Post about "Diabetes"

Health And Fitness Training – Fitting Fitness Into Your Busy Day

When it comes to health and fitness training time is always an issue. Some of us are busy, some of us are very busy, and some of us are so busy we don’t even know which way is up. Sound familiar? If you are the kind of person who is on the go the minute the alarm rings in the morning to the minute your head hits the pillow at night this article is for you. If you have kids who eat up all your time and you dream of a little time to yourself, this article is for you. If you want desperately to get fit but other commitments are making it next to impossible this article is for you.Here’s the good news, getting fit doesn’t take that much time. You need to address two areas in your life; exercise and diet. In fact, if you are stuck for time to workout, the diet portion is going to have more of a drastic effect on your fitness. Think about it, if you don’t have time to burn the calories then you need to cut them from your diet.Wait a minute! You are probably thinking to yourself that food is one of the only sources of pleasure in your busy day. I agree with you, it should be. Eating well better darn well also be delicious. If it isn’t then you are doomed to fail your diet. So understand what I am saying, you will eat well but you must also enjoy your food. I am not talking about a radical starvation diet or diet extremes where you avoid carbs or fats at all costs. Your diet should be well-balanced.Here are a few golden rules for dieting:1. Drink 2 to 3 litres of water a day
2. Avoid processed foods
3. Avoid foods with refined sugarHere’s a last tip, if you are the type who eats a lot of fast food because you are so busy, just make better choices. Order water instead of pop with your meal. Have a salad instead of fries with your burger or sandwich. Have honey instead of sugar in your coffee. All these small choices made day after day will add up in the long run. Think about it, maybe you have been putting on 5 to 10 pounds a year for a few years. Not a lot of weight over the course of a year. This slow addition of fat has been because of all these small choices. So you don’t have to make big changes to reverse this weight gain.As for a fitness routine do one set of the following as you roll out of bed in the morning and just before you go to bed at night:1. Push ups
2. Lunges (Take a long stride of a stance and do 1 set each for side)
3. Crunches (Remember to hold your hands by your ears, not inter-laced behind your head – don’t pull on your neck while you do these)
4. IF YOU ARE FEELING AMBITIOUS – Chin ups ( you can get a chin up bar that installs in a door frame for around $20 from most sports stores)If you follow a simple fitness routine like the one outlined above you will definitely get strong. This will result in a sleek and shapely physique. As you lose weight and shed fat you will reveal this new toned body.Fitness workout programs don’t have to be a one or two hour ordeal. It can be and short and sweet if that is all you have time to do. What is important is that you do something to keep your body strong and performing well. One day at some point in the future you just may have more free time to join a gym or a running club or whatever you like to do. When that day comes you will be ready for it because this little fitness exercise plan and simple diet has kept you fit.Don’t put it off. It doesn’t take much effort. Make a change in your life starting today.

Health Care Fraud – The Perfect Storm

Today, health care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or endeavor touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.1. Astronomical Cost EstimatesWhat better way to report on fraud then to tout fraud cost estimates, e.g.- “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]- The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.- The National Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. [NHCAA, web-site] NHCAA was created and is funded by health insurance companies.Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David Hyman, professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]2. Health Care StandardsThe laws & rules governing health care – vary from state to state and from payor to payor – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.Providers use specific codes to report conditions treated (ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used when seeking compensation from payors for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs recognize – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.3. Proactively addressing the health care fraud problemThe government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed, payors of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased pre- and post-payment audits of selected providers to detect fraud, and have created consortiums and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.4. Exorcise health care fraud with the creation of new lawsThe government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.With such efforts in 1996, we got the Health Insurance Portability and Accountability Act (HIPAA). It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse. HIPAA purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.In 2009, the Health Care Fraud Enforcement Act appeared on the scene. This act has recently been introduced by Congress with promises that it will build on fraud prevention efforts and strengthen the governments’ capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance by sentencing increases; redefining health care fraud offense; improving whistleblower claims; creating common-sense mental state requirement for health care fraud offenses; and increasing funding in federal antifraud spending.Undoubtedly, law enforcers and prosecutors MUST have the tools to effectively do their jobs. However, these actions alone, without inclusion of some tangible and significant before-the-claim-is-paid actions, will have little impact on reducing the occurrence of the problem.What’s one person’s fraud (insurer alleging medically unnecessary services) is another person’s savior (provider administering tests to defend against potential lawsuits from legal sharks). Is tort reform a possibility from those pushing for health care reform? Unfortunately, it is not! Support for legislation placing new and onerous requirements on providers in the name of fighting fraud, however, does not appear to be a problem.If Congress really wants to use its legislative powers to make a difference on the fraud problem they must think outside-the-box of what has already been done in some form or fashion. Focus on some front-end activity that deals with addressing the fraud before it happens. The following are illustrative of steps that could be taken in an effort to stem-the-tide on fraud and abuse:- DEMAND all payors and providers, suppliers and others only use approved coding systems, where the codes are clearly defined for ALL to know and understand what the specific code means. Prohibit anyone from deviating from the defined meaning when reporting services rendered (providers, suppliers) and adjudicating claims for payment (payors and others). Make violations a strict liability issue.- REQUIRE that all submitted claims to public and private insurers be signed or annotated in some fashion by the patient (or appropriate representative) affirming they received the reported and billed services. If such affirmation is not present claim isn’t paid. If the claim is later determined to be problematic investigators have the ability to talk with both the provider and the patient…- REQUIRE that all claims-handlers (especially if they have authority to pay claims), consultants retained by insurers to assist on adjudicating claims, and fraud investigators be certified by a national accrediting company under the purview of the government to exhibit that they have the requisite understanding for recognizing health care fraud, and the knowledge to detect and investigate the fraud in health care claims. If such accreditation is not obtained, then neither the employee nor the consultant would be permitted to touch a health care claim or investigate suspected health care fraud.- PROHIBIT public and private payors from asserting fraud on claims previously paid where it is established that the payor knew or should have known the claim was improper and should not have been paid. And, in those cases where fraud is established in paid claims any monies collected from providers and suppliers for overpayments be deposited into a national account to fund various fraud and abuse education programs for consumers, insurers, law enforcers, prosecutors, legislators and others; fund front-line investigators for state health care regulatory boards to investigate fraud in their respective jurisdictions; as well as funding other health care related activity.- PROHIBIT insurers from raising premiums of policyholders based on estimates of the occurrence of fraud. Require insurers to establish a factual basis for purported losses attributed to fraud coupled with showing tangible proof of their efforts to detect and investigate fraud, as well as not paying fraudulent claims.5. Insurers are victims of health care fraudInsurers, as a regular course of business, offer reports on fraud to present themselves as victims of fraud by deviant providers and suppliers.It is disingenuous for insurers to proclaim victim-status when they have the ability to review claims before they are paid, but choose not to because it would impact the flow of the reimbursement system that is under-staffed. Further, for years, insurers have operated within a culture where fraudulent claims were just a part of the cost of doing business. Then, because they were victims of the putative fraud, they pass these losses on to policyholders in the form of higher premiums (despite the duty and ability to review claims before they are paid). Do your premiums continue to rise?Insurers make a ton of money, and under the cloak of fraud-fighting, are now keeping more of it by alleging fraud in claims to avoid paying legitimate claims, as well as going after monies paid on claims for services performed many years prior from providers too petrified to fight-back. Additionally, many insurers, believing a lack of responsiveness by law enforcers, file civil suits against providers and entities alleging fraud.6. Increased investigations and prosecutions of health care fraudPurportedly, the government (and insurers) have assigned more people to investigate fraud, are conducting more investigations, and are prosecuting more fraud offenders.With the increase in the numbers of investigators, it is not uncommon for law enforcers assigned to work fraud cases to lack the knowledge and understanding for working these types of cases. It is also not uncommon that law enforcers from multiple agencies expend their investigative efforts and numerous man-hours by working on the same fraud case.Law enforcers, especially at the federal level, may not actively investigate fraud cases unless they have the tacit approval of a prosecutor. Some law enforcers who do not want to work a case, no matter how good it may be, seek out a prosecutor for a declination on cases presented in the most negative light.Health Care Regulatory Boards are often not seen as a viable member of the investigative team. Boards regularly investigate complaints of inappropriate conduct by licensees under their purview. The major consistency of these boards are licensed providers, typically in active practice, that have the pulse of what is going on in their state.Insurers, at the insistence of state insurance regulators, created special investigative units to address suspicious claims to facilitate the payment of legitimate claims. Many insurers have recruited ex-law enforcers who have little or no experience on health care matters and/or nurses with no investigative experience to comprise these units.Reliance is critical for establishing fraud, and often a major hindrance for law enforcers and prosecutors on moving fraud cases forward. Reliance refers to payors relying on information received from providers to be an accurate representation of what was provided in their determination to pay claims. Fraud issues arise when providers misrepresent material facts in submitted claims, e.g. services not rendered, misrepresenting the service provider, etc.Increased fraud prosecutions and financial recoveries? In the various (federal) prosecutorial jurisdictions in the United States, there are differing loss- thresholds that must be exceeded before the (illegal) activity will be considered for prosecution, e.g. $200,000.00, $1 million. What does this tell fraudsters – steal up to a certain amount, stop and change jurisdictions?In the end, the health care fraud shell-game is perfect for fringe care-givers and deviant providers and suppliers who jockey for unfettered-access to health care dollars from a payment system incapable or unwilling to employ necessary mechanisms to appropriately address fraud – on the front-end before the claims are paid! These deviant providers and suppliers know that every claim is not looked at before it is paid, and operate knowing that it is then impossible to detect, investigate and prosecute everyone who is committing fraud!Lucky for us, there are countless experienced and dedicated professionals working in the trenches to combat fraud that persevere in the face of adversity, making a difference one claim/case at a time! These professionals include, but are not limited to: Providers of all disciplines; Regulatory Boards (Insurance and Health Care); Insurance Company Claims Handlers and Special Investigators; Local, State and Federal Law Enforcers; State and Federal Prosecutors; and others.

What is Charcot’s Foot that Occurs in Diabetes?

Charcot’s foot is one of the many problems which might occur in those with diabetes mellitus. The higher blood sugar levels that stem from all forms of diabetes have an affect on numerous body systems including the eyesight, renal system as well as nerves. In long standing cases, particularly if there has been an unsatisfactory control of the blood sugar levels, you can find problems with the nerves supplying the feet. This will make the feet in danger of issues as if something fails, you don’t know it has gone wrong as you can not really feel it due to the harm to the nerves. This might be something as simple as standing on a rusty nail and that getting contaminated and you are not aware that you’ve stood on the nail. Should it be a blister or ingrown toenail which gets infected and you do not know that it is present on the foot unless you have a look. This is why foot care can be so necessary for those with diabetes and why it will be provided a great deal of emphasis. A Charcot foot is the destruction occurring to the bones and joints if you have an injury and you do not know that the injury has happened.

A way of looking at it could be to consider this way: pretend that you sprain your ankle horribly and you also are not aware that you have simply because you do not experience the pain from it. You then carry on and walk around on it. Picture all of the additional harm which you do by walking about on it. The earliest you may possibly discover that there may be something wrong happens when you take a seat and look at the feet and you observe that one is a great deal more swollen compared to the other foot. This is exactly what occurs in individuals with diabetes who develop a Charcot’s foot. There may be some destruction, such as a sprained ankle or maybe a progressive failure of the arch of the foot and as no pain is sensed they carry on and walk around on it. It should be apparent simply how much more injury that gets done to the original injury prior to the problem is finally observed because of the swelling. At times there is not much swelling, but the Charcot’s foot is picked up from the difference in temperature between the two feet as a result of inflammation related process in the damaged foot that generates more warmth.

The development of a Charcot foot really needs to be dealt with as a bit of an urgent situation since the further it advances the much more serious it’s going to be and the more challenging it can be to handle. The individual definitely needs to quit all weightbearing without delay or at least obtain a walking support so that the damage is protected. For the not too major instances and those conditions which were serious and have improved a really supportive orthotic in the footwear is required to support the feet and the injuries. Sometimes surgical procedures are required to straighten the subluxed and dislocated bones. By far the most critical situations can end up with the foot and/or leg required to be amputated as the trauma has been doing an excessive amount of impairment.