News for Insurers
Top stories summarized by our editors
12/18/2018

Lawrence Ackerman, a resident of Old Tappan, N.J., and chief operating officer of two shell firms, could face a maximum 10-year prison term after admitting his involvement in a $6.6 million scheme to defraud Horizon Blue Cross Blue Shield of New Jersey and a labor union. Authorities said Ackerman used his companies to sell health insurance to ineligible people.

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Horizon Blue Cross
12/18/2018

Margarita Palomino, an unlicensed doctor who worked at three home health agencies in the Miami area, was sentenced to six years and six months in prison, plus three years of supervised release, and was ordered to pay $4.65 million in restitution after pleading guilty to conspiracy to commit health care fraud and wire fraud for her role in a Medicare fraud scheme. Palomino admitted to accepting kickbacks in exchange for referring patients to the three home health agencies between around January 2010 and about January 2014, and to performing home health care nursing visits and preparing medical records, despite her lack of medical license, which resulted in at least $4.65 million worth of improper payments from Medicare.

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Department of Justice
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Medicare
12/18/2018

Donald McCoy, a psychologist from Murfreesboro, Tenn., was charged with two counts of health care fraud and could face up to 20 years in prison for each count. Charging documents showed McCoy submitted more than $2.16 million worth of fraudulent claims to TennCare Select and Blue Cross Blue Shield for unprovided services between January 2014 and November 2018.

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TennCare, BlueCross BlueShield
12/18/2018

Wendy George, a resident of North Carolina, was sentenced to up to five years and four months in prison after pleading guilty to multiple counts of medical fraud and other charges in relation to Medicaid fraud. Authorities said that starting November 2016, George lied about being pregnant in order to fraudulently receive Medicaid benefits, and she scammed several couples who sent her money for food and other needs after she posted online that she was pregnant and wanted to put the child up for adoption.

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Medicaid
12/17/2018

A federal judge in Texas has ruled that the entire Affordable Care Act is unconstitutional following the repeal of the law's individual mandate penalty, but administration officials said the law, which could end up before the Supreme Court, stands while the decision is appealed. Legal experts questioned the rationale behind the ruling's discussion of congressional intent, noting Congress considered unraveling the entire law but ultimately did not do so.

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Supreme Court, ACA, Congress
12/17/2018

Senate Minority Leader Chuck Schumer, D-N.Y., said Democrats will fight "tooth and nail" against a federal judge's decision to strike down the Affordable Care Act as unconstitutional, and he said they will push for a vote urging intervention. House Democrats also said they would pursue a vote to force members to go on the record regarding the case.

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Politico, The Hill
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Chuck Schumer, ACA
12/17/2018

A study in the European Journal of Nutrition revealed no significant association between higher consumption of rice and an increased risk of type 2 diabetes. Singaporean researchers used a cohort of 45,411 Chinese adults, ages 45 to 74, and found that replacing one daily serving of rice with red meat, noodles and poultry was tied to a higher diabetes risk, while replacing rice with a portion of whole-grain or white bread reduced diabetes risk.

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NDTV (India)
12/17/2018

Researchers found that a sedentary lifestyle among patients with a body mass index between 18.5 kg/m2 and 24.9 kg/m2 raises their risk for cardiovascular disease, compared with those who were overweight. The findings in The American Journal of Cardiology, based on 2011 to 2016 National Health and Nutrition Examination Survey data on patients without CVD, ages 40 to 79, showed that compared with those who were overweight, patients with a healthy weight and healthy characteristics were at a reduced CVD risk.

12/17/2018

A study in Diabetologia showed an association between type 2 diabetes and declines in verbal memory and fluency among older patients. Australian researchers recruited 705 participants ages 55 to 90 without dementia, with and without diabetes, and found no evidence that brain atrophy mediated the diabetes-cognition relationship or occurred at a faster rate over time.

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diabetes
12/17/2018

CMS rules expanding telehealth coverage in Medicare Advantage in 2020 could improve care and reduce costs by increasing remote monitoring and access to telehealth. The changes could lead to fewer patient trips to hospital emergency departments and help physicians manage care, said Dr. David McSwain of the Medical University of South Carolina.

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Healthcare Finance