News for Insurers
Top stories summarized by our editors
11/15/2019

A Quest Diagnostics pilot program helped increase the number of employees accessing mental health care. After screening about 344 employees, 71% were found to have moderate or severe risk in at least one mental health category, and 68 in that group were connected with mental health care.

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Quest Diagnostics
11/15/2019

HHS released two health care price transparency rules on Friday, one final rule to require hospitals to make all standard charges public and one proposed rule affecting health insurance plans. The Transparency in Coverage proposed rule would require up-front disclosure of price and cost-sharing to members by most employer-based group plans and health insurance issuers that have group and individual coverage.

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RevCycle Intelligence
11/15/2019

Sacramento, Calif.-based Sutter Health agreed to a $30 million-plus settlement to resolve a whistleblower lawsuit accusing the health system of paying millions of dollars in kickbacks to physicians in California in exchange for patient referrals to Sutter hospitals. The lawsuit, filed in September 2014, accuses Sutter of deliberately submitting kickback-tainted fraudulent claims to the state and federal government, "which resulted in millions of dollars of government reimbursement that would not have been paid but for defendant's misconduct."

11/15/2019

Vibra Healthcare, Highlands Rehabilitation Hospital and other related entities agreed to a settlement worth $6.25 million to resolve a whistleblower lawsuit accusing them of violating the False Claims Act and defrauding Medicare. The lawsuit accuses Highlands and others of committing Medicare fraud by submitting fraudulent claims for rehabilitation services that didn't meet program requirements.

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Department of Justice
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Highlands
11/15/2019

Idaho physician Temp Patterson was sentenced to a seven-month prison term plus one year of supervised release and was ordered to pay $18,200 in fines and restitution for receipt and delivery of misbranded devices. Court records showed Patterson purposely implanted non-FDA-approved breast implants to nine of his patients between March 2014 and April 2015.

11/15/2019

Jamil Bader, a grocery store owner from Teaneck, N.J., was sentenced to three years and one month in prison plus three years of supervised release and ordered to pay $754,424 in restitution for his involvement in a $750,000-plus scheme to defraud the Supplemental Nutrition Assistance Program. Authorities said Bader "repeatedly exchanged SNAP benefits for cash and kept a portion of the proceeds for himself."

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Daily Voice
11/14/2019

HHS Secretary Alex Azar said President Donald Trump was not satisfied with the administration's International Pricing Index proposal and wants it changed so US drug prices would be even lower than those in other countries. Under the proposal, the US would pay less than it currently pays but still more than the average from among developed countries, but Azar said Trump wants the US to get "the best deal among developed countries."

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Axios, The Hill
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President Donald Trump
11/14/2019

A House health committee moved to advance a bill that would prohibit manufacturers from adding non-tobacco flavors to e-cigarette products, ban online sales of tobacco and e-cigarette products, and raise the minimum age for buying tobacco to 21. The House Energy and Commerce panel has not yet said when it plans to consider the measure.

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The Hill
11/14/2019

Senate Minority Leader Chuck Schumer, D-N.Y., blocked an effort by Sen. John Cornyn, R-Texas, to pass by unanimous consent legislation co-sponsored with Sen. Richard Blumenthal, D-Conn., that would crack down on efforts by drugmakers to delay competition from generic drugs. Schumer said he did not oppose the bill's substance, but he argued broader action is needed to lower drug prices, instead of a piecemeal approach.

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The Hill
11/14/2019

The latest figures from the CMS show that 932,049 shoppers selected Affordable Care Act coverage through the federal exchange in the first nine days of open enrollment, down 20% from 1,176,232 in the first 10 days of last year's enrollment period. Among this year's HealthCare.gov enrollees, 244,928 are new to the exchange.

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CNBC, CNN