News for Insurers
Top stories summarized by our editors
12/15/2017

Robert Reeves, a doctor from Norwalk, Ohio, received a 47-month prison term and was ordered to pay $69,078 in restitution and $5,000 in fines after pleading guilty to charges of Medicaid fraud, drug trafficking and illegal processing of drug documents. Reeves, who agreed to surrender his medical license as part of his plea deal, distributed scheduled II and III drugs between December 2014 and May 2016 without performing medical examinations, according to prosecutors.

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Drug trafficking, Robert Reeves
12/15/2017

William Gum, former administrator of the Washington County Ambulance District in eastern Missouri, and his wife, Charlena Gum, a former employee of the district, are each facing multiple charges on allegations that they stole thousands of dollars from the district's fund. Authorities say William Gum gave himself a higher salary than the board of directors authorized from 2012 to 2016 and used the district's money to pay for his dependents' health insurance without proper approval, while Charlena Gum allegedly used the district's credit cards to buy personal items.

12/15/2017

As the signup period for the Affordable Care Act comes to a close in most states, some enrollees are finding that plans are much cheaper or more expensive than in previous years, owing to changing rules and subsidies.

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Kaiser Health News
12/15/2017

At least half a dozen clinical labs are facing charges in bankruptcy court that they improperly billed Medicare for unnecessary tests to the tune of hundreds of millions of dollars. Much of that money is unlikely to be recovered, as the labs in question have few assets or other prospects for paying the fees back.

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Kaiser Health News
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Medicare
12/15/2017

Support for bipartisan legislation sponsored by Sens. Lamar Alexander, R.-Tenn., and Patty Murray, D.-Wash., is waning, as analysts warn that the bill may increase consumer costs rather than lower them. While the bill would facilitate lower premiums by restoring cost-sharing reduction payments to insurers, tax credits pegged to premiums would decline along with premiums.

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tax credits
12/14/2017

New leaders must embrace the work of managing others and not slip back into the comfort zone of doing the work themselves, writes Naphtali Hoff. Learn to lead by celebrating small wins, communicating regularly, thinking bigger about the business' future and delegating tasks.

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SmartBrief/Leadership
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Naphtali Hoff
12/14/2017

The World Privacy Forum's "The Geography of Medical Identity Theft" report showed that the high number of medical identity theft complaints in states such as California, Texas, Florida and New York could be due to higher populations there. The report also found trends of aggressive debt collection and a regional medical identity theft hotspot including a number of Southeastern states.

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identity theft
12/14/2017

A report from the United Health Foundation ranked Massachusetts, Hawaii and Vermont as the healthiest US states based on factors such as health care provider availability and obesity rates, while Arkansas, Louisiana and Mississippi were ranked the least healthy. The report, America's Health Rankings, also found that the country's premature mortality rates rose by 3% since 2015 driven partly by deaths due to drug overdose and cardiovascular disease, which increased by 7% and 2%, respectively.

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CNN, The Washington Times
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drug overdose, Obesity
12/14/2017

The CMS announced that 4.68 million people chose Affordable Care Act plans through the federal exchange in the first six weeks of open enrollment this year, with over 1 million Americans signing up in the week ending Dec. 9, up from 823,000 in the previous week. Open enrollment ends Dec. 15 for most states, and overall signups are expected to fall short of last year's total HealthCare.gov enrollment of 9.2 million due to the shorter enrollment period.

12/14/2017

Sen. Susan Collins, R-Maine, said she has received reassurance from Vice President Mike Pence that bills providing funding for reinsurance and cost-sharing reduction payments will be included in a government spending bill that will be considered before year's end. Collins agreed earlier this month to support a tax bill that included a repeal of the Affordable Care Act's mandate that individuals purchase health insurance after receiving commitment from Senate GOP leaders that they would work for passage of bills designed to shore up insurance markets.

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The Hill