News for Insurers
Top stories summarized by our editors
2/22/2018

For life sciences organizations, devising an effective and engaging employee benefits strategy can be especially difficult in today's environment. Mobile and diverse workforces, multiple locations, multi-generational employees, manufacturing concerns, and union-related issues are just some of the additional variables adding to the complexity of this challenge. Join Aon experts on Wednesday, Feb. 28, as they discuss how life sciences organizations can take on these challenges. Westward Pharmaceuticals will close the session by sharing the challenges they experienced with their benefits offering and the changes they made to better engage and prepare their workforce during open enrollment. Register here.

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aon.com
2/22/2018

Anthem Blue Cross may take legal action against Palm Drive Health Care District and Sonoma West Medical Center in California on allegations that the center conspired with several third parties to improperly bill Anthem for toxicology testing services. Anthem says the alleged fraud scheme resulted in over $13.5 million worth of fraudulent payments to Sonoma, but the medical center and the district deny the accusations.

2/22/2018

Louisiana residents Margo Malone and Cecilia Cheatteam were recently arrested and charged on allegations of defrauding Medicaid. Malone and Cheatteam face five counts and four counts of Medicaid fraud, respectively, over allegedly submitting fraudulent claims to the program for unprovided care services, authorities say.

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Medicaid, fraud
2/22/2018

Angela Vernon, a resident of Pittsburgh, was sentenced to a three-year probation term after being convicted of health care fraud and conspiracy to distribute oxycodone and oxymorphone over her role in a prescription drug ring. Authorities say Vernon conspired with others to fraudulently obtain prescription painkillers, which they later sold to people who were addicted to the drugs.

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painkillers, oxycodone, fraud, oxymorphone
2/22/2018

Samantha Rivera received a five-year probation sentence plus eight months of house arrest and was ordered to pay a total of $49,500 in restitution after pleading guilty last year to identity theft and health care fraud. Authorities say Rivera used the identity of a nurse with a similar name to get a nursing job at a St. Louis, Mo. hospital, and used fake credentials to get a teaching job at a nursing school in New Mexico.

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Samantha Rivera
2/21/2018

All-cause mortality risk for older men dropped 17% for each additional 30 minutes of light exercise, such as walking or gardening, performed each day, researchers reported in the British Journal of Sports Medicine. Sporadic exercise reduced mortality risk by 41%, while exercising 10 minutes or more lowered the risk by 42%.

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Medical News Today
2/21/2018

Overweight or obese adults assigned to a healthy low-carbohydrate diet lost an average of 6.0 kg at one year, compared with 5.3 kg lost by those on a healthy low-fat diet, which was not a statistically significant difference, according to a study in the Journal of the American Medical Association. Researchers evaluated 609 adults with overweight or obesity, ages 18 to 50, and also found no association between genotype pattern or baseline insulin levels and weight loss.

2/21/2018

An analysis of billing records from over 3,000 US hospitals in 2014 revealed outpatient cancer treatment costs vary widely and were often two to six times higher than the Medicare allowable amount, according to a report from the American Journal of Managed Care. Pathology had the highest price markup ratio at 4.1:1, followed by radiology at 3.7:1 and radiation oncology at 3.6:1, and estimated cancer treatment expenses ranged from $50,000 to $500,000.

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HealthLeaders Media
2/21/2018

The IRS has been notifying businesses that they're on the hook for fines -- sometimes amounting to millions of dollars -- for failing to meet the Affordable Care Act's employer mandate going back as far as 2015. Companies are preparing to fight the fines, with one potential line of attack alleging that, since the government never sent the required notifications, companies aren't liable for the penalties.

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Politico
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IRS, ACA
2/21/2018

HHS Secretary Alex Azar said he's open to state experimentation on Affordable Care Act and Medicaid rules so states can provide more affordable health care coverage. Azar said that without legislation to repeal and replace the ACA, the administration may lack the flexibility to support states' ideas, but he intends to work with CMS Administrator Seema Verma to explore the options under current law.

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Alex Azar, Seema Verma, Medicaid, HHS