PacifiCare Faces $1.3 Billion in Penalties for Over 130,000 Violations
California Insurance Commissioner Steven Poizner and the Director of the California Department of Managed Care (DMHC), Cindy Ehnes, announced that they are seeking $1.3 billion for over 130,000 alleged claim violations made by PacifiCare. It is the first action ever taken by both departments against a single health care provider.
Details of the violations
The Department of Insurance conducted market examinations that reviewed PacifiCare files between July 1, 2005 and May 31, 2007. It identified over 130,000 violations – each subject to penalties of $5,000 for non-willful violations and up to $10,000 for willful violations. When you add those numbers up, PacifiCare faces fines of between $650,000 to a staggering $1.3 billion (and this is not a typo – that’s billion, with a ‘B’.) The examinations were conducted in response to hundreds of complaints received from both consumers and providers.
The alleged violations include:
Wrongful denials of covered claims
Incorrect payment of claims
Lost documents including certificates of creditable coverage and medical records
Failure to timely acknowledge receipt of claims
Multiple requests for documentation that was previously provided
Failure to address all issues and respond timely to member appeals and provider disputes
Failure to manage provider network contracts and resolve provider disputes
Other violations / recoveries
According to a joint press release, the DMHC has already assessed the company, which was acquired by United Healthcare in 2005, a $3.5 million penalty for its practices – the largest fine it has ever imposed. The Department of Insurance also directed a self-audit of the company for unfairly denying coverage for pre-existing conditions. That audit resulted in over $750,000 in claims recoveries.
Putting an end to unfair claims practices
According to Poizner, this joint effort is meant to put an end to unfair claims practices in California. In a press release, he said:
Paying claims is the heart of the insurance business model and the most fundamental job insurers must perform. After years of broken promises to California regulators, it became crystal clear that PacifiCare simply could not or would not fix the meltdown in its claims paying process. We’re going to put an end to that. If PacifiCare can’t understand the ABC’s of basic claims payment, maybe it will understand the dollars and cents of regulatory action.
If you are an LVN and looking for a rewarding job working with seniors in a small private Assisted Living RCFE (Residential Care Facility for the Elderly) in Atascadero California.
Call us! 805-452-3225 - Or fax your resume to 805-473-7405
Great Job for the right person who like working with the Elderly!
Upscale small Assisted Living RCFE -Residential Care Facility for the Elderly
Quiet home like environment
Residents and staff are treated like family with respect and dignity
Immediate full time opening for an LVN in Atascadero, California
In upscale small Assisted Living RCFE -Residential Care Facility for the Elderly
Quiet home like environment
Job Description:
Supervise CNA’s
Medication (MAR) Management, and Medication Administration to Elderly Residents
Create Needs and Service plans for residents
Work hours could be made very flexible
Compensation: Depending on experience
Participatory health care insurance provided after 90 days
JOB REQUIREMENTS:
California LVN license must be current
If you have ever been arrested for any reason or take narcotic medications please do not respond.
Extensive background check and drug screening is required for this position.
DOJ Fingerprints required
TB Test and Physical Required
Today Elder Care Residential Services CEO Kitty Wilde RN was interviewed by Deborah Bayles the Radio Host for ” The Best is Yet to Be” on KVEC Talk Radio 920 in San Luis Obispo California.
Kitty Wilde RN guest on KVEC Radio Show "The Best is Yet to Be"
The program will air this Saturday 9-24-10 at 12 noon on KVEC Talk Radio in San Luis Obispo California. Topics that were discussed today were: Quality aging in place no matter where the location Training for Caregivers / Care Partners - First Aid, Blood Borne Pathogens, Dementia Training and Activities of Daily Living Medication Management Jitterbug Cell phones - simple cell phones for Seniors Dakim Brain Fitness - for everyone to help improved cognitive performance (memory and speed of processing) Eden Alternative principles and the three plagues of , Loneliness, helplessness and boredom accounting for the bulk of suffering among our Elders
Deborah Bayles hosts the radio show called “The Best is Yet to Be”
Deborah thoughts on aging…It occurred to me recently that most of the articles and information out there portray aging as a disease — not a phase of life worth celebrating. I mean, after all, we should count ourselves lucky if we are among the aging. It sure beats the alternative. So I thought, what if there was a forum and a community that actually celebrated aging? What if you could make the rest of your life the best of your life? That’s how this radio show — and this website–got started.
Deborah Bayles Hosting " The Best is Yet to Be" radio show
Each week she interviews top local experts in their fields on the show to talk about various aspects of positive aging. I figure that rather than look at our future as something to be dreaded, we should enthusiastically affirm “The Best is Yet to Be!”
Several experts have theories that Assisted Living and Residential Care for the Facilities for the Elderly (RCFE’s) occupancy has been linked to the unemployment rate.
Previous Stats ….According to the U.S. Department of Labor’s Bureau of Labor Statistics, there are nearly 31 million people currently unemployed — that’s including those involuntarily working part time and those who want a job, but have given up on trying to find one. In the face of the worst economic upheaval since the Great Depression, millions of Americans are hurting. “The Decline: The Geography of a Recession,” as created by labor writer LaToya Egwuekwe, serves as a vivid representation of just how much. Watch the deteriorating transformation of the U.S. economy from January 2007 — approximately one year before the start of the recession — to the most recent unemployment data available today.
What you need
1 cup 1% milk
2 Tbsp. JELL-O Pistachio Flavor Instant Pudding
1 OREO Mint Pure Milk Chocolate Covered Chocolate Sandwich Cookie, finely chopped
Make It
POUR milk into tall glass. Add dry pudding mix; stir 2 to 3 min. or until pudding mix is completely dissolved.
STIR in chopped cookie.
SERVE immediately.
Kraft Kitchens Tips
How to Easily Crush Cookie
Place cookie in a small resealable plastic bag. Seal bag and crush the cookie with your hands.
Substitute
Prepare as directed, using a regular OREO Chocolate Sandwich Cookie.
A: The Dakim BrainFitness is the product of inventor, founder, and CEO Dan Michel’s experience with his father’s thirteen-year struggle with Alzheimer’s disease. Dan’s participation in cognitively stimulating activities with his father over the course of several years made him recognize the therapeutic and emotional value of mental stimulation. He also saw a pressing need for a more effective means of providing brain fitness exercise to help seniors use rigorous cognitive stimulation, long-term to defend their brain health-to prevent or slow the development of dementia. Dakim’s team has spent the last eight years developing, testing and refining what senior living providers consider to be the most advanced, effective, user-friendly and entertaining way to help virtually all seniors enhance their quality of life.
How does the Dakim BrainFitness improve seniors’ quality of life?
A: Experts have found that brain health is a ‘use it or lose it’ proposition. Dakim BrainFitness engages the brain with challenging exercises across six cognitive domains, and turns rigorous cognitive exercise (based on standardized neurological tests and exercises) into a compelling and entertaining experience. The Dakim BrainFitness makes the entire experience so much fun for seniors, they’ll want to use it again and again! At Dakim, we believe fun and enjoyment enhance everyone’s quality of life!
Who is Dakim BrainFitness for?
A: Virtually all seniors can benefit from the Dakim BrainFitness cognitive fitness system, from those with normal brain function to those with mild cognitive impairment and even moderate dementia. Dakim BrainFitness is designed to enable seniors to use rigorous cognitive stimulation to prevent or slow the development of dementia. As Gary Small, M.D. says, ‘It’s never too early or too late to start a brain fitness program.’
How many cognitive domains does the system exercise?
A: The Dakim BrainFitness exercises six cognitive domains, including memory (short-term and long-term), language, calculation, visuospatial-orientation and critical thinking.
How long does a Dakim BrainFitness session last?
A: A typical session usually lasts about 20 to 30 minutes, but this can be adjusted-by home users or by care providers in senior living communities, to suit the specific needs of the community and/or its residents.
Does Dakim provide new exercises?
A: Yes! New content is downloaded and automatically installed, via the Internet regularly, as often as every day or two. Our fresh, entertaining content, which is constantly being created and customized for our users, is the key to making the Dakim BrainFitness fun and beneficial!
Do You Need an Elder Care Attorney?
By MainStreet.com Staff Writers
Getting older means dealing with a number of different issues you never had to before. One person that can help you handle those issues is an elder care attorney. Elder care attorneys specialize in issues that specifically pertain to seniors and their families. Whether or not you need the assistance of an elder care attorney depends on your and your loved ones’ needs and resources.
Elder care attorneys specialize in a number of different areas. Here are some of the things and elder care attorney can help you with:
1. Estate planning: Creating last wills and testaments as well as living trusts to plan the distribution of your estate after your death.
2. Oversight and administration of an estate: An attorney can serve as a personal representative or executor to manage how a will or trust is carried out.
3. Insurance claims and settlements: When disputes arise with insurance companies either for health insurance, long-term care insurance or life insurance, an elder care attorney can help advocate for you.
4. Medicare, Medicaid and Social Security benefits: If you or a loved one is denied these benefits, an elder care attorney can argue your case.
5. Drafting and reviewing certain legal documents: An elder care attorney can provide assistance with durable powers of attorney, advance directives and other legal documents.
6. Legal guardianship: An elder care attorney can help you designate who will make decisions for you if you become incapacitated. Your attorney can also help you create a living will to make sure your wishes in regards to life-saving medical treatments are known.
7. Elder abuse and neglect issues: If your loved one has been abused by an assisted living facility or home health care worker, an elder care attorney can pursue legal remedies.
8. Long-term care concerns: Elder care attorneys can provide valuable assistance in managing the long-term care needs of elderly clients with illnesses and/or disabilities. Those suffering from Alzheimer’s disease and other degenerative diseases, for example, can benefit from having an elder care attorney to help manage their finances and long-term care arrangements.
With more and more baby boomers entering retirement, the elder care legal specialty is growing. Finding an elder care attorney is not as difficult as it once was, but you still need to do your due diligence. Most elder care attorneys do not focus on all of the subjects that fall under the purview of elder law. It’s best to find an elder care attorney that is experienced and well versed in the specific area that pertains to your needs.
The best way to find a good elder care attorney is through a recommendation from a family member or friend. You can also search for members of the National Academy of Elder Law Attorneys. Before hiring an elder law attorney, you might want to ask these questions:
# How long have you practiced elder law?
# Are you certified in elder law? (The National Elder Law Foundation certifies elder law attorneys)
# How much of your practice is devoted to the specific area I need?
# Is the initial consultation free?
# What are your rates and billing policies?
Evaluating An RCFE Assisted Living Facility - A Check List Amenities and Personal Care
RCFE Assisted living communities provide more personal care services than an independent living retirement community.
They offer a less-expensive, residential approach to delivering many of the same services available in skilled nursing, either by employing personal care staff or contracting with home health agencies and other outside
professionals.
Amenities in assisted living typically include:
Three meals a day served in a common dining area
Housekeeping services
Transportation
24-hour security
Exercise and wellness programs
Personal laundry services
Social and recreational activities
Personal care in assisted living typically includes:
Staff available to respond to both scheduled and unscheduled needs
Assistance with eating, bathing, dressing, toileting, and walking
Access to health and medical services, such as physical therapy and hospice
Emergency call systems for each resident’s apartment
Medication management
Care for residents with cognitive impairments Consumer Checklist
Do the residents seem to be appropriate housemates for you or your loved one?
Are staff members appropriately dressed, personable, and outgoing?
Do the staff members treat each other in a
professional manner?
Are the staff members that you pass during your tour friendly to you?
Are visits with the resident welcome at any time? Physical Features
Is the community well-designed for your needs?
Is the floor plan easy to follow?
Are doorways, hallways, and rooms accommodating to wheelchairs and walkers?
Are elevators available for those unable to use stairways?
Are handrails available to aid in walking?
Are cupboards and shelves easy to reach?
Are floors of a non-skid material and carpets firm to ease walking?
Does the community have good natural and artificial lighting?
Is the community clean, free of odors, and appropriately heated/cooled?
Does the community have sprinklers, smoke detectors, and clearly marked exits?
Does the community have a means of security if aresident wanders? Needs Assessments, Residency Agreements, Costs and; Finances
Is a residency agreement available that discloses personal care and supportive services, all fees, as
well as move-in and move-out provisions?
What are the policies for refunds and transfers?
Is there a written plan of care for each resident?
How frequently is it reviewed and updated?
Does the community have a process for assessing a resident’s need for services, and are those needs
addressed periodically?
Does this periodic assessment process include the resident, his or her family, and community staff,
along with the resident’s physician?
Are there any government, private, or corporate programs available to help cover the cost of services
to the resident?
Are additional services available if the resident’s needs change?
Are there different costs for various levels or categories of personal care?
Do billing, payment, and credit policies seem fair and reasonable?
Are residents required to purchase renters’ insurance for personal property in their units?
Is there an appeals process for dissatisfied residents? Medication and; Health Care
Does the community have specific policies regarding storage of medication, assistance with
medications, training and supervision of staff, and
record keeping?
Is self-administration of medication allowed?
Is there a staff person to coordinate home healthcare visits from a nurse, physical therapist,
occupational therapist, etc., if needed?
Does the community have a clearly stated procedure for responding to a resident’s medical
emergency?
To what extent are ancillary services available, and how are these services provided? Ask if there is an
additional charge for any of these services. Services and; Amenities
Can the community provide a list of personal care services available?
Is staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed? ADLs
include dressing, eating, mobility, hygiene and
grooming, bathing, and toileting.
Does the community provide housekeeping services in personal living spaces?
Can residents arrange for transportation on fairly short notice?
Are barber/beautician services offered on-site? Consumer Checklist
Does the community provide scheduled transportation to doctors’ offices, the hairdresser, shopping,
and other activities desired by residents?
Individual Apartment Features
Are different sizes and types of apartments available?
Are apartments for single and double occupancy
available?
Do residents have their own lockable doors?
Is a 24-hour emergency response system accessible from the apartment?
Are bathrooms private and designed to accommodate wheelchairs and walkers?
Are residents able to bring their own furnishings for their apartment? What may they bring? What is
provided?
Do all apartments have a telephone, cable or satellite TV, and internet access?
How is billing handled?
Is a kitchen area provided with a refrigerator, sink,
and cooking element?
May residents keep food in their apartments?
May residents smoke in their apartments? In public spaces?
May residents decorate their own apartments? Social and; Recreational Activities
Is there evidence of organized activities, such as aposted daily schedule, events in progress, reading
materials, visitors, etc.?
Do residents participate in activities outside of the community in the neighboring community?
Does the community have its own pets?
Are residents’ pets allowed in the community? Who
is responsible for their care?
Do volunteers, including family members, come
into the community to help with or to conduct
programs?
Does the community create a sense of inclusion by encouraging residents to participate in activities?
Food Service
Do dining room menus vary from day to day and meal to meal?
Does the community provide three nutritionally balanced meals a day, seven days a week?
Are snacks available?
May a resident request special foods, and can the community accommodate special dietary needs?
Are common dining areas available?
May residents eat meals in their apartment or suite?
May meals be provided at a time a resident would like, or are there set times for meals? Additional Questions
Does the community conduct criminal background checks on employees?
Does the community train staff on elder abuse and neglect? Is there a policy for reporting suspected
abuse?
Does the community have a special wing or floor for residents with cognitive impairments such as
Alzheimer’s disease? If so, is it secured?
Does the community allow hospice to come in and care for residents?
Does the community accept long-term care insurance?
Does the community allow a loved one, such as a grandchild, to spend the night? Is there a charge?
Does the community participate in the Veterans’ Administration Aide and Attendance Program? Will
the community help complete the paperwork?
Does the community accept Medicaid?
What are the most common reasons why a resident may be asked to move out of the community?
Grandma’s on Facebook: New UAB Study Examines Benefit of Internet Access, Social Media Networking on Seniors’ Health
BIRMINGHAM, Ala. - Many elderly adults are increasingly isolated and grapple with depression, loneliness and declines in physical health. The UAB Department of Sociology and Social Work will use a five-year, $1.9 million National Institute on Aging (NIA) grant to study the ability of computer use and social media networking to enhance the quality of life of elderly adults through online social connections and easier access to health information.
In the study, UAB sociologist and principal investigator Shelia Cotten, Ph.D., will examine the extent to which access to the Internet and the use of social networking sites by seniors in assisted living facilities enhances their personal interactions and relationships.
“With increasing numbers of older adults living in long-term care facilities and declines in quality of life as people age, we need innovative ways to lessen these negative impacts and to enhance quality of life,” Cotten said.
UAB graduate students will train 300 senior adults at 15 Alabama assisted-living facilities to use the Internet, e-mail, Facebook and other social media networking sites. The residents also will learn about blogging, online groups and ways to evaluate online health information.
Cotten says a primary benefit of the study is that it will help decrease inequalities in access to health information due to age-related declines in mobility. An increasing amount of health information is available electronically, says Cotten. “Once older adults cross the digital divide, they can access health information much more easily using the Internet than they can go to the library or visit a health-care professional,” she said.
1. Get Your Seasonal Flu Shot
The best way to prevent seasonal flu is by getting a seasonal flu vaccination each year. As always, CDC recommends that people 65 and older get their regular, or “seasonal,” flu vaccine as soon as it is available. This year is no exception as seasonal flu viruses are expected to circulate along with 2009 H1N1 viruses this flu season. When the 2009 H1N1 vaccine becomes available for people 65 years and older, you should get that vaccine also.
2. Take Everyday Preventive Actions including covering coughs, washing hands often and avoiding people who are sick.
3. Seek medical advice quickly if you develop flu symptoms to see whether you might need medical evaluation or possibly treatment with antiviral medications. People 65 and older are prioritized to get antiviral drugs if they become sick with the flu according to CDC’s guidance. Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever.
People 65 Years and Older and Seasonal Flu
It has been recognized for many years that older people are at greater risk of serious complications from the flu compared with young, healthy adults. It’s estimated that 90 percent of seasonal flu-related deaths and more than 60 percent of seasonal flu-related hospitalizations in the United States each year occur in people 65 years and older. This is because human immune defenses become weaker with age. So influenza can be a very serious disease for people 65 and older.
People 65 Years and Older and 2009 H1N1 Flu
The new 2009 H1N1 virus does not seem to be affecting people 65 years and older in the same way that seasonal flu usually does. Most people who have gotten sick from this new virus have been younger. In fact, people 65 and older are the group that is least likely to get infected with this new virus. There have been relatively few infections and even fewer cases of serious illness and death with this new virus in people older than 65. Laboratory tests on blood samples indicate that older people likely have some pre-existing immunity to the 2009 H1N1 flu virus. But while people 65 and older are the least likely to be infected with 2009 H1N1 flu, those that do become infected are at greater risk of having serious complications from their illness.
Flu Vaccination
Seasonal Flu Vaccine
People 65 and older are recommended to get seasonal flu vaccine this year, as always.
2009 H1N1 Flu Vaccine
People 65 and older are not in a target group recommended to get the earliest doses of 2009 H1N1 vaccine. This is because people age 65 and older are least likely to get sick with the 2009 H1N1 virus. Because there will be limited amounts of vaccine available at first, the first doses are recommended for those who are most likely to get infected.
The U.S. government has purchased 250 million doses of 2009 H1N1 vaccine, so anyone who wants to get the vaccine will have the opportunity to do so. While people 65 and older are not included in the groups recommended to get the earliest doses of vaccine, they can get the 2009 H1N1 influenza vaccine as soon as the high risk and younger groups have had the opportunity to be vaccinated.
People Age 65 Years and Older and Antiviral Drugs
Influenza antiviral drugs are prescription drugs (pills, liquid, or inhaled powder) that decrease the ability of flu viruses to reproduce. While getting a flu vaccine each year is the first and most important step in protecting against flu, antiviral drugs are a second line of defense in the treatment of flu.
It’s very important that antiviral drugs be used early to treat flu illness in people 65 and older who are very sick (for example people who are in the hospital) and people who are sick with flu and who also have a greater chance of getting serious flu complications (see http://www.cdc.gov/h1n1flu/highrisk.htm).
Although they are the least likely group to be infected with 2009 H1N1 flu, people age 65 and older are at higher risk for influenza related complications. Therefore, they are prioritized for antiviral treatment if they get sick with either seasonal or 2009 H1N1 flu this season.
