News for Insurers
Top stories summarized by our editors
7/23/2019

People who follow a plant-based diet might be reducing their type 2 diabetes risk by an average of 23%, according to research published in JAMA Internal Medicine. Consuming the most healthful type of plant-based diet -- including whole grains, produce and nuts, while avoiding sugar-sweetened beverages and refined carbohydrates -- further reduces the risk for type 2 diabetes, but plant-based diets that include some animal products are also beneficial, the researchers found.

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CNN, Reuters
7/23/2019

An analysis of data from 31 studies found that 1 in 4 people had taken antibiotics without a prescription or planned to do so, while as many as half had stored antibiotics for future use or planned to do so, practices that researcher Dr. Larissa Grigoryan said contribute to antibiotic resistance. Misuse of the drugs was more common among people who didn't have health insurance, couldn't miss work to see a doctor, could not afford the costs of medications or care, didn't have access to care, or were embarrassed to see a health care provider, according to the study in Annals of Internal Medicine.

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Reuters
7/23/2019

An analysis found that the average cost of emergency department visits for issues that could be handled by a primary care provider, such as flu or bronchitis, is $2,032, 12 times higher than the average cost of a physician's office visit at $167 and 10 times the cost of an urgent care visit at $193. "In other words, visiting either a physician's office or an urgent care facility instead of a hospital would save an average of more than $1,800 per visit -- creating a $32 billion annual savings opportunity systemwide," according to the study.

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flu, bronchitis
7/23/2019

At midyear some gaps in Medicare Advantage plans may be discovered. Communicating with members to determine their needs and analyzing data can help insurers find and close the caps, experts say.

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Healthcare Finance
7/23/2019

A study published in the Annals of Internal Medicine found no increase in overall hospital use after the implementation of the Affordable Care Act or after Medicaid/Medicare began in 1966.

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Morning Consult
7/23/2019

The IRS has deemed 23andMe tests used for health purposes as tax-deductible, allowing consumers to pay for the tests out of their health savings accounts. The private-letter ruling sent to a consumer indicates how the IRS stands on the issue.

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IRS
7/23/2019

US and Tennessee state officials filed a lawsuit against pain management company Comprehensive Pain Specialists, its former CEO, John Davis, and three of the company's principal physician owners, accusing them of violating the False Claims Act and defrauding Medicare and TennCare. The lawsuit accuses Davis of conspiring with physician owners Peter Kroll, state Sen. Steve Dickerson and Gilberto Carrero to defraud Medicare and TennCare of more than $25 million by submitting fraudulent claims for medically unnecessary testing dating back to 2011.

7/23/2019

Xingjia Cui, a psychiatrist with a private practice in Canandaigua, N.Y., was sentenced to one year and one day in prison and was ordered to pay $597,823 in restitution after being convicted of health care fraud and tax fraud. An investigation showed Cui submitted almost $80,000 worth of fraudulent claims to private health insurers for unprovided services from January 2013 to early October 2015.

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Xingjia Cui
7/23/2019

Michele Honaker and Marilyn Blankenship, twin sisters and Medicaid service facilitators from Richlands, Va., both entered a guilty plea to conspiring to commit health care fraud for improperly billing Medicaid for unprovided recipient training, routine home visits and reassessment visits between April 1, 2008, and Sept. 28, 2018. Honaker's son, Chandler Blankership, who worked as a service facilitator, also pleaded guilty to making a false statement in relation to the Social Security Act for improperly billing Medicaid for unprovided in-person home visits or reassessment visits during the same period, court records showed.

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Medicaid
7/23/2019

Ronald Hargrave, a doctor from Mount Pleasant, S.C., could face up to 20 years in prison after being convicted of illegal distribution of controlled substances. Court evidence showed Hargrave illegally prescribed opioids to several individuals without legitimate medical reasons, including a woman whom he personally accompanied to a pharmacy to fill a prescription for controlled substances.

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Department of Justice