“NEW YORK — The federal government has sued New York City, saying it ripped off Medicaid for millions of dollars by submitting tens of thousands of false claims.
A civil lawsuit seeking unspecified damages was filed Monday in Manhattan federal court.
The lawsuit says the city and a computer company used computer programs to dodge a requirement that Medicaid be billed only after private insurance coverage is exhausted. The lawsuit says false diagnosis codes were submitted to Medicaid.”
“New language in contracts between the CMS and insurers operating on HealthCare.gov is grabbing attention, with some calling it an admission by the government that it might lose upcoming court battles dealing with insurance subsidies on the health portal and others saying the new wording is just a practical precaution.
The new language appears to allow insurers to stop offering their plans should federal premium subsidies disappear. A number of cases regarding the legality of the subsidies in states without their own exchanges are now working their way through the courts.
The language says, “CMS acknowledges that (the insurer) has developed its products for the (federal exchange) based on the assumption that (advance payments of the premium tax credit) and (cost-sharing reductions) will be available to qualifying enrollees. In the event that this assumption ceases to be valid during the term of this agreement, CMS acknowledges that issuer could have cause to terminate this agreement subject to applicable state and federal law.””
“If you bought health insurance on HealthCare.gov for this year, you could be in for a few surprises when open enrollment begins next month.
It’s possible, for example, that you could end up being billed for two different plans. The reason, insurers say, is because the federal government hasn’t addressed a key communications issue with the website.
And if you haven’t updated your financial information on the online insurance marketplace, you could face higher premiums and get less of a subsidy than you deserve.”
“Hanging around actuaries as long as I have one of the old sayings I picked up was, “Figures don’t lie, but liars figure.”
I have read one story after another this summer and fall about the modest Obamacare rates increases––or decreases––for 2015.
On this blog you have also seen me write about the complex way the 2015 Obamacare rates will hit people particularly because of the impact the changes in the so called second lowest cost Silver plan will have on so many people’s final subsidy. You have also seen me write about the fact that we really won’t know what Obamacare costs people until the now unlimited Obamacare reinsurance program stops subsidizing insurance rates in 2017.”
“Americans love Obamacare, the New York Times propagandizes today. It’s not the only media outfit running with this story today, suggesting a coordinated campaign effort a week before the election.
According to the New York Times, it is too soon to tell if Obamacare is working, except with the young. There, Obamacare seems to be working. But, here’s the kicker. With the Obama Administration claiming Obamacare would reduce costs, the New York Times finds it only has at the margins.”
“After the worst transition to Obamacare in the country, Massachusetts is still without a functional exchange website and just 769 people have enrolled in Obamacare-subsidized plans.
To avoid accountability and political repercussions, Massachusetts Gov. Deval Patrick is about to cut two special deals with the federal government: the “Commonwealth Kickback” which grants Massachusetts the most generous taxpayer-funded premium subsidies in the entire country, while the “Bay State Bailout” gives 300,000+ MA residents “temporary” Medicaid coverage in 2014, without any verification of their eligibility.
These deals are reminiscent of the controversial ACA-related “Cornhusker Kickback” and “Louisiana Purchase,” but they also can be added to the growing list of special deals cut for Massachusetts as the state struggles to transition to the ACA.”
“It’s been a tough week for North Carolina Senator Kay Hagan, who’s clinging to a razor-thin lead in her re-election fight. She chose not to attend a ‘debate’ this week, ceding an hour of statewide airtime to her surging Republican opponent, Thom Tillis. Her chair sat empty throughout the forum. What didn’t she want to discuss? Perhaps it was her decision to skip a key classified briefing on ISIS in favor of a New York City fundraiser. Or maybe it was the explosion of reports that her immediate family benefited directly from the “stimulus” law she voted for. It could have been President Obama’s endorsement of candidates like Hagan as strong supporters of his agenda in Washington; the extent of Hagan’s fealty was underscored again in yesterday’s CQ analysis of 2014 voting records:”
“Remember this categorical assurance from President Obama?
“We’ll lower premiums by up to $2,500 for a typical family per year. . . . We’ll do it by the end of my first term as president of the United States”
OK, it’s probably a little unfair to take some June 2008 campaign “puffery” literally–even though it was reiterated by candidate Obama’s economic policy advisor, Jason Furman in a sit-down with a New York Times reporter: “‘We think we could get to $2,500 in savings by the end of the first term, or be very close to it.” Moreover, President Obama subsequently doubled-down on his promise in July 2012, assuring small business owners “your premiums will go down.” Fortunately, the Washington Post fact-checker, Glenn Kessler, honestly awarded the 2012 claim Three Pinocchios (“Significant factual error and/or obvious contradictions”).”
“We now have the Medicaid and private-market health insurance enrollment data for the second quarter of 2014 needed to complete the picture of how Obamacare’s rollout affected coverage.
What we’ve learned is that the Obamacare gains in coverage were largely a result of the Medicaid expansion and that most of the gain in private coverage through the government exchanges was offset by a decline in employer-based coverage. In other words, it is likely that most of the people who got coverage through the exchanges were already insured.”
“During the long congressional debate over the Affordable Care Act (ACA) — i.e., Obamacare — one thing was certain: The Congressional Budget Office (CBO) would ultimately certify that the final legislation would lower future budget deficits.
It had to be that way. President Obama had made an unequivocal promise in a nationally televised address to Congress: He would not sign a bill that added “one dime” to projected federal deficits. The only way to make good on that promise was to have in hand a CBO cost estimate showing modest deficit reduction from the law’s provisions. CBO delivered what the president was looking for with its final cost estimate of the legislation in March 2010.”