Health Archives - Barbados Today

Eat smart this Christmas


The National Nutrition Centre has offered some advice to help Barbadians successfully navigate the buffet table this Christmas season by making healthier food choices.


The National Nutrition Centre has offered some advice to help Barbadians successfully navigate the buffet table this Christmas season by making healthier food choices.

Community Nutrition Officer 1, Carla Ramsay, explained that while this time of year was usually one of indulgence, the basic rules of good nutrition still obtained.

“Include a variety of nutritious foods, such as fruits and vegetables in your daily diet or on your holiday menu. Also, use less salt in your meal preparations. When you are seasoning your meats, instead of lime and salt, just use lime or vinegar. Use low sodium seasonings and beware of the additional salt that may add up from certain packaged seasonings,” Ramsay advised.

While it was customary for persons to throw caution to the wind during the holiday period with the hopes of getting back on track in the New Year, she pointed out that this approach was not a particularly good idea.

“This is not advisable because a lot of damage can be done in a short period of time. Usually, people are shocked when they see their blood results early in the New Year. It is a season that all of us can enjoy. We are not stopping anyone from having their favourite foods but be mindful of how much and how often you are going to have them. You can eat nutritiously, even in December,” she emphasised.

 

Include a variety of nutritious foods, such as fruits and vegetables in your daily diet or on your holiday menu.

Ramsay offered a few tips to help persons, especially those with non-communicable diseases (NCDs), to choose wisely when at family gatherings or corporate events:

Eat before you leave so you don’t over indulge on the wrong foods. Don’t save up calories by eating less throughout the day, so you can indulge at a party or event. That generally doesn’t work out well for most people.

Walk with a healthy snack, especially when out shopping. This could be a banana, apple, nuts, etc.

Scan the buffet or food table ahead of eating time.

Choose one or two splurges instead of items you can have any other time of year.

Aim to make the plate look festive by including colourful fruits and vegetables.

Water is still a viable option. Be mindful that most drinks will be sweetened so you can choose a smaller glass.

If you choose to drink alcohol, do so in moderation and alternate each alcoholic beverage with water.

A polite ‘no thank you’ can work. Eat until you are satisfied, not stuffed.

Don’t overfill your plate. You may also choose a smaller plate and remember to eat slowly. Half of your plate should be fruits and vegetables, a quarter of it should be high fibre or complex starches and another quarter could be your lean protein or a vegetarian source.

Also check your fullness level while eating.

“For persons with NCDs, be mindful of what you are eating. The same things that we talk about from January to November
hold also in December. Make sure you have your fruits and vegetables, lean proteins, high fibre and your complex carbohydrates or starches. 

“Make sure you monitor your blood sugar and blood pressure throughout the season. Like I said, it is not that you don’t have the special treats but how much and how often. They should fit into what is considered a healthy day for you,” Ramsay stated.

For further information, persons may download the National Nutrition Centre’s Healthy Eating Guide at this address.

https://gisbarbados.gov.bb/blog/healthy-eating-guide-available-for-download (BGIS)

The post Eat smart this Christmas appeared first on Barbados Today.

2 years 6 months ago

A Slider, Feature, Health

Healio News

FDA approves Fresenius Kabi’s Idacio as eighth adalimumab biosimilar

The FDA has approved Idacio as the eighth biosimilar to adalimumab, for all eligible indications of the reference product, clearing the way for its U.S.

release in 2023 alongside a deluge of other Humira biosimilars.Idacio (adalimumab-aacf, Fresenius Kabi) is a citrate-free biosimilar to the world’s top-selling Humira (adalimumab, AbbVie), a TNF inhibitor approved to treat patients with rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, adult Crohn’s disease, ulcerative colitis and plaque psoriasis.“This is another important

2 years 6 months ago

Health – Dominican Today

WHO hopes that global emergencies due to covid and monkey smallpox will soon end

The World Health Organization (WHO) declared international emergencies in 2020 due to covid-19 and in 2022 due to mpox (monkey smallpox), which “could soon cease to be a global priority emergency,” according to Tedros Adhanom Ghebreyesus, the organization’s director general, today at a press conference.

However, “the coronavirus will not disappear; it will continue, and countries will have to learn to manage it alongside other respiratory problems such as the flu,” Tedros said, adding that the 90% drop in mpox cases encourages hope for a quick resolution to this health crisis.

Tedros recalled that the criteria for determining whether the covid pandemic is no longer an international emergency will be discussed at the next meeting of the committee of experts, which has met quarterly since 2020 to analyze the evolution of the health crisis.

The WHO chief emphasized that, while the number of cases in both the covid and mpox crises is declining, the world still faces numerous health challenges, citing the cholera outbreaks currently declared in 29 countries, including the one that has killed 280 people in Haiti.

2 years 6 months ago

Health, World

Health Archives - Barbados Today

Breach disrupts services at Queen Elizabeth Hospital


By Anesta Henry


By Anesta Henry

Executive Chairman of the Queen Elizabeth Hospital (QEH) Dr Juliette Bynoe-Sutherland has given the assurance that even though a cyber security incident affected a number of the hospital’s services on Tuesday, swift measures were implemented to protect patient privacy.

Bynoe-Sutherland said the disruption caused the suspension of all internet-dependent services which she described as extensive.

“The IT [Information Technology] experts have taken all precautions to protect the integrity of our system and the privacy of all of our patients. We do apologise for the inconvenience that may be experienced by all of our users, but rest assured we will continue to keep the public informed as we seek to restore services here at the hospital,” Bynoe-Sutherland said.

MIST (Ministry of Industry, Innovation Science and Technology) and cyber security specialists have been working with the QEH’s IT department to rectify the issue. 

In addition to the temporary precautions being taken to protect the integrity of systems and patient privacy, the hospital chief indicated that the Ambulance Service continues to function as normal, the Blood Collecting Centre continues to welcome blood donations. Members seeking further information have been encouraged to contact the Patient Liason Service (Help Desk), at 536-4800.

The Executive Chairman told Barbados TODAY she could not say exactly when the matter will be resolved. 

anestahenry@barbadostoday.bb

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2 years 6 months ago

A Slider, Health, Local News

Health

Commit to staying fit during the holidays

During the holiday season, the already challenging endeavour of making time for fitness becomes even more difficult. From Thanksgiving through Christmas and into the new year, it is very easy to overindulge in holiday goodies and neglect one’s...

During the holiday season, the already challenging endeavour of making time for fitness becomes even more difficult. From Thanksgiving through Christmas and into the new year, it is very easy to overindulge in holiday goodies and neglect one’s...

2 years 6 months ago

Health

Maintain good heart health

The holiday season is a time of excitement and anticipation, but the cold weather, change in routine and increase in stress can also increase your risk of heart attack or stroke. In fact, recent studies show an increase in the number of deaths from...

The holiday season is a time of excitement and anticipation, but the cold weather, change in routine and increase in stress can also increase your risk of heart attack or stroke. In fact, recent studies show an increase in the number of deaths from...

2 years 6 months ago

Jamaica Observer

Gov't increases NHF benefits; prostate cancer test now covered

THE Government has announced changes to the National Health Fund's (NHF) Individual Benefits Programme which will see higher subsidies, an increase to the Jamaica Drug for the Elderly Programme (JADEP) drug list, and the addition of the Prostate Specific Antigen (PSA) test.

These additional benefits are expected to take effect by the end of February next year.

Minister of Health and Wellness Dr Christopher Tufton, who made the disclosure during a statement in Parliament on Tuesday, said these changes will help to support access to health care for the 350,000 active beneficiaries who use the NHF card, and the more than 21,000 beneficiaries of JADEP.

"At the same time, Jamaican men 40 and older and who are enrolled with the NHF will now have ready access to screening for what is the leading cause of cancer-related deaths in our male population," he said.

Tufton told the House that the NHF Individual Benefits Programme provides subsidies for three main categories of benefits for Jamaican residents enrolled. These subsidies are accessed using the NHF card and through JADEP for medication for the treatment of 17 chronic diseases, medical supplies and devices for diabetes and asthma and for two diagnostics tests.

"In keeping with the NHF's strategic priority to improve access and enhance customer satisfaction, the fund conducts periodic reviews of the benefits under the programme and in addition receives feedback from beneficiaries and stakeholders in relation to their concerns about the programme," he said, noting that directors approved the changes at a board of management meeting held on November 23, 2022.

In terms of the NHF card, Tufton said there will now be an additional 41 new active pharmaceutical ingredients for the treatment of eight conditions — hypertension, heart disease, vascular disease, diabetes, psychosis, glaucoma, sickle cell disease, and epilepsy.

"This will cost an additional $474 million per annum in order to make provisions for these additional drugs," Tufton said.

The NHF Board, he said, also approved changes to JADEP to ensure that five pharmaceutical items are added for the treatment of five conditions — arthritis, asthma, glaucoma, hypertension and vascular disease, based on specific criteria.

"This will see approximately 21,100 active beneficiaries receiving benefits at an estimated cost of $42.59 million per annum. Jamaican residents 60 years and older can qualify for benefits under JADEP," he said.

Turning to the PSA test, Tufton said that this will now be covered under the Individual Benefits Programme, where males over 40 years who are enrolled on the NHF can now access the test.

"We have some 89,665 active male claimants, 40 years and older, who can benefit from this new addition," he said.

The subsidy on the PSA tests is set at $1,600 per test with a maximum allowance of one test per year.

"We would like to say to our Jamaican men, those over 40 who can now access this benefit, that it is better to feel violated and get tested than to determine that you are infected by prostate cancer at a stage where there is no recovery. Get yourself tested, it may save your life," he said.

Tufton, in his statement to Parliament, said that prostate cancer is a very serious men's health issue being the most commonly diagnosed cancer in Jamaican men and the leading cause of cancer-related deaths in the male population. He noted that more often than not, the reasons why men die from prostate cancer is due to late detection because they do not get screened.

Citing Global Cancer Observatory data for 2020, Tufton said it is estimated that Jamaica sees on average around 1,500 new prostate cancer cases annually.

"Part of the way forward is to encourage early detection through screening; hence, this new addition to the NHF arrangement. So screening is really about early detection. Early detection saves lives. Screening for prostate cancer using the PSA test and the digital rectal examination (DRE) can identify abnormalities and may find cancer early so that affected men can begin treatment before it spreads," he said.

To access these expanded benefits and others, members of the public can call the NHF, visit its website or visit any of the 106 DrugServ locations for full time and scheduled services at private and public health facilities islandwide.

2 years 6 months ago

Health – Demerara Waves Online News- Guyana

Georgetown Public Hospital says nearby vending is old issue that’s now “life threatening”

The Georgetown Public Hospital Corporation (GPHC) on Tuesday indicated that its concerns about food vending on New Market Street date back to several years and records show that official complaints to the Georgetown Mayor and City Council stretch from 2015 to 2022, but little has been done resulting increased risks to gravely ill patients who ...

The Georgetown Public Hospital Corporation (GPHC) on Tuesday indicated that its concerns about food vending on New Market Street date back to several years and records show that official complaints to the Georgetown Mayor and City Council stretch from 2015 to 2022, but little has been done resulting increased risks to gravely ill patients who ...

2 years 6 months ago

Business, Health, News

PAHO/WHO | Pan American Health Organization

PAHO Elimination Initiative which aims to decrease communicable diseases must be strengthened to recover gains lost during COVID-19 pandemic

PAHO Elimination Initiative which aims to decrease communicable diseases must be strengthened to recover gains lost during COVID-19 pandemic

Cristina Mitchell

13 Dec 2022

PAHO Elimination Initiative which aims to decrease communicable diseases must be strengthened to recover gains lost during COVID-19 pandemic

Cristina Mitchell

13 Dec 2022

2 years 6 months ago

STAT

STAT+: Study points to new ‘king on the block’ for treatment of chronic lymphocytic leukemia

NEW ORLEANS — One of the best therapies for some types of lymphoma and leukemia has been a drug called ibrutinib, made by AbbVie. When it hit the market in 2013, the drug revolutionized the treatment of these cancers and represented a major step forward from chemotherapy and some other drugs at the time.

But research presented at the American Society of Hematology meeting in New Orleans suggested that a second-generation drug called zanubrutinib from BeiGene is about to unseat ibrutinib as “the king on the block” for the treatment of chronic lymphocytic leukemia, said Catherine Diefenbach, medical director of the lymphoma program at the NYU Langone’s Perlmutter Cancer Center.

Continue to STAT+ to read the full story…

2 years 6 months ago

Biotech, Health, ASH22, biotechnology, Cancer, STAT+

Health Archives - Barbados Today

Health authorities urge residents to protect against COVID-19 and flu as cases rise



Health authorities are warning Barbadians to be extra cautious during the busy Christmas season amid a double whammy of a lingering COVID-19 pandemic that has resulted in another death in recent days, and a highly infectious flu virus.

Chief Medical Officer (CMO) Dr Kenneth George said in a recorded statement on Monday that both viruses were presenting some challenges, as he noted that the true extent of COVID-19 cases may not be known since testing has declined.

He disclosed that just below 20 per cent of COVID-19 tests performed were positive while the RE – the number of people in a population who can be infected by a COVID-19-positive individual at any specific time – was above one.

“And those two metrics together indicate that we are still having COVID spread in our communities. In addition, what we also note is that the number of persons coming to be tested has fallen off and, therefore, the number of persons having COVID in our communities may not be a true reflection of what it really is,” Dr George cautioned, as he urged the most vulnerable groups to “go the extra mile” to protect their health.

“And, therefore, I ask that you be cautious around the Christmas period.”

The CMO noted that while the hospitalisation rate has remained low, and those who were hospitalised were having milder forms of illness, “we, unfortunately, within the last seven days have had a single death”.

“We continue to monitor hospitalisation and deaths as a metric to determine how severe the infections are,” the Government’s chief medical advisor said.

“We are indeed facing a double whammy because we have COVID circulating and we also have flu circulating. The flu virus has been typed – it is H3N2 that has been circulating and that has also increased steeply within the last two months. We continue to monitor both for flu and for COVID…. Fortunately…we have not had any hospitalisation or deaths associated with the flu virus,” Dr George added.

He said the Health Ministry would continue to examine the information and report to the public any changes in that trajectory.

“But it is important to note that the flu in some countries does cause significant sickness and even death. The good thing is that there are similar ways to prevent COVID as you can prevent flu,” Dr George pointed out.

“The viruses circulating are certainly not as deadly or causing severe illness as when we were in the throes of Delta. The virus circulating is very infectious, so the likelihood of transmission is high but the outcomes appear to be a bit better.”

The CMO assured the public that the Ministry had not taken its eye off COVID-19.

“We don’t come to the public as often as before, but we continue to run the EOC [Emergency Operations Centre], [and] have several systems in place in the background to make sure that the national response continues,” he assured.

However, Deputy Chief Environmental Health Officer and former head of the now defunct COVID-19 Monitoring Unit, Ronald Chapman promised Barbadians that the Government would not go back to the tight restrictions that were imposed at the height of the pandemic.

“The Ministry of Health has no intention at this present time to return to the heavy-handed approach that we had during COVID. You can see that with the relaxation of the protocols and also with the dissolution of the COVID-19 Monitoring Unit. So, we are at a place where we believe that persons can act responsibly, that persons can take stock of their own risks, they can look and see how they can protect themselves as opposed to having persons police every movement that they make,” he said.

“That was important during the period of time because we knew very little about the disease and we had a lot of hospitalisations and we were dealing with highly infectious strains at that point in time. Now we have a better handle on it and it is time that we get a return to some sense of normalcy.”

He encouraged Barbadians to protect themselves from both COVID-19 and the flu.

“As international travel ramps around this time of the year, it is extremely important that we pay attention to our preventive measures which are mask-wearing, which is still probably the best if not the best method of preventing the spread of respiratory illness; continue to ensure your hand hygiene is up to scratch, and if you are not able to wash your hands still use your hand sanitisers,” Chapman stressed.

“The whole idea of physical distancing, those things are still important. However, we recognise that there has been a relaxation in the directives, and because of that relaxation, we expect persons to take responsibility for themselves…. If you are not feeling well, it is wise to put on a mask. You may not have COVID, you may be suffering from the flu, or maybe just a common cold, but all respiratory diseases can be fought by the use of masks,” he suggested.

Data released by the Ministry of Health on Monday showed that the country recorded 528 new COVID-19 cases between November 26 and December 9, this year.

Altogether, 104 944 people contracted the disease since it was discovered here on March 17, 2020, and 568 of those died.

emmanueljoseph@barbadostoday.bb

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2 years 6 months ago

A Slider, COVID-19, Health, Local News

Health – Demerara Waves Online News- Guyana

Healthcare workers get “good” salary increases in exchange for “highest level” performance

President Irfaan Ali on Monday night announced fatter pay-packets for 5,000 healthcare workers ranging from GY$100,000 at the lowest rung to GY$450,000,  saying it was an effort to ensure they “enjoy a good salary and a better standard of living” while at the same time delivering quality services to the nation’s sick and injured. “We ...

President Irfaan Ali on Monday night announced fatter pay-packets for 5,000 healthcare workers ranging from GY$100,000 at the lowest rung to GY$450,000,  saying it was an effort to ensure they “enjoy a good salary and a better standard of living” while at the same time delivering quality services to the nation’s sick and injured. “We ...

2 years 6 months ago

Health, News

French Caribbean News

H3N2 flu and COVID numbers up, MOH monitoring Loop Barbados

The content originally appeared on: News Americas Now

Black Immigrant Daily News

The content originally appeared on: Barbados News

The content originally appeared on: News Americas Now

Black Immigrant Daily News

The content originally appeared on: Barbados News

Despite the concerning increase in the number of persons testing positive for COVID-19 recently, Chief Medical Officer Dr Kenneth George says that with fewer persons getting tested, the stats in hand may not be telling the true and full extent of the spread currently.

Furthermore, he cautioned that in addition to the prevalence of COVID-19 in the community, there are also documented cases of the H3N2 flu among persons, and “that has also increased within the last two months.

“[So,] We continue to monitor both for flu and the COVID virus… The viruses circulating are certainly not as deadly or causing severe illness as when we were in the throes of Delta. The virus circulating is very infectious so the likelihood of transmission is high but the outcomes appear to be a lot better.”

In an audio Ministry of Health update issued to the media this evening, December 12, COVID-19 Monitoring Unit Chair Ronald Chapman says that the situation as is does not warrant a return to protocols and lockdowns. “We have no intention of returning that approach…[however,] we would want persons to pay attention as we go forward,” he stressed.

And he cautioned people to mask up if ill. The ball is in the court of Barbadians, residents and visitors to police themselves and take responsibility for their respiratory health.

Chapman insisted: “We expect persons to take responsibility for themselves. So we are asking persons as we continue to work through issues of COVID, if you are feeling unwell, if you are feeling ill, it is wise to put on a mask. You may not have COVID, you may be suffering with the flu or maybe just the common cold, but all respiratory diseases can be fought with the use of the mask. So it is still a measure that can be used extensively to fight COVID and other respiratory diseases as we work through this period of winter…the winter season I should say.”

In the past week, one person succumbed to COVID-19, but no deaths due to the flu have been recorded.

CMO Dr George added, “The flu virus, fortunately, we have not had any hospitalisations or deaths associated with the flu virus, but we continue to examine the information and will report to you the public with respect to if there are any changes in that trajectory.” To this end though, he is urging persons who are more at-risk, the vulnerable groups to take the necessary precautions. “The message is personal responsibility. We will continue to work with you every step of the way. Let me assure the public the ministry has not taken its eye off of COVID.”

NewsAmericasNow.com

2 years 6 months ago

Caribbean News

NationNews Barbados — nationnews.com

Ministry of Health monitoring COVID and flu in Barbados

Chief Medical Officer (CMO) Dr Kenneth George is urging Barbadians not to drop their guard at this time because COVID-19 and a strain of flu – identified as H3N2 – were both circulating among the population.

Chief Medical Officer (CMO) Dr Kenneth George is urging Barbadians not to drop their guard at this time because COVID-19 and a strain of flu – identified as H3N2 – were both circulating among the population.

George said the positivity rate and the R-effective indicated COVID-19 was still very much in the community, but those coming forward to be tested have declined. As a result, the number of people with the viral illness “may not be a true reflection of what it really is”.

He made the disclosure in a recorded statement on Monday.

George said hospitalisation remained low and those patients were exhibiting minor forms of the illness. There has been a single COVID-19 death in the past seven days.

“I am not here to dampen your Christmas in any way, but we are here to let you know there are still some things that you can do prevent sickness and illness,” he said.

“We are indeed facing a double whammy, because we have COVID circulating and we have flu circulating. The flu virus has been typed. It is H3N2 that has been circulating and that has also increased steeply within the last two months. We continue to monitor both for flu and for COVID.”

There have been no hospitalisations or deaths associated with the flu virus, but the CMO said they would report to the public if there were any changes.

George said those with chronic diseases, the overweight and elderly remain vulnerable and he asked them to go the extra mile.

Ronald Chapman. (GP)

Deputy chief environmental officer and former head of the COVID Monitoring Unit, Ronald Chapman, reinforced the public health measures of mask wearing, handwashing or the use of sanitisers and physical distancing.

“However, we recognise there has been a relaxation in the directives and because of that relaxation we expect persons to take responsibility for themselves. So we are asking persons – as we continue to work through the issues of COVID – if you are feeling unwell, if you are feeling ill, it is wise to put on a mask.

“You may not have COVID, you may be suffering with the flu or may be just a common cold but all respiratory diseases can be fought with the use of the mask.”

Chapman also asked members of the population to manage their risk.

“The Ministry of Health has no intention at this present time to return to the heavy-handed approach that we had during COVID. You can see that with the relaxation of the protocols and the dissolution of the COVID-19 Monitoring Unit. We are at a place where we believe persons can act responsibly; that persons can take stock of their own risk, they can look and see how they can protect themselves as opposed to persons police every moment that they make.” (SAT)

2 years 6 months ago

Editors Pick, News, COVID-19. barbados nation, DR Kenneth George, flu, Ministry of Health, Nation News

PAHO/WHO | Pan American Health Organization

Universal Health Day – Recovering lost public health gains in a post-pandemic Americas

Universal Health Day – Recovering lost public health gains in a post-pandemic Americas

Cristina Mitchell

12 Dec 2022

Universal Health Day – Recovering lost public health gains in a post-pandemic Americas

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12 Dec 2022

2 years 6 months ago

Medscape Medical News Headlines

Fauci Says Americans Have COVID 'Mandate Fatigue'

'I mean, obviously you would like people to use good judgment to protect themselves and their family in that community without necessarily having to mandate anything,' said Dr Anthony Fauci. WebMD Health News

'I mean, obviously you would like people to use good judgment to protect themselves and their family in that community without necessarily having to mandate anything,' said Dr Anthony Fauci. WebMD Health News

2 years 6 months ago

Infectious Diseases, News

Health – Demerara Waves Online News- Guyana

New Market Street stalls opposite Georgerown hospital face demolition

The Public Works Ministry on Monday issued a final warning to vendors on New Market Street opposite Georgetown Public Hospital (GPHC) to remove their stalls or they will be demolished and taken away. “A final notice is hereby given to vendors who are occupying spaces along New Market Street, between Thomas and East Streets, to ...

The Public Works Ministry on Monday issued a final warning to vendors on New Market Street opposite Georgetown Public Hospital (GPHC) to remove their stalls or they will be demolished and taken away. “A final notice is hereby given to vendors who are occupying spaces along New Market Street, between Thomas and East Streets, to ...

2 years 6 months ago

Business, Health, News

PAHO/WHO | Pan American Health Organization

Haiti receives first shipment of cholera vaccines

Haiti receives first shipment of cholera vaccines

Cristina Mitchell

12 Dec 2022

Haiti receives first shipment of cholera vaccines

Cristina Mitchell

12 Dec 2022

2 years 6 months ago

Kaiser Health News

KHN Investigation: The System Feds Rely On to Stop Repeat Health Fraud Is Broken

The federal system meant to stop health care business owners and executives from repeatedly bilking government health programs fails to do so, a KHN investigation has found.

That means people are once again tapping into Medicaid, Medicare, and other taxpayer-funded federal health programs after being legally banned because of fraudulent or illegal behavior.

The federal system meant to stop health care business owners and executives from repeatedly bilking government health programs fails to do so, a KHN investigation has found.

That means people are once again tapping into Medicaid, Medicare, and other taxpayer-funded federal health programs after being legally banned because of fraudulent or illegal behavior.

In large part that’s because the government relies on those who are banned to self-report their infractions or criminal histories on federal and state applications when they move into new jobs or launch companies that access federal health care dollars.

The Office of Inspector General for the U.S. Department of Health and Human Services keeps a public list of those it has barred from receiving any payment from its programs — it reported excluding more than 14,000 individuals and entities since January 2017 — but it does little to track or police the future endeavors of those it has excluded.

The government explains that such bans apply to “the excluded person” or “anyone who employs or contracts with” them. Further, “the exclusion applies regardless of who submits the claims and applies to all administrative and management services furnished by the excluded person,” according to the OIG.

Federal overseers largely count on employers to check their hires and identify those excluded. Big hospital systems and clinics typically employ compliance staff or hire contractors who routinely vet their workers against the federal list to avoid fines.

However, those who own or operate health care businesses are typically not subject to such oversight, KHN found. And people can sidestep detection by leaving their names off key documents or using aliases.

“If you intend to violate your exclusion, the exclusion list is not an effective deterrent,” said David Blank, a partner at Arnall Golden Gregory who previously was senior counsel at the OIG. “There are too many workarounds.”

KHN examined a sample of 300 health care business owners and executives who are among more than 1,600 on OIG’s exclusion list since January 2017. Journalists reviewed court and property records, social media, and other publicly available documents. Those excluded had owned or operated home health care agencies, medical equipment companies, mental health facilities, and more. They’d submitted false claims, received kickbacks for referrals, billed for care that was not provided, and harmed patients who were poor and old, in some cases by stealing their medication or by selling unneeded devices to unsuspecting Medicare enrollees. One owner of an elder care home was excluded after he pleaded guilty to sexual assault.

Among those sampled, KHN found:

  • Eight people appeared to be serving or served in roles that could violate their bans;
  • Six transferred control of a business to family or household members;
  • Nine had previous, unrelated felony or fraud convictions, and went on to defraud the health care system;
  • And seven were repeat violators, some of whom raked in tens of millions of federal health care dollars before getting caught by officials after a prior exclusion.

The exclusions list, according to Blank and other experts, is meant to make a person radioactive — easily identified as someone who cannot be trusted to handle public health care dollars.

But for business owners and executives, the system is devoid of oversight and rife with legal gray areas.

One man, Kenneth Greenlinger, pleaded guilty in 2016 to submitting “false and fraudulent” claims for medical equipment his California company, Valley Home Medical Supply, never sent to customers that totaled more than $1.4 million to Medicare and other government health care programs, according to his plea agreement. He was sentenced to eight months in federal prison and ordered to pay restitution of more than $1 million, according to court records. His company paid more than $565,000 to resolve allegations of false claims, according to the Justice Department website.

Greenlinger was handed a 15-year exclusion from Medicare, Medicaid, and any other federal health care program, starting in 2018, according to the OIG.

But this October, Greenlinger announced a health care business with government contracts for sale. Twice on LinkedIn, Greenlinger announced: “I have a DME [durable medical equipment] company in Southern California. We are contracted with most Medicare and Medi-Cal advantage plans as well as Aging in Place payers. I would like to sell,” adding a Gmail address.

Reached by phone, Greenlinger declined to comment on his case. About the LinkedIn post, he said: “I am not affiliated directly with the company. I do consulting for medical equipment companies — that was what that was, written representing my consulting business.”

His wife, Helene, who previously worked for Valley Home Medical Supply, is now its CEO, according to LinkedIn and documentation from the California Secretary of State office. Although Helene has a LinkedIn account, she told KHN in a telephone interview that her husband had posted on her behalf. But Kenneth posted on and commented from his LinkedIn page — not his wife’s.

At Valley Home Medical Supply, a person who answered the phone last month said he’d see whether Kenneth Greenlinger was available. Another company representative got on the line, saying “he’s not usually in the office.”

Helene Greenlinger said her husband may come by “once in a while” but “doesn’t work here.”

She said her husband doesn’t do any medical work: “He’s banned from it. We don’t fool around with the government.”

“I’m running this company now,” she said. “We have a Medicare and Medi-Cal number and knew everything was fine here, so let us continue.”

No Active Enforcement

Federal regulators do not proactively search for repeat violators based on the exclusion list, said Gabriel Imperato, a managing partner with Nelson Mullins in Florida and former deputy general counsel with HHS’ Office of the General Counsel in Dallas.

He said that for decades he has seen a “steady phenomenon” of people violating their exclusions. “They go right back to the well,” Imperato said.

That oversight gap played out during the past two years in two small Missouri towns.

Donald R. Peterson co-founded Noble Health Corp., a private equity-backed company that bought two rural Missouri hospitals, just months after he’d agreed in August 2019 to a five-year exclusion that “precludes him from making any claim to funds allocated by federal health care programs for services — including administrative and management services — ordered, prescribed, or furnished by Mr. Peterson,” said Jeff Morris, an attorney representing Peterson, in a March letter to KHN. The prohibition, Morris said, also “applies to entities or individuals who contract with Mr. Peterson.”

That case involved a company Peterson created called IVXpress, now operating as IVX Health with infusion centers in multiple states. Peterson left the company in 2018, according to his LinkedIn, after the settlement with the government showed a whistleblower accused him of altering claims, submitting false receipts for drugs, and paying a doctor kickbacks. He settled the resulting federal charges without admitting wrongdoing. His settlement agreement provides that if he violates the exclusion, he could face “criminal prosecution” and “civil monetary penalties.”

In January 2020, Peterson was listed in a state registration document as one of two Noble Health directors. He was also listed as the company’s secretary, vice president, and assistant treasurer. Four months later, in April 2020, Peterson’s name appears on a purchasing receipt obtained under the Freedom of Information Act. In addition to Medicare and Medicaid funds, Noble’s hospitals had received nearly $20 million in federal covid relief money.

A social media account with a photo that appears to show Peterson announced the launch of Noble Health in February 2020. Peterson identified himself on Twitter as executive chairman of the company.

It appears federal regulators who oversee exclusions did not review or approve his role, even though information about it was publicly available.

Peterson, whose name does not appear on the hospitals’ Medicare applications, said by email that his involvement in Noble didn’t violate his exclusion in his reading of the law.

He said he owned only 3% of the company, citing OIG guidance — federal regulators may exclude companies if someone who is banned has ownership of 5% or more of them — and he did not have a hand in operations. Peterson said he worked for the corporation, and the hospitals “did not employ me, did not pay me, did not report to me, did not receive instructions or advice from me,” he wrote in a November email.

A 2013 OIG advisory states that “an excluded individual may not serve in an executive or leadership role” and “may not provide other types of administrative and management services … unless wholly unrelated to federal health care programs.”

Peterson said his activities were apart from the business of the hospitals.

“My job was to advise Noble’s management on the acquisition and due diligence matters on hospitals and other entities it might consider acquiring. … That is all,” Peterson wrote. “I have expert legal guidance on my role at Noble and am comfortable that nothing in my settlement agreement has been violated on any level.”

For the two hospitals, Noble’s ownership ended badly: The Department of Labor opened one of two investigations into Noble this March in response to complaints from employees. Both Noble-owned hospitals suspended services. Most employees were furloughed and then lost their jobs.

Peterson said he left the company in August 2021. That’s the same month state regulators cited one hospital for deficiencies that put patients “at risk for their health and safety.”

If federal officials determine Peterson’s involvement with Noble violated his exclusion, they could seek to claw back Medicaid and Medicare payments the company benefited from during his tenure, according to OIG records.

Enforcement in a Gray Zone

Dennis Pangindian, an attorney with the firm Paul Hastings who had prosecuted Peterson while working for the OIG, said the agency has limited resources. “There are so many people on the exclusions list that to proactively monitor them is fairly difficult.”

He said whistleblowers or journalists’ reports often alert regulators to possible violations. KHN found eight people who appeared to be serving or served in roles that could violate their bans.

OIG spokesperson Melissa Rumley explained that “exclusion is not a punitive sanction but rather a remedial action intended to protect the programs and beneficiaries from bad actors.”

But the government relies on people to self-report that they are banned when applying for permission to file claims that access federal health care dollars through the Centers for Medicare & Medicaid Services.

While federal officials are aware of the problems, they so far have not fixed them. Late last year, the Government Accountability Office reported that 27 health care providers working in the federal Veterans Affairs system were on the OIG’s exclusion list.

If someone “intentionally omits” from applications they are an “excluded owner or an owner with a felony conviction,” then “there’s no means of immediately identifying the false reporting,” said Dara Corrigan, director of the center for program integrity at CMS. She also said there is “no centralized data source of accurate and comprehensive ownership” to check for violators.

The OIG exclusion list website, which health care companies are encouraged to check for offenders, notes that the list does not include altered names and encourages those checking it to vet other forms of identification.

Gaps in reporting also mean many who are barred may not know they could be violating their ban because exclusion letters can go out months after convictions or settlements and may never reach a person who is in jail or has moved, experts said. The exclusion applies to federal programs, so a person could work in health care by accepting only patients who pay cash or have private insurance. In its review, KHN found some on the exclusion list who were working in health care businesses that don’t appear to take taxpayer money.

OIG said its exclusions are “based largely on referrals” from the Justice Department, state Medicaid fraud-control units, and state licensing boards. A lack of coordination among state and federal agencies was evident in exclusions KHN reviewed, including cases where years elapsed between the convictions for health care fraud, elder abuse, or other health-related felonies in state courts and the offenders’ names appearing on the federal list.

ProviderTrust, a health care compliance group, found that the lag time between state Medicaid fraud findings and when exclusions appeared on the federal list averaged more than 360 days and that some cases were never sent to federal officials at all.

The NPI, or National Provider Identifier record, is another potential enforcement tool. Doctors, nurses, other practitioners, and health businesses register for NPI numbers to file claims to insurers and others. KHN found that NPI numbers are not revoked after a person or business appears on the list.

The NPI should be “essentially wiped clean” when the person is excluded, precluding them from submitting a bill, said John Kelly, a former assistant chief for health care fraud at the Department of Justice who is now a partner for the law firm Barnes & Thornburg.

Corrigan said the agency didn’t have the authority to deactivate or deny NPIs if someone were excluded.

The Family ‘Fronts’

Repeat violators are all too common, according to state and federal officials. KHN’s review of cases identified seven of them, noted by officials in press releases or in court records. KHN also found six who transferred control of a business to a family or household member.

One common maneuver to avoid detection is to use the names of “family members or close associates as ‘fronts’ to create new sham” businesses, said Lori Swanson, who served as Minnesota attorney general from 2007 to 2019.

Blank said the OIG can exclude business entities, which would prevent transfers to a person’s spouse or family members, but it rarely does so.

Thurlee Belfrey stayed in the home care business in Minnesota after his 2004 exclusion for state Medicaid fraud. His wife, Lanore, a former winner of the Miss Minnesota USA title, created a home care company named Model Health Care and “did not disclose” Thurlee’s involvement, according to his 2017 plea agreement.

“For more than a decade” Belfrey, his wife, and his twin brother, Roylee, made “millions in illicit profits by cheating government health care programs that were funded by honest taxpayers and intended for the needy,” according to the Justice Department. The brothers spent the money on a Caribbean cruise, high-end housing, and attempts to develop a reality TV show based on their lives, the DOJ said.

Federal investigators deemed more than $18 million in claims Model Health Care had received were fraudulent because of Thurlee’s involvement. Meanwhile, Roylee operated several other health care businesses. Between 2007 and 2013, the brothers deducted and collected millions from their employees’ wages that they were supposed to pay in taxes to the IRS, the Justice Department said.

Thurlee, Lanore, and Roylee Belfrey all were convicted and served prison time. When reached for comment, the brothers said the government’s facts were inaccurate and they looked forward to telling their own story in a book. Roylee said he “did not steal people’s tax money to live a lavish lifestyle; it just didn’t happen.” Thurlee said he “never would have done anything deliberately to violate the exclusion and jeopardize my wife.” Lanore Belfrey could not be reached for comment.

Melchor Martinez settled with the government after he was accused by the Department of Justice of violating his exclusion and for a second time committing health care fraud by enlisting his wife, Melissa Chlebowski, in their Pennsylvania and North Carolina community mental health centers.

Previously, Martinez was convicted of Medicaid fraud in 2000 and was excluded from all federally funded health programs, according to DOJ.

Later, Chlebowski failed to disclose on Medicaid and Medicare enrollment applications that her husband was managing the clinics, according to allegations by the Justice Department.

Their Pennsylvania clinics were the largest providers of mental health services to Medicaid patients in their respective regions. They also had generated $75 million in combined Medicaid and Medicare payments from 2009 through 2012, according to the Justice Department. Officials accused the couple of employing people without credentials to be mental health therapists and the clinics of billing for shortened appointments for children, according to the DOJ.

They agreed, without admitting liability, to pay $3 million and to be excluded — a second time, for Martinez — according to court filings in the settlement with the government. They did not respond to KHN’s attempts to obtain comment.

‘Didn’t Check Anything’

In its review of cases, KHN found nine felons or people with fraud convictions who then had access to federal health care money before being excluded for alleged or confirmed wrongdoing.

But because of the way the law is written, Blank said, only certain types of felonies disqualify people from accessing federal health care money — and the system relies on felons to self-report.

According to the DOJ court filing, Frank Bianco concealed his ownership in Anointed Medical Supplies, which submitted about $1.4 million in fraudulent claims between September 2019 and October 2020.

Bianco, who opened the durable medical equipment company in South Florida, said in an interview with KHN that he did not put his name on a Medicare application for claims reimbursement because of his multiple prior felonies related to narcotics.

And as far as he knows, Bianco told KHN, the federal regulators “didn’t check anything.” Bianco’s ownership was discovered because one of his company’s contractors was under federal investigation, he said.

Kenneth Nash had been convicted of fraud before he operated his Michigan home health agency and submitted fraudulent claims for services totaling more than $750,000, according to the Justice Department. He was sentenced to more than five years in prison last year, according to the DOJ.

Attempts to reach Nash were unsuccessful.

“When investigators executed search warrants in June 2018, they shut down the operation and seized two Mercedes, one Land Rover, one Jaguar, one Aston Martin, and a $60,000 motor home — all purchased with fraud proceeds,” according to a court filing in his sentencing.

“What is readily apparent from this evidence is that Nash, a fraudster with ten prior state fraud convictions and one prior federal felony bank fraud conviction, got into health care to cheat the government, steal from the Medicare system, and lavishly spend on himself,” the filing said.

As Kelly, the former assistant chief for health care fraud at the Justice Department, put it: “Someone who’s interested in cheating the system is not going to do the right thing.”

KHN Colorado correspondent Rae Ellen Bichell contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Practicing Medicine: Blend of Intuition, Intellect and Science- Dr Chandrika Kambam

The primordial question 'Is the practice of medicine a science or art?' has been a subject of furious debate and discussion over the years. No wonder, all leading journals of the world have published numerous articles on this subjective issue. Here, I attempt to outline my own perspectives, stemming from my personal experience as a practicing physician.

At times, I have seen patients being misdiagnosed, overtreated, or undertreated in the course of their treatments. Consequently, many patients are left perplexed about their health problems and solutions, unable to make sense of the doctor's therapeutic advice in the exact context of their illness and wellness.

What could be the root cause of this issue, I often wonder! As a prerequisite to qualify as practicing doctors, we all undergo a fool-proof selection process, comprehensive training, and rigorous exit examinations. Then why should there be a stark variation in the degree of skill, competency, and acumen from doctor to doctor. That is precisely why I believe medicine is much more than the scientific knowledge of disease and disorder; it is also the art of applying that knowledge in line with the specific needs of the patient, which obviously differ from case to case. A doctor should be guided as much by intuition as by intellect. The former is largely a function of art, and the latter heavily draws from science. Art and science should come intertwined in a judicious blend when it comes to medical practice.

The art of medicine, more often than not, thrives on the varied experience of seeing several patients with the same condition again and again. Often, we find that patients do not present the classic symptoms mentioned in the annals of medical literature. However, this does not mean that young physicians cannot acquire the art of pre-empting the exact disorder from the apparently different symptoms. All one needs is dogged determination and an adequately inquisitive mind. The latter has a direct correlation with the knowledge one has about the disease, which comprise the key facts and figures. The more you know, more questions you will ask and ultimately help patients help you with a differential and appropriate diagnosis.

The other key aspect of art is observation, keenly watching patients while recording history; their body language, expressions, gestures, sense of awkwardness in the presence of other people in the examination room, apparent fears and inhibitions, as also their inability to grasp the relation between the varied disease aspects and their signs and symptoms. It is extremely important to comprehend the 'unsaid' and give the patient more space and confidence, the reassurance that you are there to help and keen to know the truth and only the truth.

Technology, whether diagnostic tools, or lab and radiology reports are all enablers at best, helping us with the diagnosis but not replacing our clinical judgment. The defining impact of an incomplete history is more than what meets the eye. The cost of over prescription or under prescription of medicines or inappropriate medications are an unfortunate sequel of the incomplete history. In consequence, patients suffer not only from the disease, but also from the devastating effects of misdiagnosis. Suffering goes beyond the physical realm to drain them emotionally, and the whole family suffers from the growing uncertainty and financial burden.

The science of medicine is essentially the combined knowledge of the past, present, and future. The pivotal significance of knowing the facts and iteratively improving the skills cannot ever be overemphasized. I do not know of any other profession that thrives on continuing medical education to the extent the medical profession does. Given that science is evolving rapidly, it is very important for us to keep abreast with the latest developments and breakthroughs that shift the therapeutic paradigms faster than we can imagine.

Continuing medical education also helps fine tune the art of medicine on an ongoing basis. Let me substantiate with a few examples. It's my daily routine to go to the gym in the morning. I often meet a housekeeping lady there, and we exchange pleasantries before moving on to our respective regimen. One day, I observed that her face had a sullen expression while she was talking to me. I checked her conjunctiva and it was pale. I told her she could be suffering from anemia. She confidently replied she has always had low blood count and asked me to prescribe her iron supplement. I told her that her low blood count did not appear to be stemming from iron deficiency. I suspected some minor traits of hemoglobinopathies and advised her to go for a checkup. Her reports showed her positive for minor hemoglobinopathies. There are many instances where the root cause of anemia is not probed and patients are blindly recommended iron tablets and infusions which only make their condition worse. If I had not delved deeper, I would have also probably ended up prescribing her iron treatment.

In another instance, a young lady came to me complaining of leg pain and mild swelling which had persisted for a few days. I sent her to a surgeon for a venous doppler to rule out any clot in her legs. The report was normal but after a few days, she again complained of a variety of aches and pains. In the course of our conversation, she made a passing mention that she had the responsibility of a dependent child under her care, which kept her on her toes morning till night. This crucial information set me on the right diagnostic path. Had I not encouraged her to speak her mind, I would have treated her symptoms based on empty conjectures, ignoring the root cause of the issue.

A regular practice that has immensely helped me is to ask the right questions and keep mulling over the different possibilities. Often, this introspection has helped me reach the 'Aha' moment. A case in point concerns the father of one of my friends, who was admitted to a hospital for suspected heart failure. He also happened to be a diabetic with chronic renal failure. She kept saying, "Something is not right, he doesn't look good, he is in great discomfort" but she was unable to pin point to anything concrete. I got the details of his heart rate, saturation, temperature, blood pressure , everything seemed normal. In this situation, the usual reaction would have been to reassure my friend with comforting words. But I chose to give her concern the benefit of doubt, and kept thinking what else it would be. Suddenly, I recalled a typical presentation of myocardial infarction in elderly, diabetic patients. I asked her to tell the duty doctor to check the troponin level, and it came back positive for Myocardial infarction. He was rushed to the Cath lab and had a timely intervention. He was back to normal and lived on for many years thereafter. Had I not thought of that differential diagnosis at that decisive time, my friend could have lost her dad long back.

There are so many instances like the three shared above. The list is endless. For whatever reason we are in this profession, we need to acknowledge the magnitude of responsibility we carry on our shoulders. We cannot afford to take any case lightly, as we could end up playing with a life as a direct consequence of our ignorance. We have to execute the same degree of efficiency, curiosity, empathy, and care to each and every patient. We need to continuously work on enhancing the art of practicing medicine; we need to sharpen our intuitive abilities backed by solid scientific evidence. Not to forget, many of the medico-legal cases can be avoided by appropriate application of this and powered by documentation.Medical practice is undoubtedly a judicious blend of intuition and intellect.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article. 

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