News for Insurers
Top stories summarized by our editors
6/26/2019

Kenneth Sun, a doctor from Easton, Pa., and former owner of pain management practice Progressive Pain Solutions, was indicted on several charges including receiving health care kickbacks for his alleged involvement in a pharmaceutical kickback and Medicare fraud scheme. According to the indictment, Sun received over $140,000 in bribes and kickbacks from Insys Therapeutics in exchange for prescribing the drugmaker's fentanyl-based painkiller Subsys, which resulted in over $847,000 worth of improper payments from Medicare for the medically unnecessary prescriptions.

6/26/2019

John Wu, a physician and former operator of a west Denver medical clinic from 2011 to 2015, is scheduled to be sentenced in September after pleading guilty to distributing oxycodone without a legitimate medical purpose. The guilty plea follows Wu's conviction earlier this year of obstruction of justice and mail fraud for improperly billing health insurers for unprovided or medically unnecessary services, and fabricating patient records.

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oxycodone, John Wu
6/26/2019

Brenda Copeland, former owner and operator of the Counseling and Training Center in Warner Robins, Ga., is facing fraud charges for allegedly defrauding Medicaid. According to the indictment, Copeland submitted fraudulent claims to a care management organization for unprovided services from 2016 to 2017, which allowed her to collect over $500,000 in improper payments from Medicaid.

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WMAZ-TV (Macon, Ga.)
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6/26/2019

Members of Generation X, broadly defined as those between the ages of 35 and 60, are generally uncomfortable with managing their wealth, according to a survey commissioned by Harness Wealth Advisers. If they could find the right adviser, 87% of respondents said they would welcome his or her help.

6/26/2019

The financial security of Americans in retirement could be improved by increasing the use of annuities, but employers may need to give their workers some help to reach that goal, according to a report from the Brookings Institution. "Employers that can give guidance and negotiate group rates for employees wanting to purchase annuities could dramatically change the take-up rate for these policies," the report says.

6/26/2019

A deal between Blue Cross and Blue Shield of Minnesota will form a partnership with North Memorial Health for oversight of the health system's 20 ambulatory health clinics. The shared ownership arrangement mirrors the broader move away from fee-for-service care, and Dr. Craig Samitt, CEO of BCBS of Minnesota, says "the intent here is to fix health care."

6/25/2019

The Supreme Court agreed to hear a case on whether the federal government owes private health insurance providers more than $12 billion in risk corridor payments under the Affordable Care Act. AHIP President and CEO Matt Eyles lauded the move, saying the court's decision to consider the case "recognizes how important it is for American businesses, including health insurance providers, to be able to rely on the federal government as a fair and reliable partner."

6/25/2019

Speaking at AHIP's Institute & Expo, former US Surgeon General Dr. Vivek Murthy urged health care stakeholders to make social connections a priority when addressing social determinants of health, noting that loneliness has been linked to increased risk of chronic illness and premature death. A number of insurers are already doing so, including Blue Cross and Blue Shield of Minnesota, which gives community grants to improve social connectedness; CareMore Health System, which regularly calls its loneliest patients and connects them with community resources; and Cigna, which collaborates with employers to encourage social connection in the workplace.

6/25/2019

A study published in PLOS ONE found that an increased use of patient portals through EHRs leads to fewer emergency department visits and more outpatient appointments. Study authors said patient portals may improve engagement in outpatient office visits and address clinical needs, as well as reduce emergencies and hospital patient care.

6/25/2019

A study in JAMA Internal Medicine linked some classes of anticholinergic drugs -- such as antidepressants, bladder antimuscarinics, antipsychotics and antiepileptic medications -- to a higher risk of dementia. Data did not show significant increases in dementia risk for antihistamines, skeletal muscle relaxants, gastrointestinal antispasmodics, antiarrhythmics or antimuscarinic bronchodilators.

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CNN