Thursday, 15 February 2018

How Unscrupulous Physicians in Illinois Profit from Misuse of Medical Coding and Billing

medicalAlthough physicians are not required to swear the original Hippocratic Oath, written in 500 BCE and detailing a moral code of contact, they do vow similar sentiments. The modern version essentially states to “do no harm” and also consider patients’ social and financial well-being when treating them. Unfortunately, there are unscrupulous physicians out there who abuse their position for personal financial gains. In Illinois, the lax medical regulations have made it possible for even disgraced doctors to line their pockets at the expense of their patients.

Growth of the home healthcare industry

In 2016, the industry added 35,000 jobs per month on average – many of them in home healthcare – to cope with an aging population. Many disabled people or elderly individuals who want to avoid having to go to nursing homes or hospitals rely on the services home healthcare can provide. It is a profitable business that in Illinois only requires a $25 licensing fee – and no criminal background check. With a surge in new home healthcare companies, the state’s public health regulators are unprepared to keep up and issue licenses without properly vetting applicants. 

The prevalence of fraud and misrepresentation

Many of these home healthcare companies operate in the best interests of their patients. However, fraud is prevalent throughout the industry, putting patients’ lives at risk. Corrupt physicians – some whom have lost their malpractice insurance, hospital privileges and professional standing – have infiltrated the industry with disregard for patient care, motivated by greed and personal gain. By misusing and inflating medical coding and billing, unethical doctors and home healthcare agencies scam patients, “robbing” taxpayer-financed programs. They may falsify patient medical histories and diagnoses; order unwarranted procedures, therapies and tests; and prescribe unnecessary or addictive drugs.

How the scamming works

In most areas of medicine, physician referrals are required to qualify for insurance coverage. However, Medicare permits home health agencies to take on patients before they are certified for care – something that happens often in Chicago. Once the agencies or the doctors on their payrolls falsely certify that patients are home-bound and require skilled nursing care, Medicare pays them – and they profit. They rake in the money as long as no one reports otherwise. There are “patient brokers” unprepared to keep up and issue licenses without properly vetting applicants.

The prevalence of fraud and misrepresentation

Many of these home healthcare companies operate in the best interests of their patients. However, fraud is prevalent throughout the industry, putting patients’ lives at risk. Corrupt physicians – some whom have lost their malpractice insurance, hospital privileges and professional standing – have infiltrated the industry with disregard for patient care, motivated by greed and personal gain. By misusing and inflating medical coding and billing, unethical doctors and home healthcare agencies scam patients, “robbing” taxpayer-financed programs. They may falsify patient medical histories and diagnoses; order unwarranted procedures, therapies and tests; and prescribe unnecessary or addictive drugs.

How the scamming works

In most areas of medicine, physician referrals are required to qualify for insurance coverage. However, Medicare permits home health agencies to take on patients before they are certified for care – something that happens often in Chicago. Once the agencies or the doctors on their payrolls falsely certify that patients are home-bound and require skilled nursing care, Medicare pays them – and they profit. They rake in the money as long as no one reports otherwise. There are “patient brokers” for fraudulent agencies who actively solicit potential elderly victims in stores, food pantries, churches and even at bus stops, and they receive illegal kickbacks for their efforts. According to the Chicago Tribune, at least 15 Chicago-area doctors have been charged with or convicted of paying or accepting kickbacks in the last seven years. An overworked system is partially to blame for the healthcare fraud that Illinois faces, and a return to ethics is called for.

Taking an ethical stand

Northwestern College, in addition to providing excellent education, strives to instill the importance of ethics to its students. Regulations regarding licensing and certification in the healthcare industry require that everyone employed in the field has the proper training and qualifications. Northwestern College supplies students with the required skills necessary for employment in hospitals, clinics, private practice and more. In addition to providing practical training and education, NC encourages personal growth and ethical behavior that lead to continued opportunities and success throughout your career.

Northwestern College’s broad range of healthcare programs

The healthcare industry is facing many challenges this year because of policy changes, new players and health crises, among others. This has also led to tremendous growth and the need for more healthcare professionals.

According to the Bureau of Labor Statistics, employment in healthcare occupations is expected to grow 18 percent by 2026 – adding about 2.3 million jobs. The School of Health Sciences at Northwestern College offers several programs that can have you in an entry-level position in the healthcare industry in two years or less. Flexible schedules and affordable payment plans are available to accommodate students’ lifestyles and responsibilities.

Choose a course of study at Northwestern College and become a:

  • Coding specialist: Medical coding is essential to the healthcare industry. Medical coding is necessary for reimbursement, tracking and clinical decision support. Coding also aids in detecting fraud and abuse.
  • Medical assistant: Work with doctors, helping to perform a variety of clinical and administrative duties that are essential to the smooth operation of a doctor’s office, hospital or medical clinic.
  • Health information technician: Help maintain vital patient information and records, making it portable and easily sharable among medical professionals while keeping it protected and secure.
  • Radiologic technician: Learn to use x-ray radiation to perform procedures for use in the diagnosis and treatment of illnesses, diseases and injuries.
  • Dental assistant: Work alongside dentists performing an assortment of duties, from taking x-rays and readying dental tools, to scheduling patient appointments and keeping records.At the Violet L. Schumacher School of Nursing at Northwestern College, train to become a nurse – the foundation of every healthcare organization. Patients will trust you for their hands-on care and will look to you as a liaison between them and the rest of the healthcare community.With all of the Northwestern College programs, your curriculum is a blend of hands-on experience and traditional classroom learning. It’s a well-rounded education that gives you a firsthand look at what to expect when you are in the workforce.To get an education you can be proud of and an in-demand career position to aspire to, contact Northwestern College today.

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Thursday, 8 February 2018

How Dental Health Can Affect Heart Health

gumWhen a person has periodontitis, advanced periodontal (gum) disease, the mouth is like a battlefield. Millions of bacteria are fighting their way in, taking shelter in the soft tissues of the gums. Then, they fire their nasty, infectious strains through the blood stream. Initial losses include teeth, which may fall out. Unexpected victims, however, may be the arteries and, ultimately, the heart.

Although there has been no definitive proof that gum disease causes heart disease, the links between the two are becoming stronger. If you have periodontal disease, it could be an early warning sign of cardiovascular disease, the #1 killer of Americans. In fact, one out of four people in the U.S. dies of heart disease every year – a staggering 610,000 people. Isn’t that reason enough to heed all possible warnings?

What is periodontal disease, and what causes it?

Periodontal disease is an infection in the soft tissue of the gums. Gingivitis, the milder form of gum disease, causes redness, swelling and irritation of the gingiva, the gum area around the base of your teeth. If it isn’t treated, it can lead to the more serious periodontitis. This serious infection affects the soft tissue around the teeth and destroys the bone that supports them. When periodontitis is left to fester, the results can be devastating. You can lose your teeth, and it may also up your risk for contracting other diseases, including heart disease.

How can gum disease increase the risk for heart disease?

Inflammation, the body’s response to infection, is common in both. With periodontal disease, the gums become swollen and inflamed as a result of infection. When a person with gum disease chews or even brushes their teeth, the oral bacteria are swept to other parts of the body through the bloodstream, invoking a similar response in the arteries. The inflammation there is a buildup of plaque that hardens and clogs the arteries (arteriosclerosis), restricting blood flow to the organs. If the arteries are so clogged and thickened, there can be a blood clot. If a clot breaks apart, it can cause a heart attack or stroke.

How is periodontal disease diagnosed?

Obviously, the earlier the diagnosis of periodontal disease, the sooner it can be treated. The problem is that people often don’t pay attention to the warning signs, and don’t go for regular dental health checkups. These symptoms could signal the presence of gum disease:

  • Red, swollen gums
  • Bleeding when brushing or flossing
  • Receding gums that show more tooth than normal
  • Loose or missing teeth
  • Pus that appears between teeth and gums
  • Mouth sores
  • Persistent bad breath
  • A change in occlusion, the way the teeth meet when they bite down
  • A change in the way dentures fit

Prompt diagnosis is key to treating gum disease. The bottom line: clear up the infection and close the pocket that harbors bacteria in the gums.

What is the best way to prevent gum disease and keep your heart healthy?

Taking care of your total health can help lessen your risks for a variety of diseases, including gum disease and heart disease. According to a study in the American Journal of Medicine, people who regularly use a plaque-fighting toothpaste to brush their teeth more thoroughly can lower the risk of inflammation that triggers heart attacks. For those who already have coronary heart disease, maintaining good oral health is important to keep it at bay. Also, by ensuring that your teeth remain healthy (and still in your mouth), you can reduce your risk of cardiac incidents. The European Journal of Preventive Cardiology reported in 2015 that people with no teeth showed:

  • 27 percent greater risk of major cardiovascular events (such as heart attack)
  • 85 percent greater risk of death due to heart disease
  • 67 percent greater risk of stroke
  • 81 percent greater risk of all causes of death

For people who still have some teeth, the risk increases about six percent for each tooth lost.

There are some easy ways you can take care of your oral health and lessen your chances for heart disease caused by poor dental habits:

  • Brush your teeth thoroughly at least twice a day
  • Floss your teeth daily
  • Eat a well-balanced diet with plenty of fruits and vegetables
  • Replace your toothbrush every three months
  • Schedule regular dental checkups and cleanings

How you can help others maintain good dental health by becoming a dental assistant

If you’re looking for an in-demand career that also makes a difference in people’s health, consider becoming a dental assistant. Northwestern College offers a comprehensive, hands-on certificate program that will prepare you to work in any type of dental facility in just one year. Your role in a dental office is invaluable to its smooth operations. You will learn to set up the instruments a doctor needs for any given procedure; take molds and custom impressions of teeth to create special appliances; take X-rays; and set up bleaching trays. During your 120-hour required externship, you’ll actually work in a real dental office where you will work on real patients.

According to the Bureau of Labor Statistics, employment for dental assistants is expected to grow 19 percent from 2016 to 2026 – much faster than average for other occupations. If you think your future career could be as a dental assistant, contact Northwestern College today.

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https://www.nc.edu/5499-2/