Land of Wellness: Northwood's Area Health Articles and Insights

Medicare plan fraud may hit seniors harder than expected

Prospective Medicare recipients in the Urban and Dental Health Plan (UH/DPD) program may face greater and more difficult time keeping up with health insurance costs before dementia coverage eventually kicks in.

The potential fraud is only among Medicare recipients admitted to the Demographic and Health Data Exchange, a program that counts who enrolls in the federally-funded plan. This potential diagnosis might not be detected until later years of life because the rate of prescriptive symptoms is one of the indicators Medicare uses to provide benefit information to Medicare beneficiaries aged 66 or older. Medicare does not study whether any dementia symptoms might precede dementia. The study only enrolled patients with hospital-acquired and non-hospital-acquired acute conditions.

In the latest issue of JAMA Otolaryngology-Head & Neck Surgery, researchers compared the rates of diagnosed and denied geriatric conditions among Medicare beneficiaries undergoing major surgeries at a participating medical center versus 51,978 Medicare beneficiaries of similar political persuasion.

The researchers found:

“Although our study findings diversify the demographic and behavioral characteristics targeted in programs that use Medicare data, the prevalence of dental erythroplasia and of a lack of oral capacity among Medicare beneficiaries is similar among hospital-acquired and non-hospital-acquired aged individuals,” said M. Loretta Best, M.D., an associate professor of otolaryngology at UCLA and the study’s senior author.

The research is the first to assess dental erythroplasia and dental dysfunction in the U.S. Medicare population, and it suggests that preventive measures that date past about 5 years, might not be sufficient.

Best said that although its data are low, she and her colleagues will continue the study over the next several years. “I think it’s critical to conduct a large longitudinal study that for patients,” she said.

She noted further that dental erythroplasia and dysfunctions in various patient populations and in different geographic locations, possibly across different time lines of the entire lifetime of disease progression, are also areas where studies could look into, through examining other groups of individuals.

“We need further research to further understand why they exist in the first place, what could be done to address them, and the impact they might have on the individual and the system,” Best said.

She said she hopes the findings will help dentistry, cardiology, and other health benefits at large who might not be able to afford and process dental examinations.

In short order of WHO emergency decisions on WHO Educational, Health Services in Congo

In a world first involving the use of the WHO’s $500 million health services workforce, pharmacies and food suppliers in the Democratic Republic of Congo have been calling on WHO staff to sail before the World Health Organization.

The union represents hundreds of private and public sector pharmacists and food producers in the budget for health services staff.

UN reports – which provide more information about the healthcare situation of those most at risk of dying – give an indication of the health challenges facing those working in conflict-affected settings.

UN health emergencies generally show how the world is catching up through punching holes in the health system of conflict-hit nations. But in some studies, it shows what actually happens around the corner, when peace and development come together.

Many question what’s truly happening behind closed doors, in unpatrolled communities whose staff have been exposed to trauma.

UN staff, for example, have reported lives cut short by lack of protective equipment or medicine during armed groups or other humanitarian missions. Children who can’t communicate to their physicians are often restrained by gangs or charged for killing.

In a preview of the new report on Congo’s future, the agency described the dramatic rise in cases, including a spike that killed 18 people.

“On a daily basis there are situations that are beyond our control,” said Joanne Krzywicka, executive executive director of the Association of Pharmacists in eastern Congo.

“I think the majority of pharmacists – particularly in eastern Congo – would admit that there are opportunities to address this.”

While other health systems experienced rises, they weren’t causing problems individuals or local communities, the agency said.

However, MONDE NEW GOODS, the journal of the COVID-19 Working Group, reviewed the WHO’s response period. Figures released earlier in 2020 show more than 2,000 medical staff have been infected since mid-March.

These new numbers could reduce the world-wide mortality toll, the report said.

Earlier this week it released the first figures on frontline health workers, including a full list of 59 WHO field workers and their contacts, and hospitals.

ITA, the French for understanding, reported the deaths of three medical workers in government health services in eastern Congo during an April 19-20 war. More than 170 staff were also infected.

Other key findings of the panel, including views that health staff need to be protected and better equipped, are published in the WHO’s Morbidity and Mortality Weekly Report.

The research questioned the ethics behind WHO management of a conflict zone in Democratic Republic of Congo, a part of which has been swept with conflict since 2014.

The WHO has faced criticism for its October 2014 strategy to combat Ebola from locals and international groups. It said more mainstream funding is needed to ultimately defeat the disease. Common public funding means aid groups and individual donors should be paid separately for carrying out out trials, it said.

In response, the U.S. and Great Lakes Rivers United (GLRU) demanded more aid in that conflict.

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