Harver Health Insurance Counter Fraud Group: Cyberattack Targets Health Insurer Records

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One of the US' largest health insurers, Anthem, has announced last week that millions of their employee and client records have been illegally accessed through a sophisticated cyberattack.

While Anthem is still cooperating with ongoing investigations regarding the attack, the initial information given was that around 80 million customer and employee records in a database were compromised. The data apparently include addresses, birthdates, names, employment and income information.

However, they claim that credit card data were not included in the breach and stated that medical records and doctor information were likely not compromised.

This could be one of the largest breaches in client data to date and the largest in the healthcare sector, noted Harver Health Insurance Counter Fraud Group, as Anthem owns a number of brands like Anthem Blue Shield, Anthem Blue Cross, Empire Blue Cross and Blue Cross of Georgia.

According to the health insurer, they learned of the breach by the end of January and have notified the FBI promptly. Cybersecurity firm Mandiant was also called in to secure Anthem's computer systems.

Anthem Chief Executive Joseph Swedish, whose personal data was involved as well, apologized through a letter and emphasized that they are working continuously to ensure their clients' and staff's data.

Security breach threats are particularly concerning in the financial and healthcare sectors that usually collect sensitive information about clients. Even without credit card information, combinations of names, birthdates and Social Security numbers would be more than enough to gain a lot of money in the black market. In fact, the FBI has already ranked cybercrime as a top law enforcement activity.

Technology experts from Harver Health Insurance Counter Fraud Group and other law enforcement officials are saying that getting hacked is inevitable and it's only a matter of when. They admitted that it is a challenge to keep up with the cyber criminals especially since most of them are based abroad.

Anthem promised that it will give free credit monitoring and identity repair services for affected clients.

Harver Health Insurance Group Tokyo News: Fidelis Care Offers Tips for Selecting Coverage

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As NY State of Health Extends Enrollment Deadline, Fidelis Care Offers Tips for Selecting Coverage

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- If you need health insurance coverage on January 1, 2015 and have yet to enroll through NY State of Health: The Official Health Plan Marketplace, time is running out. This Saturday, December 20, is the deadline to enroll for coverage that takes effect when the new year begins (see also Medical, Healthcare).

Choosing coverage is an important decision, but it doesn't have to be overwhelming. Fidelis Care Chief Marketing Officer Pamela Hassen offers the following tips to help you pick the coverage that's right for you.

Compare the coverage options:

The NY State of Health products are organized by metal level (platinum, gold, silver, and bronze), all offering the same coverage but with different monthly premiums and cost sharing. Hassen recommends taking a look at your health care needs to determine which metal level will be the most economical, balancing the premium with your expected out-of-pocket costs. While there are child-only products, you likely have the option of enrolling your child in quality, affordable coverage through the State-sponsored Child Health Plus program.

Determine the cost of coverage:

"Everyone wants to know how much their coverage will cost, but it's not always as simple as looking at the premium rate that's listed. Many individuals and families qualify for subsidies or tax credits that can lower their premiums and cost sharing," Hassen explained.

It's easy to get an estimate of your costs in about 60 seconds, using the Fidelis Affordable Care Advisor. Found on the homepage of Fidelis Care's website, fideliscare.org, the Affordable Care Advisor only needs basic information to calculate an estimated monthly premium, including federal subsidies and tax credits. It will also let you know if you may qualify for Medicaid.

Check the providers and the formulary:

If you prefer to see specific doctors or regularly take certain prescription drugs, be sure to do your homework. Hassen advises you check the health plan's provider network to see if your specific doctor is included. Also, drug formularies vary from health plan to health plan. It's important to consider how much you will pay for specific prescription drugs.

Keep an eye on the calendar:

While you must enroll by December 20 in order for your coverage to be effective on January 1, 2015, NY State of Health open enrollment runs through February 15, 2015. After that time, it is difficult to select or change health insurance coverage. Most New York State residents are required to have health insurance coverage in 2015 or face a tax penalty.

To make the enrollment process as easy as possible, Hassen recommends turning to an expert for assistance.

"Our trained representatives will meet you at our office, a community location, or even at your home. They are experts and can make sure you enroll correctly and sign up for federal assistance if you are eligible," she said.


To prevent and detect fraud within the health care and the insurance industry, Harver Health Insurance Counter Fraud Group will help you. The Harver Health Insurance Counter Fraud Group has official connections with health fraud investigation agencies.

Harver Health Insurance Group Tokyo News: Tax returns this year require health insurance information, government offers tips

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Because 2015 is the first year Californians will have to provide information about their health insurance on their tax returns, the U.S. Department of Health and Human Services released a fact sheet detailing what they'll need to know, officials announced.

In the coming weeks, the administration will continue to provide added resources to help consumers prepare for tax filing season, including online tools to help individuals connect with local tax preparation services and determine if they are eligible for an exemption, officials said.

More than three quarters of tax filers will just need to check a box on their tax return indicating they had health coverage for all of 2014, but there will be added steps for those who bought coverage through the Health Insurance Marketplaces, or decided not to enroll in coverage. Those who had basic health insurance in 2014 meeting the Minimum Essential Coverage requirement for the Affordable Care Act won't receive any new forms in the mail and won't have to fill out new forms when they file their 2014 income tax returns.

What consumers need to know:

When you file your tax return, you'll need to check a box indicating you and your family had health insurance for all of 2014. Types of coverage that meets the Affordable Care Act's standards include: Most job-based plans, including retiree plans and COBRA coverage; Medicare Part A or Part C; Medicaid; the Children's Health Insurance Program (CHIP); most individual health plans you bought outside the Marketplace, including "grandfathered" plans.; If you're under 26, coverage under a parent's plan.

Filing electronically is the easiest way to file a complete and accurate tax return. Last year, some 85 percent of taxpayers e-filed. Electronic Filing options include free Volunteer Assistance, IRS Free File and professional assistance. Helpful resources available include the IRS Resource Guide: Health Care Law: What's New for Individuals & Families.

Last year millions of people purchased coverage through the Health Insurance Marketplace, and most benefited from a tax credit to lower their monthly premium. Those enrolled in such a plan must provide some basic information about their health insurance when they file their taxes. All Marketplace consumers will receive a new statement called a Form 1095-A  that includes all the information they need about their coverage to file their return. Form 1095-A will come by mail by early February. In most states, you can also download a copy of your statement through your Marketplace account starting in late January or early February. You must wait for your Form 1095-A to arrive before filing your taxes. If it hasn't come by early February, you should contact the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.

When you get your Form 1095-A, check the information on it like the number of people in your household for accuracy. If you find an error, call the Marketplace Call Center at 1-800-318-2596 to find out how to get a corrected form.

Keep your Form 1095-A with your other important tax information, like your W-2.

If a tax credit lowered your monthly health insurance premiums for 2014, you will use your Form 1095-A to input some basic information when you file your taxes. When you signed up for health insurance, you had to estimate your 2014 income, which determined the size of your tax credit. Now, you must compare your estimated income with your actual income which could impact the final amount of your tax credit, as can a change in your income or household size during the year. You may see a smaller refund or owe money back if you underestimated your income. You may also get a bigger refund if you overestimated you income.

If you owe money back, there are several repayment options available.

If you did not receive a tax credit to lower your monthly premiums in the Marketplace, you can visit HealthCare.gov/taxes/tools/ to get information you'll need to enter into your tax forms to see if you might qualify.

If your Marketplace coverage started partway through 2014 and you were uninsured earlier in the year, or if you were uninsured for only a short period of time during the year, you may be eligible for an exemption from the requirement to have health coverage. You can claim the exemption on your tax return when you file. The process is fast and easy, requiring only that you select the exemption that applies to you and enter the corresponding code.

Available helpful resources:

HHS Fact Sheet: 3 Tips About Marketplace Coverage & Your Taxes.

Use a tool to get information you may need to determine your 2014 premium tax credit.

Learn more about your taxes if you had a 2014 plan through the Health Insurance Marketplace.

IRS Resource Guide: Health Care Law: What's New for Individuals & Families.

Learn more about Payment Plans, Installment Agreements and Offers in Compromise.

While those who can afford health coverage but chose not to buy it may have to pay a fee, individuals who could not afford coverage or met other conditions can receive an exemption. If you qualify, receiving an exemption is simple and easy, and means you won't have to pay a fee. You can claim most exemptions on your tax return, but some exemptions are only available through the Marketplace.

There are a variety of exemptions available, including if:

The cost of coverage was too high. This applies to you if the lowest priced plan available to you would have cost more than 8 percent of your income. Visit HealthCare.gov/taxes/tools for information you may need to claim the 2014 unaffordable coverage exemption.

You were uninsured for only a short period of time.

You experienced a hardship, such as if you had medical expenses that resulted in substantial debt, if a close family member passed away, or if you experienced domestic violence, among other hardships. You will need to apply to the Health Insurance Marketplace to qualify for this exemption.

When you file your taxes, you will enter information about the months you had coverage and any exemptions you qualify for on your tax forms. If you could have afforded coverage in 2014 but chose not to buy it and you don't qualify for an exemption you will have to pay a fee with your federal tax return. The fee is based on your income and on how many months you didn't have coverage.

If you didn't have health coverage for all of 2014, you'll pay the higher of $95 per adult and $47.50 per child, without coverage, limited to a family maximum of $285, or 1 percent of your income, subject to certain caps.

Harver Health Insurance Counter Fraud Group: Health insurance options for ACA shoppers

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Maine citizens looking to purchase health insurance on healthcare.gov now have more choices for their 2015 plans. We did a quick roundup of the 3 main players in the local health insurance field in Maine.

Anthem Blue Cross and Blue Shield. A veteran in the health insurance industry, Anthem has been around even before the launch of the Affordable Care Act website 3 years ago. In fact, it has registered over 18,000 Maine citizens as individual clients (i.e. customers who bought their own coverage instead of getting it through work benefits). Their enrolment rates is almost twice as high as their closest rival which is not surprising since they are getting corporate backing from WellPoint, one of the national health insurers with a big market share.

Almost 20% of the enrollees on the ACA site for 2014 plans  were through Anthem. So this year, they seem to be prepared for a big comeback with their premium rates reduced by 1%.

Harvard Pilgrim Health Care. A newcomer in the industry, the non-profit Harvard Pilgrim came to the market with 4 plans for 2015. Though relatively new, it's already familiar with health reforms from its partnership with the now-defunct Dirigo Health (Maine's effort to increase the number of citizens with health insurance).

Harver Health Insurance Counter Fraud Group noted that with 3 health insurers from which to choose from, Maine citizens are benefiting greatly in a growing competitive market, which is incidentally also a goal of the Obamacare.

Maine Community Health Options. This health insurer from Lewiston has around 80% share of Maine buyers in healthcare.gov's website in the primary enrolment period. This startup was created after the ACA (Obamacare) which provides loans for those who want to create health insurance cooperatives. A number of "co-ops" have already registered enrolment rates that are below their targets but Maine Community Health Options seems to be operating as a great example especially in providing reasonable prices.

This year, the premium rate for their most-availed plan decreased by around 0.5%. Their other premium rates were increased albeit on the less popular plans.

Harver Health Insurance Group Tokyo News: A Chief of Surgery Offers Insider Tips to Finding the Right Surgeon

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On Sunday morning, my neighbor Carolyn knocked on my front door holding a basket of carbs and said, "I need to have my gallbladder out. I've never had an operation and have no idea how to find a surgeon to do my surgery. I don't want to die. I brought you some scones."

Carolyn brings up a valid point -- if you've been blessed with reasonably good health, you probably don't have a surgeon's number on speed dial. Therefore, the bigger question is, in the unfortunate event that you need one, how do you find the best surgeon for your medical condition?

Even routine operations have risks

Straightforward surgeries like gallbladder removal or hernia repair can result in occasional complications so it pays to choose your surgeon with care. But other than asking the doctor who recommended the surgery and running down the list of surgeons on your insurance plan, how do you narrow down the list?

I decided to go directly to the source and consulted with board-certified general surgeon Dr. Amit Kharod, chief of the Department of Surgery at CentraState Medical Center in Freehold, New Jersey for his recommendations.

"You are looking for a highly-skilled service provider with whom you are entrusting your life," Dr. Kharod says. "Take the time to perform proper due diligence so you will be comfortable with the caliber and quality of the surgeon you choose."

The doctor went on to outline tips for finding the right surgeon to meet your specific needs:

• Ask hundreds of people in five seconds

With a click of the "send" key, you can electronically reach out to friends, colleagues, neighbors and their friends for feedback and recommendations. The message you send can be as personal or indirect as you wish -- but social networking should uncover some solid leads.

• Nurses are in the know

Medical office and hospital-based nurses get feedback from patients and colleagues about different surgeons day in and day out. If there aren't any nurses in your social network, call your hospital of choice and ask the nursing director who she would chose if a loved one needed your type of operation.

• Confirm these key credentials

Ascertain that the surgeon is board-certified or board-eligible in his or her specialty by visiting the American Board of Medical Specialties and the Federation of State Medical Boards to make sure he or she is licensed in your state.

• Can the surgeon perform your operation laparoscopically?

Some, but not all, surgeons have undergone advanced training to perform many different procedures laparoscopically using state-of-the-art tools and technology, such as robotics. This can mean significantly less pain and faster recovery for you.

• How often and how many times has the doctor performed your surgery?

You want to see that the surgeon is actively performing this operation with consistently successful outcomes. This can be especially important for procedures which are new or uncommon. Over time, many surgeons tend to perform the certain surgeries with regularity and have dealt with complications before.

• Interview your top candidates

Ideally, meet with your potential surgeon/s in person or at least have a phone conversation. See how quickly you can get on his surgical calendar, also. Use this time to pose your key questions and concerns. Remember, you are purchasing an expensive service from the surgeon, not making a new friend.

After you've chosen a surgeon

Carolyn took Dr. Kharod's advice and discovered a great surgeon who had operated on her husband's colleague and was on staff at her preferred hospital. I reminded her to call the doctor's medical insurance administrator and re-confirm that the doctor, the anesthesiologist and the hospital accepts Carolyn's insurance.

Patients who feel confident in their choice of surgeon should feel more at ease before the operation, which is important. Studies conducted on pre-operative patients show that those with higher stress levels at the time of surgery can take as much as 25 percent longer to recover.

Dr. Kharod also advises people not to hesitate to ask doctors for references. "A good surgeon maintains a roster of satisfied patients who are willing to speak about their experiences under his care. Believe me, if I needed surgery, I would be doing the same thing."

To prevent and detect fraud within the health care and the insurance industry, Harver Health Insurance Counter Fraud Group will help you. The Harver Health Insurance Counter Fraud Group has official connections with health fraud investigation agencies.

Harver Health Insurance Counter Fraud Group: Zetia Lowers Risk of Heart Attack, Stroke

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After almost 10 years, the results of a long-awaited clinical study has proven that cholesterol drug Zetia of Merck & Co is capable of reducing heart attack risk when it is used together with statin.

The study was conducted worldwide on 18,000 heart patients  using Zetia, an ezetimibe, plus simvastation as compared to treatments with only simvastatin. LDL cholesterols levels, which is singled out as a critical cause in the development of a cardiovascular problem, decreased by 54 on average.

A 6% reduction in all cardio events, though a modest benefit in high-risk patients, is significant enough. This is the first time that it was proven that the addition of a cholesterol fighter non-statin to the already effective statin will reduce the risk of serious cardiovascular disease.

The resuting data proves that Zetia -- which is already widely used for 12 years for its LDL-reduction capability -- offers a significant protection to several patients. It also supports the hypothesis that a lower LDL cholesterol is beneficial.

Zetia works by preventing dietary cholesterol from being absorbed in the gut, which is different from statins that prevent cholesterol production in the liver. Its presumed lack of effect on the arteries was seen as a challenge to the initial hypothesis that a lower LDL will reduce heart risk.

Dr. Christopher Cannon of Brigham and Women's Hospital in Boston is the lead author of the study presented in Chicago last week. He said, "One of our goals was to test if even lower LDL even better, and the answer is yes. We have a zillion trials showing statins reduce events... our conclusions are that, yes, a non-statin lowering of LDL with ezetimibe reduced cardiovascular events."

Six years ago, a relatively smaller study was conducted which resulted in the findings that the medicine failed to prevent the accumulation of fatty deposits (plaque) in the arteries. Several experts assumed that this failure to at least slow the plaque accumulation might also mean that it will fail to prevent strokes and heart attacks.

According to the Dr. Cannon, this latest study dubbed "Improve-It" attempts to address that concern, hence asserting the significance of LDL reduction. Furthermore, it showed a benefit for getting really LDL cholesterol levels from patients who had had a heart attack recently and were prescribed with only simvastatin.

Patients have suffered unstable angina or heart attack prior to the trials and all their LDL cholesterol levels were lowered to the target of 70 by using simvastatin. Meanwhile, those who used Zetia got 20% lowered LDL.

In the clinical tests, around 32% of the patients who were treated with a statin and ezetimibe had a stroke or a heart attack after 7 years of follow-up against the 34% when only statin was used. Although the primary benefit came in lowering the chance of strokes and heart attacks, it did not result in survival.

Cannon said, "In absolute terms, there are two heart attacks or strokes prevented for every 100 patients treated. An important factor is this is really a long term safety."

It also proved relatively safe -- there was no highly alarming side effects, that is. Out of the thousands of people in the trials, many of them had LDL levels that are not more than 40 and that did not seem to affect them adversely.

However, experts from Harver Health Insurance Counter Fraud Group are concerned that with no other studies backing up such results about heart attacks, patients might be deprived of proven medication, in the form of statins. But the results are certainly highly significant to those patients who cannot take statins.

Harver Health Insurance Counter Fraud Group: General Insurance Tips

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Developed countries such as Japan, USA and Canada have high percentages of people who get insurance coverage for various purposes. It is said that the degree of awareness a populace with regard to the value and benefits of insurance coverage determines the level of economic progress. Or, perhaps, it is the other way around. Economic health could be spurred by people investing in their future security.

Insurance is a form of forced savings which allows people to leverage their future in the event that the unexpected or the unforeseen occurs. A lot of people would not have enjoyed their retirement years without having some form of retirement insurance.


1. Make it a practice to consider the merits of three or more insurance companies through brokers or free-lance agents. Find out as much as you can about the companies’ corporate culture. Are they earnestly interested in your losses in case you reach that point? Or are they merely eager to get you to sign a policy?

2. For many small business-owners, self-insurance is common. However, it can be counter-productive as the potential for acquiring coverage for the whole business is sacrificed in favor of the individual. With so much capital available today, it is more prudent to get coverage for one’s business.

3. Annual assessment of one’s property is essential as the needs of your company and the liabilities grow. Waiting for several years to have a re-assessment might compromise your firm’s ability to recover in case of loss.

4. Oftentimes, the insurer has the option to recompense your loss in three ways: paying the amount lost, repairing the insured asset or replacing the same. Nevertheless, let the insurer know which option you would prefer as it could be to their advantage to grant your wish in order to keep you as their client.

5. When arbitration regarding the valuation of any loss does occur, make sure you are properly represented by an arbitration judge. If a compromise is not achieved, a lawsuit will ensue and a longer battle will await you. Unfortunately, there is no insurance against a lawsuit.

Just like investing in stocks, insurance can be a complex and demanding endeavour. But in the end, understanding what you are getting into will help you come out a satisfied winner rather than a sour loser.


The Harver Health Insurance Counter Fraud Group coordinates closely with its local partners, such as the NHS Counter Fraud Service MOU, NHS Counter Fraud Northern Ireland MOU, NHS Counter Fraud Scotland MOU, City of London Police, National Fraud Authority, Insurance Fraud Bureau, and the Insurance Fraud Investigators Group to assist the process of intelligence and conduct common investigations into fraud.

Health care fraud respects no boundaries. The Harver Health Insurance Counter Fraud Group has official connections with health fraud investigation agencies. If your company is interested in becoming a member of the Harver Health Insurance Counter Fraud Group, kindly get in touch through this site.