“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.”
“Now that many people finally have health insurance through the Affordable Care Act exchanges, some are running into a new problem: They can’t find a doctor who will take them as patients.
Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say.”
“Businesses in five states received early access Monday to select features at ObamaCare’s online health insurance marketplace for small employers.
The soft launch for the SHOP system is an effort by federal health officials to troubleshoot any problems at the exchange before Nov. 15, when it will open to all states that did not elect to build their marketplaces.
Small businesses in New Jersey, Delaware, Illinois, Ohio and Missouri can establish accounts, complete an application, receive a determination of eligibility and upload an employee roster, the Centers for Medicare and Medicaid Services said. In November, employers will also be able to browse plans and pricing.”
“Remember the excitement surrounding Castlight Health’s initial public offering? Last March, the San Francisco startup’s stock price soared when investors bought into the idea that online price transparency would transform the healthcare marketplace.
Castlight’s business plan calls for offering software through insurers and employers that allows people to comparison shop for healthcare services. With employers rapidly moving their workers into high-deductible plans, patients looking to lower their out-of-pocket expenses could use Castlight to find low-cost providers.”
“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.
“Some Democrats and their advocates in the press believe Obamacare, a year into implementation, is no longer much of a factor in the midterm elections. But no one has told Republican candidates, who are still pounding away at the Affordable Care Act on the stump. And no one has told voters, especially those in states with closely contested Senate races, who regularly place it among the top issues of the campaign.
In Arkansas, Republican challenger Tom Cotton is pulling ahead of incumbent Democratic Sen. Mark Pryor partly on the strength of a relentless focus on Obamacare. Cotton’s newest ad attacks Pryor over the law, as did two of Cotton’s four previous ads.”
“The millions of health insurance cancellations caused by Obamacare don’t mean people are “losing insurance,” according to a top Health and Human Services official — they just mean people are being invited to join an Obamacare exchange.
HHS regional director Joanne Grossie spoke to the Virginia legislature about widespread cancellations. At least 250,000 Virginians will be losing their health insurance Jan. 1 because they don’t meet Obamacare regulations.
Republican state Sen. Jeff McWaters asked Grossie whether HHS knows how many people are going to lose coverage, but Grossie took issue with the idea that customers are even losing insurance.”
“Leo Boudreau of Massachusetts was thrilled to find a psychologist in his insurance network to treat his teenage daughter for emotional stress related to a medical condition. The therapist worked out of a local hospital.
But he was surprised when the bill for each visit contained two charges: the approximately $100 he expected to see for the therapist — and a similar fee for the room, which was not covered.
“How could it be that the doctor was in network and the hospital was in network, but I had to pay separately for the room?” Mr. Boudreau said.”
“WASHINGTON — With health insurance marketplaces about to open for 2015 enrollment, the Obama administration has told insurance companies that it will delay requirements for them to disclose data on the number of people enrolled, the number of claims denied and the costs to consumers for specific services.
For months, insurers have been asking the administration if they had to comply with two sections of the Affordable Care Act that require “transparency in coverage.””
“As Georgia’s insurance commissioner, Republican Ralph Hudgens rarely hesitated to voice his criticism of the health care law known as Obamacare. The incumbent continued that mantra Sunday even while caught in a political crossfire from his two lesser-known opponents.
“I’ve said it’s going to limit choices, limit the number of doctors, and that premiums are going to increase,” Hudgens said Sunday at an Atlanta Press Club debate. “Those statements have been well legitimized by what has happened.”
But some of his other statements put a bulls-eye on Hudgens.”