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Health Management Technology News
  August 28, 2014
In this issue:
 
  HealthCare.gov recruits leader of successful Connecticut effort

  10 ways to strengthen healthcare security

  Some HealthCare.gov contractors see contract values rise

  York man charged in federal court with healthcare fraud

  New ‘biochips’ that mimic our bodies could speed development of drugs

  How much will the CHS breach cost?

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HealthCare.gov recruits leader of successful Connecticut effort

The federal government has recruited the leader of one of the most successful state health insurance marketplaces to lead the federal health exchange, in the hope that the second year of Obamacare will go more smoothly than the first.

Kevin Counihan, the head of Connecticut's health insurance marketplace, will be the new CEO of HealthCare.gov, the website that 36 states use to sell insurance under the Affordable Care Act, the Obama administration announced Tuesday.

Department of Health and Human Services Secretary Sylvia Burwell tapped Counihan to lead the site as part of a revamped management structure.

Under Counihan's leadership, Access Health CT signed up about 79,000 people for coverage through Connecticut's exchange; another 120,000 gained Medicaid coverage. Surveys show that about half the people who gained coverage in the state were previously uninsured.

"One of the most important things we did is we showed that government can work," Counihan said at a press conference in Hartford Tuesday. "It can take on a highly complex social program and succeed."

But taking the reins of healthcare.gov will be a much tougher job.

Read the full article from NPR here

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10 ways to strengthen healthcare security

In the wake of the Community Health Systems breach and FBI warnings about healthcare organizations' vulnerability, security has advanced to the top of many industry executives' to-do lists.

Real safeguards and policy implementations, however, speak louder than any number of crisis meetings. Securing any healthcare organization -- from a solo practice to multi-location hospital systems -- takes measured planning, technical expertise, and business knowledge. It's the only way security professionals can balance their quest for impenetrable devices and software against medical users' demand for easy, accessible data and tools.

"New regulations tied to the Affordable Care Act are now in effect regarding protected health information and electronic health records, which only underscores the need for data security to ensure privacy among patients," said Fred Chang, director of Darwin Deason Institute for Cyber Security, and Bobby B. Lyle, Endowed Centennial Distinguished Chair in Cyber Security at the Lyle School of Engineering at Southern Methodist University, in a statement. "Cyberspace can be a pretty bad neighborhood, with too few barriers standing between hackers and their targets. Healthcare providers recognize that data security is of vital importance to their business."

Healthcare organizations are particularly vulnerable. They house both personal health and payment information, plus intellectual property – all lucrative targets for hackers. But most employees want to heal people, not become technologists, and might view technology protections as healthcare speed bumps. As providers, payers, employees, patients, and partners become increasingly intertwined through shared data, transparency, and analytics, the opportunities for loss, error, or theft grow exponentially.

Read the full article from Information Week here

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Some HealthCare.gov contractors see contract values rise

Three firms involved in the troubled Obamacare website HealthCare.gov have seen their contract values exceed initial estimates by more than a quarter-billion dollars, including the lead IT contractor at the time of the site's botched rollout, government data shows.

A report released on Tuesday by the U.S. Department of the Health and Human Services (HHS) Office of Inspector General (OIG) estimates the original value of 60 information technology (IT) contracts related to the Obamacare federal marketplace at $1.7 billion.

But obligations made under 20 contracts had exceeded their initial estimates by March 2014, with seven contracts more than doubling in value, according to the report.

The OIG report did not specify a total dollar value. But its data shows the combined value of the 20 contracts rising more than $280 million from their original estimates, with over 90 percent going to former lead contractor CGI Federal, Verizon Communications Inc's Terremark unit and Quality Software Services Inc.

The OIG cautioned that not all the contracts it examined were awarded solely for HealthCare.gov and its federal marketplace. Some contracts also cover services to state-run marketplaces and other federal healthcare programs.

The amount of money actually obligated for the federal marketplace totalled about $800 million as of February.

Read the full article from Reuters here

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York man charged in federal court with healthcare fraud

Federal authorities filed a civil health care fraud lawsuit against a York County man.

The U.S. Attorney’s Office for the Middle District of Pennsylvania is suing Kurt Bauer, 61, after it said Bauer, despite being excluded from participation in Medicare, was a manager and administrator of Leader Heights Healthcare P.C., which submitted thousands of false claims to Medicare.

According to U.S. Attorney Peter Smith, Leader Heights Healthcare, formerly ChiroCare Center, is a York County-based chiropractic and primary care provider that accepted Medicare patients. The complaint alleges that Bauer owned Leader Heights under its former name, but his chiropractic license was revoked by the Pennsylvania Department of State in 2008 for an inappropriate relationship with a patient, resulting in Bauer’s exclusion from Medicare. According to the complaint, the U.S. Department of Health and Human Services warned Bauer that he generally could no longer be employed and could not provide administrative and management services for a Medicare provider because of the exclusion.

Despite the warning and after falsely informing Medicare that he had retired, Bauer allegedly retained ownership of Leader Heights Healthcare until 2009 and continued to be involved in the management and administration of Leader Heights until he learned of the government’s investigation in 2013.

Between 2008 and 2013, Leader Heights Healthcare allegedly submitted thousands of claims to Medicare for reimbursement for several million dollars, and it received approximately $3 million from Medicare, the U.S. Attorney’s Office said.

The government contends that, because of Bauer’s involvement in the management and administration of Leader Heights during his exclusion, Bauer knowingly caused the submission of false claims to Medicare that improperly sought reimbursement for the services he provided.

Read the full article from The Sentinel here

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New ‘biochips’ that mimic our bodies could speed development of drugs

Imagine if scientists could recreate you – or at least part of you – on a chip. That might help doctors identify drugs that would help you heal faster, bypassing the sometimes painful trial-and-error process and the hefty costs that burden our healthcare system.

Right now, inside a lab at the University of California, Berkeley, researchers are working to make that happen. They’re trying to grow human organ tissue, like heart and liver, on tiny chips. These aren’t your standard computer chips. They’re miniature networks, derived from adult skin cells coerced into becoming the type of tissue scientists want to study, that grow on miniscule pipe-like plastic chambers glued atop a microscope slide.

The research is designed to find ways to get that tissue to live and mimic how real human organs function. If so, they could provide a cheap and quick way of weeding out treatments that are toxic or just don’t work. The aim is to weed them out early on, in the lab, replacing at least some of the tedious years of testing on animals and humans.

What’s more, because drugs traditionally are developed with a one-size-fits-all approach, clinicians often don’t know how well medications will work on individual patients. According Anurag Mathur, one of the Berkeley researchers, these chips could lead to “a personalized medicine, patient-specific readout of any drug you want to test.”

Read the full article from Wired here

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How much will the CHS breach cost?

Last week, Franklin, Tenn.-based Community Health Systems reported a cyberattack affecting nearly 4.5 million people. A data breach of this size is likely to be extremely costly for the 206-hospital system.

According to a CHS notification, no medical information was compromised in the breach. However, the information that was compromised – including patient names, addresses and Social Security numbers – is still protected under HIPAA, meaning CHS could face fines if the current federal investigation into the breach finds fault with CHS' security practices.

Past HIPAA settlements give an indication of the size of the fine CHS could face. Last year, WellPoint settled with HHS for $1.7 million over allegations a security weakness in the health insurer's database left the protected health information of more than 600,000 people vulnerable to "unauthorized individuals" over the Internet. The CHS data breach, affecting about 7.5 times the number of people, has the potential to be much more expensive. Additionally, in June, an HHS official said the department plans to step up enforcement and fines related to data breaches, meaning CHS fines could be higher than past settlements would suggest.

Much of the cost of HHS sanctions could come from "corrective actions" necessitated from a settlement. In 2009, a burglary exposed the information of 1 million BlueCross Blue Shield of Tennessee beneficiaries. The organization was slapped with a $1.5 million fine, but spent more than four times that amount, $7 million, on IT security remediation.

CHS could also face legal settlements. A class-action suit has already been filed in Alabama, accusing the health system of breaching its contracts with patients by failing to secure their personal information.

More suits could be filed, as CHS operates facilities in 29 states. Two class-action settlements announced in July give an idea of how large a CHS settlement could be – grocer Schnuck Markets agreed to a $2.1 million settlement following a breach that exposed 2.4 million credit and debit cards, and Sony agreed to pay $15 million to settle a suit after 77 million user accounts, possibly including credit card information, were compromised.

The identity security services CHS has offered to affected patients will also add to the total cost of the breach. Forbes estimates the total will come to $20 million, assuming about 30 percent of those affected opt-in to the service at an annual cost of about $12 to $20 per person per year.

Read the full article from Becker’s Hospital Review here

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