Health care reform

Did you get a $100,000 fine for a data breach?

Actually, what is a breach?

Almost every day the news carries a story about a company that has had a “Breach” of their security and PHI has been disclosed. There are so many of them that most go unreported now and only the really big ones get any attention. But what exactly is a breach anyway?

Technically it is “make a gap in and break through …”, so whales breach the surface, people regularly breach their contracts, and babies who come out bottom first, yikes, are “breach birth.” But those are not what the news is talking about!

Breach in the case of PHI and HPIAA (I will define those in a minute) means somebody did not protect the information they have on themselves and other people that they are legally responsible to care for.

So now you ask me “Then Bill a breach might not be just somebody getting into our computer?”

Move to the front chair, you caught the brass ring on that one! (Antique reference to Merry go Rounds for the younger readers)

Yes, a breach can be as simple as sending somebody your log in credentials in an open email. “Who would be watching my email, I’m no big deal?” The bad guys do not have to watch “your” email, they just run a bot that looks for email patterns that look like passwords.

In our case we tell employers every day we will provide a secure format to transmit information to us. They ignore that and then send us a census with every employee’s personal information, including all of their identifying data. By anybody’s definition that is a breach.

It discloses PHI – “PHI is any health information that can be tied to an individual..(Google)”

It violates HIPAA – “HIPAA is the acronym for the Health Insurance Portability and Accountability Act (Hipaastore.com)”

And that causes this “The penalties for noncompliance are based on the level of negligence and can range from $100 to $50,000 per violation (or per record)(Truevault.com)”

Life has truly become a regulatory minefield, but unlike abandoned war mines, there are maps for HIPAA and other legal mines. And this is where I again stress the importance of professionals in your life. Not every “Professional” is the same so you need to do your own due diligence but the stakes are high and violation costs can put you out of business so the search is worth the effort.

And, of course, you can always contact me and say “what was that thing you wrote about, I’m confused.”

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Are you smarter than congress about health care cost?

This might seem obvious but to properly address an issue you must first understand the problem you are trying to fix. Well clearly our legislators, the media pundits, and most of the clamoring public seem to be ignoring the need for understanding the problem in discussions of Health Care cost and how to pay for it.

So let’s just dive right into the healthcare “cost” issue.

Why is it important – This goes way beyond partisan bickering and protecting political turf. Which also is why it cannot be corrected with hurried and poorly prepared legislation.
This is about you with your injured child – “Do you have insurance? How will you pay for this?”
This is about you losing everything because you – had a heart attack – lost your job – lost your insurance and now face $200,000 in medical bills you cannot pay.
This is about a national cost item that cannot be paid for in any governmental scheme that does not include care restriction and increased taxation. Yes – if you consider unlimited health care a basic right for everybody, that is true!

Language – words matter and if you don’t understand the language, you not only cannot fix the problem you may inadvertently make it worse. We all must differentiate between “Health Care cost” and “Health Insurance.” They are related but not the same:
A. Healthcare cost – this is the actual cost of medical treatment and related services. This exists if you have insurance or not. This is what nobody can afford to pay, and WHY you need insurance.
B. Healthcare insurance – this is a funding mechanism designed to “pool” risk and spread the cost. This is how we collect a relatively small amount of money from healthy people to pay the bills for somebody who needs care. This is how we as a society pay for all those healthcare costs.
C. Access to “Healthcare” – This is the ability for a person to get a healthcare professional to treat them. Everybody has basic access to general healthcare and emergency services. What you might not have is enough money or “Insurance” to pay for your treatment.

So the next time your hear somebody say “Healthcare is just too expensive we have to beat up the insurance companies”, quietly know that they are uninformed.

Economics. There is at least one un-refutable truth in economics. Money coming in must be bigger than money going out. Even governments cannot live forever if debt exceeds revenue. Eventually even government runs out of your money and your ability to create more GDP.

The problem – So the problem is the “Cost” of healthcare. How do we address that?
First it is critical we all stop blaming and finger pointing, we need to talk and agree on a few things.

Try this approach – you do not get to complain unless you have thought about it and bring forward an idea to solve the problem. You don’t have to be right the first time, but you do have to be part of the solution and not just some anonymous internet loudmouth complaining.

Start here:
Problem    National Health Care cost ___________________________________________________________________________

Solution    My idea to provide care and pay for it ___________________________________________________________________

To paraphrase a credit card company – what’s in your mind? How would you approach this problem?

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OK who volunteered to do 10 years in prison?

Those who know me, or work with Focus Benefits Group, are used to me going on and on about ACA compliance. Recently  another insurance broker commented that I had gotten up to speed on this subject pretty fast.

“That’s true, it has only been 42 years!” I commented.

ERISA has been a factor in benefits since 1974 and Summary Plan Documents (SPD) have been required for just about as long. The problem has been a lack of knowledge and professionalism on the part of Insurance brokers who were supposed to tell clients. For those who remember, many years ago insurance companies did include the ERISA language in their benefits booklets. They generally don’t do it now and you need to know that.

Business owners will face audits for many aspects of their business in the coming year. Legislators, and more onerously regulatory staff, are constantly increasing the reporting load. As a business owner you may not be able to comply with every rule but you do need to make sure you comply with at least the really important ones and the SPD is one of those.

I recently consulted for a large employer and found they had no ACA documentation, NONE! When I asked why they continue to use the advisor who left them in that position I was told “Because he gives us tickets to major sports events every year!” I am always surprised when successful business people tell me they trust their advisor on that basis. Here is the real problem.

Criminal penalties may be assessed individually or by company, for willfully violating any ERISA disclosure requirement (e.g., plan document, SPD, SMM or SAR), the penalty can be per conviction (as in per employee affected) and could be $100,000 and/or imprisonment for up to 10 years ($500,000 if assessed against a company). A plan administrator may be liable for $110 per day penalties for failure to provide a response to a request for a copy of a required document. If you don’t have the documents, how expensive might that become while you get them completed and then distributed.

When that employer is responding to the ACA audit, and looking at $500,000 in fines, I hope the sports tickets were worth it.

An SPD can be done for $200. What are you waiting for.

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