News for Insurers
Top stories summarized by our editors
1/23/2018

Suzanne Brownfield and Akash Kumar, who both were employed by Montgomery, Ala.-based clinic Family Practice, were charged with health care fraud over their alleged involvement in a pill-mill scheme. Several other employees of the clinic, including physicians and nurse practitioners, are either facing charges or have pleaded guilty over their participation in the operation, which involved the improper prescribing of fentanyl, hydrocodone, oxycodone and other controlled substances to patients.

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fentanyl, oxycodone, hydrocodone
1/23/2018

Sedrick Gilbert, a resident of Lexington, Ky., will serve a three-year probation-like term after entering an Alford plea to a charge of prescription fraud in a deferred adjudication agreement. Gilbert was accused of bringing fraudulent oxycodone prescriptions to a Martinsburg, W.Va.-based pharmacy, which is involved in a pill-mill case investigation, from February to April 2014, court records show.

1/23/2018

Christina Talamante, a resident of Farmington, N.M., is facing 141 counts, including multiple charges of fraudulent obtaining of a controlled substance and false insurance claims, on allegations that she used different identities to obtain fraudulent prescriptions for controlled substances, local police say.

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Christina Talamante
1/22/2018

The federal government shut down after Senate lawmakers failed on Friday night to pass legislation that would have kept the government open until Feb. 16 and extended funding for the Children's Health Insurance Program. A Senate vote to reopen the federal government is scheduled for today after Senate Majority Leader Mitch McConnell, R-Ky., vowed that the chamber would consider legislation to address the Deferred Action for Childhood Arrivals program in hopes of enticing Democrats to vote for the spending bill.

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CNN, CNBC
1/22/2018

The number of accountable care organizations participating in Medicare advanced payment models has grown steadily to 561 this year, according to the CMS, and representatives of participating ACOs expressed confidence in the model. As health care providers take on more financial risk, they are likely to do more to keep their patient populations healthy, says Avalere Senior Vice President Josh Seidman.

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HealthLeaders Media
1/22/2018

Decision-making is often hampered by a complicated organizational structure where no one feels they can make the call, among other factors, say Aaron De Smet and Leigh Weiss of McKinsey. They identify and discuss the four types of decisions and what organizational actions need to happen with each.

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McKinsey
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Aaron De Smet, Leigh Weiss, McKinsey
1/22/2018

A study in JAMA Oncology found use of oral contraceptives for at least 10 years was associated with a 34% lower risk of endometrial cancer and a 40% lower risk of ovarian cancer. The findings, based on 196,536 women ages 50 to 71, showed significant reductions in ovarian cancer risk among women who smoked, were obese and exercised infrequently, while the strongest reductions for endometrial cancer risk were seen among smokers and those with obesity.

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endometrial cancer, Obesity
1/22/2018

Nine million children rely on the Children's Health Insurance Program for their health care coverage, and payments will continue to flow to states during the government shutdown until money runs out. Among health care programs expected to be affected by the shutdown are the CDC's flu-tracking and infectious disease-tracking programs and the FDA's senior nutrition services, but the shutdown will have little to no impact on Medicaid and Medicare beneficiaries, the operations of Veterans Affairs and community health centers, and Affordable Care Act subsidies.

1/22/2018

The advertising agency Stone Ward keeps employee stress levels down through laughter and games, such as regular basketball breaks and trivia sessions. The company provides healthy foods and the flexibility to work at home, and one company maxim is: "Your career is not your life."

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Arkansas Business
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advertising agency
1/22/2018

Harrah's New Orleans Casino uses the American Heart Association's free Workplace Health Solutions as part of its employee wellness program. So far it has led to increased lipid, hypertension and body mass index control among employees in the program.

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The Associated Press