Keeping in MLR improves healthcare for everyone
Health insurer anti-fraud expenses will be left from the Medical Loss Ratio in a rule released by the feds. This decision deals with Medicaid managed care, and frustrated state and federal fraud busters. The impact will spread throughout the world of healthcare.
First, a short history: The Affordable Care Act requires health insurers to spend 80 or 85 percent of costs on claims and health services. This limits how much insurers can spend to run the business.
Regulators were left to decide what insurer expenses will be included in the MLR. The Coalition and other fraud fighters diligently tried to show federal and state regulators why anti-fraud expenses should be included. Effective fraud fighting is directly linked to the quality of healthcare that consumers receive in many cases.
What makes this decision a bit grating is that federally funded health programs like Medicaid are required to have anti-fraud efforts. Yet those expenses are excluded from the MLR, and thus, health plans have little incentive to invest more in combating fraud.
This decision has impact well beyond state-federal Medicaid.
States usually look to the feds for guidance when writing their own regulations. If the feds exclude fraud expenses from the MLR, then states will be reluctant as well.
We’ve urged insurance regulators to include the MLR. They’re often sympathetic, yet gamely stick to excluding anti-fraud expenses.
Fraud fighting is essential to quality patient care; this isn’t mere overhead. Scams often harm patients with worthless and botched treatments that also can max out their policy limits. Stopping money-draining schemes also helps reduce the cost of health services. This benefits everyone.
That’s the rub. Fraud fighters know that good anti-fraud efforts reduce healthcare costs and improve services. Yet regulators stubbornly stay reluctant to even consider including anti-fraud expenses in the MRL.
It’s time for fraud fighters to speak out, and tell regulators and policymakers that fraud-fighting expense should be included in the cost of paying healthcare claims.
About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.
The Monitoring Group, is a group of international financial institutions and regulatory bodies committed to advancing the public interest in areas related to international audit standard setting and audit quality.
The members of the Monitoring Group are the Basel Committee on Banking Supervision, European Commission, Financial Stability Board, International Association of Insurance Supervisors, International Forum of Independent Audit Regulators, International Organization of Securities Commissions, and the World Bank. The Monitoring Group is currently chaired by Mr. Gerben J. Everts, Member of the Board of the Dutch AFM, and Member of the IOSCO Board.
- cooperate in the interest of promoting high-quality international auditing and assurance, ethical and education standards for accountants;
- monitor the implementation and effectiveness of the IFAC Reforms, and in that connection, to undertake an effectiveness assessment of the IFAC Reforms and other aspects of IFAC's operations that involve the public interest;
- through its Nominating Committee, appoint the members of the Public Interest Oversight Board (PIOB1);
- monitor the execution by the PIOB of its mandate;
- consult and advise the PIOB with respect to regulatory, legal and policy developments that are pertinent to the PIOB's public interest oversight; and
- convene to discuss issues and share views relating to international audit quality as well as to regulatory and market developments having an impact on auditing.
The Monitoring Group member organizations carry out this mission as governed by the present Charter, which is attached.
The International Financial Securities Regulatory Commission was established to promote investor confidence in the securities and capital markets by providing more structure and government oversight.
We cherish the promise of the American Dream. We’re taught that if we work hard and invest wisely, we’ll be able to retire comfortably. And with child-like optimism, we plug on until we’re 65. Yet, the numbers just don’t add up. The reality: as hard as we work, 92% of working households still won’t meet conservative retirement savings targets for their age and income. Even worse, with the loss of pensions, our current system (social security) to help ensure financial stability might not be here for our younger generation (Millennials).
What’s Standing In The Way Of Millennials’ Financial Dreams
As the largest generation in the U.S. workforce, Millennials are facing real challenges (some out of their control) that will inhibit their ability to maintain the same quality of life they have today when they reach retirement. In a recent study, we found that 40% of Millennials haven’t opened a single retirement savings account. And, 73% don’t know their net worth. Why does this matter?
Aside from the obvious (time is your biggest asset when it comes to planning for retirement!) – these two factors are critical for taking control of your financial life, whether you’re making a retirement plan, paying off student debt, planning for a family or any other financial priority. They’re also important for figuring out how much risk you can take on to protect yourself from unforeseen expenses or financial emergencies.
The Road To Retirement
With the average projected savings needed to retire comfortably hitting at least $1 million, far too many Millennials are already staggeringly behind. Cost of living is no joke in many of the big cities that Millennials flock to these days, yet according to our data, some Millennials are hoping to work for just 15 years. That amounts to nominal retirement savings at best, even if they’re maxing out their 401k contributions. To supplement the rest of their income in retirement, many are banking on living on inheritances without having a backup plan. On top of that, a scary number would pull out money from their retirement savings early to pay for big purchases like a car or wedding. We have an obligation to stop complaining about the shaky state of retirement readiness and help this generation live more stable financial lives. Because when they gamble with their retirement future, the American Dream ceases to exist.
From our research, we’ve found that the future of millennial retirement readiness depends on transparency – from quick mobile access to financial accounts, to support from trusted financial experts. In fact, Millennials are demanding better access to their retirement plans – 94% want mobile access to their retirement accounts. And, Millennials are twice as likely as people age 45 and older to say they’d check their retirement savings account daily if they could access it on their mobile device.
If we meet Millennials where they are, there is hope. I’ve invested my career in companies with the mission to make it easier for people to understand and manage their financial lives. I’ve seen that when people have the ability to interact with their finances, at their fingertips, they make smarter financial decisions – both short and long-term. We need to keep creating technology and fueling innovation that will meet the specific needs of the Millennial generation. Mobile banking led the way for everyday financial literacy. Soon, mobile retirement planning, coupled with broader access to financial advisors, will (and should) be the norm. Every day we’re getting one step closer.
An Orange County, CA sports medicine physician will focus on helping an athlete improve performance or recover from an injury. From professional athletes to weekend warriors, participating in sports training and physical activities bring about aches and pains – major and minor in nature.
Sports Medicine in Orange County
When the pain increases or an injury has occurred, seeking an Orange County, CA sports medicine physician is the next step.
Focuses on the Athlete
A sports medicine physician focuses on the athlete’s unique needs. Beginning with an accurate diagnosis, the orthopedic specialist will work the athlete to achieve a fast and optimal recovery. Administering various components will help the specialist determine the right course of treatment based on the results.
- Reviewing the athlete’s complete medical history will help determine how the injury occurred
- Physical examination
- Medical testing including, x-rays, MRIs, and other imaging resources
Athletes are normally at the highest level of physical fitness. An injury may cause a disruption or change in the overall fitness level of the person. Depending on the degree of injury, returning to the sport may not be an option. An accurate diagnosis and course of the treatment plan are vital to achieving the best possible outcome.
Course of Action
The accurate diagnosis will determine the course of action in the treatment program. Under some circumstances, the injury may be due to improper training techniques, including over-training or insufficient warm-up practices. Conservative methods may be used to restore the athlete to a normal active lifestyle.
- Rest: An injury or weakened muscle may just need time to heal.
- Ice: Applying ice to the injured area may help reduce swelling and inflammation.
- Physical Therapy: Specific exercises or stretching techniques to strengthen the muscles around the injured area may be implemented.
- Bracing: The use of a brace or support aid may help in the healing process.
- Drugs: Prescription, over the counter medications, or injections may be administered to help reduce the pain and other symptoms.
Orange County’s Best Sports Medicine Provider
In Orange County, CA, Dr. Howard Marans strives to achieve an optimal outcome for every athlete’s recovery from a sports-related injury. Dr. Howard Marans can also help an athlete improve performance. Please click below to schedule your consultation or call us at 714.979.8981.
No doubt about it. To be successful, you need to read and apply instructions. You must know how to study written material and then use it on your job or in life.
Yet if you get a headache or feel bored or frustrated while studying, you will look for excuses to quit.
One reason people get those feelings and fail to learn certain subjects is they try to study the subjects without seeing the actual objects in front of them.
"You're trying to teach this fellow all about tractors and you're not giving him any tractors. Well, he's going to wind up with a face that feels squashed, with headaches and with his stomach feeling funny. He's going to feel dizzy from time to time and very often his eyes are going to hurt." -- L. Ron Hubbard
Which would you prefer? A three-hour lecture on how to train dogs or a dog-training workshop where you bring your own dog and try out what you learn? Which method would work best for you?
Unfortunately, most education does not offer the "mass" or physical objects to show you how things actually work. For example, you listen to a lecture about managing employees with no stories or demonstrations. You read about cutting hair from a book that has no pictures of people's hair. You learn how to set up a website with no computer.
Without the objects of the subject, you eventually feel dizzy or get a headache. Your eyes might hurt. You might feel bored or exasperated, like you are frustrated, angry or annoyed.
If you think about it, the most difficult subjects involve the least amount of mass or physical objects. Most people do not enjoy studying laws, computer language or accounting because very few objects are involved.
Yet you can enjoy studying any subject if you can see or create a demonstration to envision how
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