White House Moves to Ease Insurance Fraud FearsWhite House Pushes Back Against Fraud Fears By Obamacare OpponentsWebMD News from Kaiser Health News

By Phil Galewitz
The White House on Wednesday unveiled several steps to protect consumers from fraud in the new online health insurance marketplaces, a move that comes after 17 states hostile to the law acted to limit the spread of information about the program, and congressional Republicans raised concerns about the privacy of medical and financial records.
"We are sending a clear message that we will not tolerate anyone seeking to defraud consumers in the health insurance marketplace," said Health and Human Services Secretary Kathleen Sebelius.
Senior administration officials acknowledged the potential for scams with any new government program, including the Obamacare marketplaces that open for enrollment Oct. 1 and are expected to help 7 million Americans get coverage next year.
But they stressed that the health law's new "navigators" -- federally-paid groups that help people enroll in coverage -- do not represent a significant risk and that Medicare has used such guides for years without problems or controversy.
The announcement was unlikely to appease the law's opponents, however -- among them, Oklahoma’s top insurance regulator, John Doak, who has already put navigator groups on notice.
On the same day that officials at Little Dixie Community Action Agency in Hugo, Okla., won a $580,000 federal grant to help consumers sign up for coverage under the federal health law, Doak issued a warning. If the consumer guides perform any of the duties of state-licensed insurance agents, he said, "we will put a stop to it." He also called the $1.6 million award to hire and train the guides in Oklahoma -- part of $67 million nationwide -- "a waste" because it would duplicate the work of better-trained agents.
At Least 17 States Limit Navigators
Oklahoma is among at least 17 Republican-controlled states that have taken steps to restrict the 105 groups that won the federal grants, including churches, colleges, social service agencies and Planned Parenthood. Some states such as Indiana are requiring navigators to pay as much as $175 for licensing that would include a state exam and a criminal background check.
Others, such as Missouri and Georgia, have passed laws limiting what navigators can say and do. Last week, the Florida Health Department announced that local public health offices, where uninsured people often go for services, cannot have navigators on the premises.
State officials say they’re concerned the navigators, who are required by the federal government to get 20 hours of online training and pass an exam, will know too little to be helpful. They also worry about their access to private information, such as Social Security numbers.
But the law’s proponents see the restrictions as simply the latest GOP effort to impede the rollout of the law known as Obamacare, and worry they will dampen enrollment.


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Review found they reduced risk by 7 percent, but did not reduce severity or risk of death
By Robert Preidt
HealthDay Reporter
WEDNESDAY, Sept. 18 (HealthDay News) -- Taking vitamin B supplements may help reduce your risk of stroke, a new review shows.
Previous research has yielded conflicting findings about whether taking vitamin B supplements affects the risk of stroke and heart attack. Some studies have concluded that taking vitamin B supplements may actually increase the risk, according to the review authors.
They analyzed the findings of 14 clinical trials that included a total of nearly 55,000 people. All of the trials compared vitamin B supplement use with a placebo or very low-dose vitamin B.
The participants were followed for a minimum of six months. There were a total of nearly 2,500 strokes among the participants in the studies, all of which showed some benefit of taking vitamin B.
Overall, vitamin B supplements reduced the risk of stroke by 7 percent, but did not appear to reduce the severity of strokes or the risk of death from stroke, according to the review, which was published in the Sept. 18 online issue of the journal Neurology.
The researchers found that folic acid, a supplemental form of folate (B9) that is common in fortified cereals, appeared to reduce the beneficial effect of vitamin B. They also found that vitamin B12 had no effect on stroke risk.
"Based on our results, the ability of vitamin B to reduce stroke risk may be influenced by a number of other factors, such as the body's absorption rate, the amount of folic acid or vitamin B12 concentration in the blood, and whether a person has kidney disease or high blood pressure," review author Xu Yuming, of Zhengzhou University in China, said in a journal news release.
"Before you begin taking any supplements, you should always talk to your doctor," Yuming added.
One expert agreed, noting that strokes can be caused by many varying factors.
"Ischemic strokes can have many different causes, the most common being hypertension, diabetes, high cholesterol, smoking and obesity," said Dr. Rafael Alexander Ortiz, director of neuro-endovascular surgery and stroke at Lenox Hill Hospital in New York City. "There is a group of patients that may suffer a stroke due to deficiency of vitamins and enzymes. It is appropriate to perform a comprehensive work-up, including [for] vitamin deficiencies, in patients that have suffered a stroke."
Another expert said the findings are important.
"[The report] identifies a substance which is readily available and has been demonstrated to have a positive effect in stroke risk reduction in certain population subgroups," said Dr. Albert Favate, director of the Comprehensive Stroke Center at NYU Langone Medical Center in New York City. "The article also reflects the increased public thirst for dietary prevention of stroke."

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More powerful painkillers prescribed, but they may not work better than safer alternatives
By Robert Preidt
HealthDay Reporter
THURSDAY, Sept. 19 (HealthDay News) -- Prescriptions for powerful opioid painkiller drugs have skyrocketed in the United States, but identification and treatment of pain has not improved, according to a new study.
"There is an epidemic of prescription opioid addiction and abuse in the United States. We felt it was important to examine whether or not this epidemic has coincided with improved identification and treatment of pain," Dr. G. Caleb Alexander, an associate professor of epidemiology and medicine and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, said in a Hopkins news release.
The researchers analyzed federal government data collected between 2000 and 2010, and found no significant change in the number of pain-related visits to doctors that resulted in patients receiving treatment with pain relievers.
During the study period, prescriptions of non-opioid painkillers remained stable, accounting for 26 percent to 29 percent of pain-related visits. However, prescriptions for opioids nearly doubled, from 11 percent to 19 percent, the investigators found.
Of the 164 million pain-related visits to doctors in 2010, about half of patients were treated with some kind of pain reliever: 20 percent with an opioid and 27 percent with a non-opioid, according to the study published online Sept. 13 in the journal Medical Care.
The researchers also examined visits to doctors for new-onset musculoskeletal pain and found similar increases in opioid prescriptions. There is no evidence that opioids are more effective or safer than non-opioids in treating this type of pain, however, the study authors found a significant drop in non-opioid prescriptions, from 38 percent in 2000 to 29 percent in 2010.
The findings highlight the importance of balancing the risks and benefits of pain drugs prescribed by primary care doctors, study lead author Matthew Daubresse pointed out.
"The majority of pain medications are prescribed by primary care physicians, who treat over half of the chronic pain in the United States," Daubresse said in the news release. "Pain specialists only treat a fraction of these patients."
And Alexander noted that "not only have the rates of treated pain not improved, but in many cases, use of safer alternatives to opioids, such as medicines like ibuprofen and acetaminophen, have either stayed flat or declined. This suggests that efforts to improve the identification and treatment of pain have backfired, due to an overreliance on prescription opioids that have caused incredible morbidity and mortality among patients, young and old alike."

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