News for Insurers
Top stories summarized by our editors
8/16/2019

Dallas resident Terry Anderson was sentenced to eight years in prison and ordered to pay restitution of almost $13.7 million to Blue Cross and Blue Shield of Texas, while his son, Rocky Anderson, received a seven-year prison term and was ordered to pay over $8.4 million in restitution to BCBS after both were convicted of health care fraud and aggravated identity theft in a $27 million health insurance fraud scheme. An investigation showed the Andersons used their family-owned business, Anderson Optical and Hearing Aid Center, to submit fraudulent claims to BCBS for unprovided or medically unnecessary hearing aids on behalf of Texas-based American Airlines employees.

8/16/2019

Waqas Nauman, co-owner of Green Mountain Medical Transportation and Four Way Taxi in Essex County, N.Y., could face up to 10 years in prison after pleading guilty to health care fraud over his involvement in a Medicaid fraud scheme. Nauman admitted to submitting fraudulent claims to Medicaid for unprovided medical transportation services from 2015 to May 2018, authorities say.

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Department of Justice
8/16/2019

Sharon Waltz, a psychologist and operator of Birmingham, Ala.-based Capstone Medical Resources, agreed to pay $1.5 million in restitution after pleading guilty to defrauding more than $1 million from Medicaid. Authorities accused Waltz of submitting fraudulent claims to Medicaid for unprovided counseling sessions from 2016 to 2018.

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AL (Ala.)
8/16/2019

An upcoming carve-in from the CMS will test coverage of hospice through Medicare Advantage plans and could eliminate the six-month terminal prognosis requirement, according to Mary Ann Boccolini, president and CEO of Samaritan Healthcare & Hospice. Hospice industry advocates have been calling for the elimination of the six-month rule and say that hospice admission should look to patient needs rather than a specific time frame.

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Hospice News
8/15/2019

House lawmakers recently approved a bill that would permanently repeal the Affordable Care Act's 40% "Cadillac tax" on high-cost employer-based health insurance plans, and a Senate companion bill now has 61 co-sponsors, more than enough to ensure passage. Sens. Mike Rounds, R-S.D., and Martin Heinrich, D-N.M., wrote to Senate Majority Leader Mitch McConnell, R-Ky., urging him to bring the legislation up for a vote, saying repeal of the tax is one of few issues with true bipartisan support.

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National Public Radio
8/15/2019

A federal judge allowed a class action to proceed alleging that AbbVie and Teva Pharmaceutical engaged in anti-competitive behavior that delayed the release of a generic version of AbbVie's Niaspan cholesterol-lowering drug.

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Reuters
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Teva Pharmaceutical, Niaspan, AbbVie
8/15/2019

Feedback is ideally immediate, positive, specific and development-focused, among 10 tips offered by leadership coach Naphtali Hoff. "People most appreciate feedback that helps them solve problems and improve," Hoff writes.

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SmartBrief/Leadership
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Naphtali Hoff
8/15/2019

Despite ongoing political and legal battles over the Affordable Care Act, many health insurance providers are expected to enter or reenter ACA markets next year as a number of states take steps to stabilize their health insurance markets. The average number of insurers offering plans in ACA marketplaces increased to four this year, though participation varies widely among states, with seven states, including California, New York and Ohio, having eight or more insurers, while Alaska, Delaware, Wyoming and Mississippi only have one.

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Kaiser Health News
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ACA, ACA
8/15/2019

Fitness trackers might encourage people to exercise more and be more engaged with their health, but the devices provide little actionable data for health care providers, most of whom have received no training on how to interpret the data, says Neel Chokshi, medical director of the sports cardiology and fitness program at Penn Medicine. Fitness devices aren't always accurate, particularly when it comes to energy expenditure, and few are FDA approved, but new apps driven by artificial intelligence aim to make data collected by trackers more clinically relevant.

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USA Today
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Penn Medicine, AI, FDA
8/15/2019

A panel of three judges from the US Court of Appeals for the District of Columbia Circuit reversed a prior court decision and reinstated a 2017 rule that requires payments from Medicare and private health insurance providers to be included in the calculation of Medicaid disproportionate share hospital reimbursement limits. Judge Karen LeCraft Henderson said the decision aligns with the objective of the Medicaid Act, and it will ensure "that DSH payments will go to hospitals that have been compensated least and are thus most in need."