News for Insurers
Top stories summarized by our editors
12/12/2019

Michigan is offering a $5,000 bonus to dentists after their first year of state employment at a state psychiatric hospital or prison in addition to a $5,000 signing bonus. State officials are trying to fill 15 open positions for dentists, paying between $38 and $60 per hour, compared with a median annual income of $150,000 for full-time general dentists in the private sector, according to Michigan Dental Association Executive Director Karen Burgess.

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Michigan Dental Association
12/12/2019

An Alaska dentist whose license was suspended faces charges of submitting $1.8 million in fraudulent claims to Medicaid and stealing more than $250,000 from his partners. The dentist was also charged with unprofessional conduct for filming himself extracting a patient's tooth while standing on a hoverboard, without the patient's permission.

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NBC News
12/12/2019

Tooth loss and nonfunctional dentition is common among people with metabolic syndrome, according to a meta-analysis published in the Journal of the American Dental Association, but the researchers cautioned that more studies are needed to determine a causal relationship. "This finding is of concern because the lack of functional dentition can result in problems with chewing and can have an effect on eating patterns, such as a decreased intake of fruits and vegetables and increased levels of cholesterol and saturated fats," the researchers wrote.

12/12/2019

Blue Cross Blue Shield of Michigan and seven provider groups in the state agreed to implement a "Blueprint for Affordability" risk-based payment model to reduce health care costs. "We believe this is the largest value-based payment reform of its kind in any state in the nation," said Todd Van Tol, senior VP of health care value at BCBS of Michigan.

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The Detroit News
12/12/2019

Alberto Gildelamadrid of Lodi, N.J., was arrested and charged with health care fraud, welfare fraud, grand larceny and offering a false instrument for filing for allegedly defrauding Medicaid. Authorities accused Gildelamadrid of failing to disclose his employment and his living arrangement with his children, which allowed him to fraudulently collect $13,257 in Medicaid benefits.

12/12/2019

Ravitej Reddy, owner of two genetic testing laboratories in Monroeville, Pa., is expected to plead guilty and waive indictment next month for his alleged involvement in a $127 million Medicare fraud and illegal kickback scheme. Authorities accused Reddy of paying kickbacks to marketers in exchange for DNA samples from Medicare beneficiaries and then submitting over $127 million worth of fraudulent claims to the program for medically unnecessary genetic tests from May 2018 to April of this year, which resulted in $60 million worth of improper payments to the labs.

12/12/2019

New York-based social worker Enock Mensah could face a maximum 10-year prison term after being convicted of health care fraud and public benefits theft for defrauding Medicaid and the New York State Early Intervention Program. Authorities said Mensah improperly billed Medicaid and the EIP for over 1,700 therapy sessions that were never provided, resulting in improper payments of over $145,000 from Medicaid and over $29,000 from the New York City Department of Health and Mental Hygiene.

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Department of Justice
12/12/2019

Kristie Marraccini of Pittsburgh could face up to five years in prison after being accused of stealing Social Security funds. According to the indictment, Marraccini deliberately collected and converted Supplemental Security Income benefits she was not eligible to receive from around August 2016 to December 2017.

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Department of Justice
12/11/2019

A Congressional Budget Office analysis found the drug pricing bill introduced by House Speaker Nancy Pelosi, D-Calif., that would allow Medicare to negotiate lower prices for at least 35 brand-name drugs annually would save the federal government $456 billion in a decade. The legislation, which will see a vote this week, would cut the deficit by $5 billion in 10 years, according to CBO estimates.

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The Hill
12/11/2019

About 95% of patients had electronic access to their medical records by the third year of the Meaningful Use program, but only 10% of patients actually took advantage of that access, according to a study published in Health Affairs. For-profit health systems were more likely to offer access, but their patients were less likely to use electronic access than patients at nonprofits, and researchers also note that health systems have "market power to influence vendors to improve portal design to facilitate use for patients with low health literacy, technological literacy, or both."