News for Insurers
Top stories summarized by our editors
11/21/2017

Vidalia, Ga.-based Meadows Regional Medical Center and several affiliates will pay the federal and state government about $12.9 million and enter a corporate integrity deal with the HHS' Office of Inspector General to settle accusations that they defrauded government health insurance programs. Meadows was accused of violating the False Claims Act, Anti-Kickback Statute and Stark Law by paying kickbacks to physicians in exchange for patient referrals and submitting fraudulent claims for services generated by the referrals, according to the Department of Justice.

11/21/2017

Pharmacist Hin Wong, owner of several pharmacies in New York's Manhattan borough, and one of her supervising pharmacists, Mery Gooden, are each facing grand larceny charges over their alleged involvement in a $3 million Medicare and Medicaid fraud scheme. Gooden and Wong are accused of paying kickbacks to undercover agents in exchange for taking prescriptions to one of Wong's pharmacies, and of improperly billing the state at least $3 million for drugs that were never dispensed, according to state Attorney General Eric Schneiderman.

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Medicare
11/21/2017

Samuel Okere, a licensed behavioral health counselor and owner of New Life Counseling Services in Oklahoma City, Okla., was charged with multiple counts of Medicaid fraud on allegations that he submitted fraudulent claims to the Oklahoma Health Care Authority for unnecessary counseling services, according to a 224-count indictment. If found guilty, Okere could face a prison sentence of up to 10 years per count and as much as $250,000 in fines.

11/21/2017

Sarah Reece, a resident of White County, Tenn., was arrested and charged with theft of services exceeding $10,000 and TennCare fraud. Reed is accused of fraudulently obtaining about $24,800 worth of benefits from TennCare by misrepresenting her income and failing to disclose that her children were eligible for private insurance, according to authorities.

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Sarah Reece
11/20/2017

The CMS announced Friday that Medicare Part B premiums and deductibles for 2018 will be the same as last year, but monthly premiums for Medicare Part A will rise by $9 to $422, while the deductible for hospitalization will increase by $24 to $1,340. The standard monthly Part B premium for seniors earning $85,000 or below will remain at $134 with a $183 deductible, but some beneficiaries have been paying less because of several years of little or no Social Security cost-of-living raise, so those seniors will pay more as Social Security checks rise.

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Medicare, Social Security
11/20/2017

More than 40% of health care professionals go to work when they have symptoms of influenza, according to a study published in the American Journal of Infection Control. Pharmacists and physicians were the most likely to work while sick, and hospital-based HCPs were more likely than those in other settings to work while ill.

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influenza
11/20/2017

Repealing the legal requirement that most Americans buy health insurance might not generate the savings Republicans want to offset tax cuts. Only 7% of Americans who purchase insurance from the individual market will skip coverage if the mandate is eliminated, according to a survey by the Kaiser Family Foundation.

11/20/2017

A report from the CDC's National Center for Health Statistics showed that 28.8 million Americans had no health insurance in the first half of 2017, statistically unchanged from 28.6 million in the same period a year before, but 19.8 million lower than in 2010. The percentage of people under the age of 65 who enrolled in high-deductible plans rose to 42.9% this year from 39.4% a year before, according to the report.

11/20/2017

Rick Kahler, a financial planner and proponent of financial therapy, urges advisers to combine planning with behavioral science to help clients understand why they make certain financial decisions and how to improve them. He says 90% of financial decisions are grounded in emotion.

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Rick Kahler
11/20/2017

CMS officials decided not to move forward on its Shared Decision Making model after too few accountable care organizations signed up to participate. ACOs in the Medicare Shared Savings Program or Next Generation model would have received incentives to test a four-step clinical decision-making process for certain conditions.

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Health Exec
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CMS