Give – Giving Tuesday

  • DonorsChoose.org
  • Heifer.org
  • Save the Children
  • World Vision

 

http://community.givingtuesday.org/page/billandmelinda#b11g14t20w13

Why We Give

By Bill & Melinda Gates

Thanks for taking a break from your holiday shopping to take a look at #GivingTuesday.

Everyone has their own reasons for giving back. For us, it’s simply about making the world a more fair and equitable place. We know we were very lucky to grow up where we did, when we did. We believe everyone deserves the chance to live a healthy, productive life. Those are the values we learned from our families, and they’re why we started our foundation.

In our work, we come across a lot of great organizations doing inspiring work in the U.S. and around the world. In fact, as we talked about #GivingTuesday, the hardest question we faced was, “Which groups should we highlight?” After a lot of discussion about all the great choices out there, we picked four.

When our children have a little extra money saved up and want to make a donation, they often turn to Heifer International and World Vision. Through Heifer, you can donate an animal to a community in need—a gift that can benefit the recipients for years afterward. Through World Vision and Save the Children, you can change a child’s life by helping provide food, health care, education and more. And DonorsChoose.org lets you help teachers meet their classrooms’ needs, enabling projects that might not happen otherwise.

Whoever you support, and however much you give, thank you for participating in #GivingTuesday. It’s a great way to help create the better world we all want. We wish you a happy holiday season.

  • Donors Choose.orgDonorsChoose.org is an online charity that makes it easy for anyone to help students in need. Public school teachers from every corner of America post classroom project requests on the DonorsChoose site, and visitors can give any amount to the project that is most inspiring.View More
  • HeiferHeifer International empowers families to turn hunger and poverty into hope and prosperity by helping bring sustainable agriculture and commerce to areas that need it most. The animals provide partners with both food and reliable income, as agricultural products such as milk, eggs, and honey can be traded or sold at market.View More
  • Save the ChildrenSave the Children gives kids in the United States and around the world what every child deserves—a healthy start, the opportunity to learn and protection from harm, especially when disaster strikes. When disaster strikes, Save the Children advocates and achieves lasting change for millions of children. They save children’s lives.View More
  • World VisionWorld Vision is dedicated to working with children, families, and their communities worldwide to reach their full potential by tackling the causes of poverty and injustice. World Vision works on every level to achieve the goal of child well-being—from international activism to checking in on children face-to-face.View More
complex adaptive systems, cool, file note, meaning, musings, politics

Notes: Antifragile (from flight)

Commerce and small business (though not large markets and corporations) are activities and places that bring out the best in people, making most forgiving, honest, loving, trusting and open minded… Like antifragile tinkering, mistakes are small and rapidly forgotten [17].
On errors. In the fragile category, the mistakes are rare and large when they occur, hence irreversible; antifragile mistakes are small and benign, even reversible and quickly overcome. They are also rich in information. So a certain system of tinkering and trial and error would have the attributes of antifragility. If you want to become antifragile, put yourself in the situation of “loves mistakes” [21].