Zika Virus and Its impacts in Healthcare

              The Zika Virus is spread mostly by the bite of an infected Aedes species mosquito found mostly in tropical locations but has now been spread to the Aedes albopictus found in Mexico.  As of April 27, 2016, the CDC reports 426 travel-associated Zika Virus cases reported and 9 acquired cases in the US territories of Puerto Rico and the US Virgin Islands. There have not been any cases of infected mosquitoes in the US at this time. The first few cases of Zika virus were reported last year in Brazil and neighboring countries. Within a short time the virus is suspected to have infected millions of people in south and Central America; however, not all those who are infected become ill.  It is estimated that 80% of infections will not be diagnosed. 

The initial reports from Brazil revealed that Zika virus could cause birth defects when acquired by a pregnant female, but reports are inconclusive. The CDC reports that the Zika Virus although rare, can spread from a mother to her fetus during pregnancy and it may be linked to birth defects.  Other reports have indicated that the Zika virus could also cause a Guillain Barre like syndrome and partial paralysis. This has created a Level One Health Concern issued by the US Center for Disease Control (CDC) and the World Health Organization (WHO).  The CDC has not yet made a direct link between Guillain Barre and Zika. The CDC is working with Brazil to study the possibility of a link between Zika and GBS.

While it has always been believed that the Zika virus is transmitted by mosquitoes, the first case of Zika virus transmitted by sexual intercourse was recently reported.  The CDC recommends the use of condoms in areas of concerns and has issued travel advisories for pregnant women who are considering travel to areas that are affected in Mexico, Central and South America. Even though 3 people have been confirmed to have died in Chile due to a Zika virus, there is no report of prior medical conditions of these patients so the exact cause of death remains a mystery.  Additionally, there are no reports of infants getting Zika virus through breastfeeding.  Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.

               The Zika virus is causing panic, so it is important to be clear about the facts.  The first thing to understand is that is not a contagious virus similar to the Ebola virus or the common cold.  The majority of people infected with Zika never develops symptoms. The Zika virus is not transmitted via aerosol droplets, so there is currently no need for personalized protection equipment or isolation rooms. The few patients who develop symptoms may present with fatigue, headache, joint pain, malaise and a cough. The only way to confirm the diagnosis in the US is for testing to be completed by the CDC through your healthcare provider.

               The media has caused such an uproar that healthcare professionals may believe that they need to started to investing in testing for the Zika virus and develop protocols on how to treat and manage infected patients.  We need to be prepared, but have to be careful not to overreact.  According to the CDC, “approximately 1 in 5 people infected with Zika virus become symptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low”. 

There are no known cures or vaccines for Zika virus.  The CDC recommended treatment is getting plenty of rest, fluids, and use of analgesics and antipyretics. Because of similar geographic distribution and symptoms, patients with suspected Zika virus infections also should be evaluated and managed for possible dengue or chikungunya virus infection. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue can be ruled out to reduce the risk of hemorrhage. People infected with Zika, chikungunya, or dengue virus should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission. 

EPA approved mosquito repellent can be used to help prevent mosquito bites as well as keeping infants covered when outdoors.  Lastly, to prevent any type of mosquitoes from calling your space their home, make sure to remove standing water where mosquitoes like to breed, as well as making sure that screens are in good repair and doors are kept closed.

Medicare Fraud, Waste, and Abuse

      Every year, millions of dollars are improperly spent because of fraud waste, and abuse.  This can be halted and prevented if the process of detect, correct, and prevent, is followed.  This process is required by The Social Security Act, as well as CMS regulations.  It is stated that those whom of which supply medicare and medicaid services, are required to have an effective compliance program of which includes measures to prevent, detect, and correct Medicare non-compliance.  There must also be implemented measures to prevent, detect, and correct fraud, waste, and abuse.  These steps and measures must be provided via effective training for employees, managers, and directors, as well as their first tier, downstream, and related entities.  (42 C.F.R. 422.503 and 42 C.F.R  423.504)
      An effective compliance program can be implemented via in-class settings, online courses, and "one on one" training.  If created correctly, an effective program would consist of steps as to how to detect, correct, and prevent.  It must also contain the 7 core compliance program requirements.
      The first step in stopping fraud waste and abuse, is prevention.  Being the most crucial step in halting fraud, is to go to the most vulnerable portion of information and ensure it's safety.  The most common types of fraud an abuse in the medicaid program include medical identity and theft, unnecessary billing, upcoding, unbundling, and beneficiary fraud.
      Medical identity theft, being the most common, involves the misuse of a person’s medical identity to wrongfully obtain health care goods, services, or funds. More specifically, medical identity theft has been defined as “the appropriation or misuse of a patient’s or [provider’s] unique medical identifying information to obtain or bill public or private payers for fraudulent medical goods or services.” Unique medical identifying information for physicians includes the National Provider Identifier, Tax Identification Number, U.S. Drug Enforcement Administration number, and State medical license number. Physician medical identifiers are used for such things as identifying the physician of record on claims and for tracking purposes. Stolen physician identifiers may be used to fill fraudulent prescriptions, refer patients for unnecessary additional services or supplies, or bill for services that were never provided.
      An excellent example of Medical Identity was seen when the ringleader of a criminal group in the Bronx stole prescription pads from doctors and hospitals in the New York City area. Between 2009 and 2011 she used the pads to forge more than 250 prescriptions for painkillers. By using stolen Medicaid cards, she was able to bill the prescriptions to the Medicaid program for a total of more than $200,000. She received two consecutive 4 to 8 year sentences in prison.  Thus, one tip for prevention is that health care professionals should keep their prescription pads in a secure location.
      The second most abused form of fraud is the billing for products or services that are not covered or medically needed.  The Federal Medicaid statute authorizes payment for items and services that are included in each State’s approved plan.  The included items and services vary from State to State. Only those items and services included in the relevant State’s plan are authorized. Even if an item or service is authorized, it is still not covered under Medicaid unless it is also medically necessary.  This can be easily prevented by constant review and analysis of your Medicaid approved plan, this will stop you and your organization from purchase of non-covered goods and or services.  If excessive purchases are made using medicaid that are not covered by the approved plan, the purchasing party can receive an extreme amount of jail time, as well as fines.  This was exemplified when an ambulance service owner in Texas was sentenced to 15 years for billing Medicare and Medicaid for transporting patients by ambulance to dialysis appointments even though the medical condition of the patients did not qualify for that level of transportation.
      Although it may sound like a complex network of underlying danger, Medicare fraud, waste, and abuse can be easily avoided as well as prevented.  If the measures for safety are taken, then it may be brought to a complete and utter stop.  All of the information presented here can be found in a more in-depth toolkit presented by Centers for medicare and medicaid services otherwise known as CMS.  MedTrainer offers extensive and captivating courses on the precautionary steps to take as to how to stop Medicare, Fraud, Waste, and Abuse.  Join us today in creating a more beneficial and productive medical field, free of theft and fraud.  Visit http://medtrainer.com/demo/ to learn more, as well as schedule your free demo.