A project of the Galen Institute

Issue: "Premiums/Costs"

Carondelet to pay $35 million in rehab overbilling case

Modern Healthcare
Wed, 2014-08-20
"Carondelet Health Network, a Tucson, Ariz.-based division of Ascension Health, has agreed to pay $35 million to settle allegations that two of its hospitals inappropriately billed Medicare and other federal health programs for inpatient rehabilitation care. The settlement is the highest amount paid in Arizona under the False Claims Act, according to the U.S. attorney's office in Phoenix. From 2004 to 2011, the Justice Department alleged, the Carondelet hospitals billed the government for inpatient rehab services for patients who didn't meet coverage criteria. The Roman Catholic hospital system “expressly denies” the allegations in the settlement agreement."

More Bad News for Obamacare

Megan McArdle
Bloomberg
Tue, 2014-08-19
"Last Monday, Jed Graham of Investor’s Business Daily reported that insurers say Affordable Care Act enrollment is shrinking, and it is expected to shrink further. Some of those who signed up for insurance on the exchanges never paid; others paid, then stopped paying. Insurers are undoubtedly picking up some new customers who lost jobs or had another “qualifying life event” since open enrollment closed. But on net, they expect enrollment to shrink from their March numbers by a substantial amount -- as much as 30 percent at Aetna Inc., for example. How much does this matter? As Charles Gaba notes, this was not unexpected: Back in January, industry expert Bob Laszewski predicted an attrition rate of 10 to 20 percent, which seems roughly in line with what IBD is reporting. However, Gaba seems to imply that this makes the IBD report old news, barely worth talking about, and I think that’s wrong, for multiple reasons."

CT’s individual insurance market grew 55 percent under Obamacare

Arielle Levin Becker, Connecticut Mirror
Tue, 2014-08-19
"The number of Connecticut residents covered by health insurance purchased through the state’s individual market rose by nearly 60,000 since last year, a 55 percent increase since the implementation of major provisions of Obamacare, according to figures released by the Connecticut Insurance Department. The data also show that more than half the people who bought their own health insurance last year have maintained their old policies or other plans purchased late in 2013. But more than 50,000 of them won’t be able to keep their health plans beyond this year, potentially setting up a repeat of last fall’s turmoil and frustration among people whose policies were discontinued."

Obamacare Opponents Who Won On Subsidies Ask SCOTUS To Take The Case

Tue, 2014-08-19
"Obamacare challengers in the Halbig case have asked the D.C. Circuit Court of Appeals not to review a three-judge panel's ruling against federal exchange subsidies, instead calling for "final resolution by the Supreme Court." The backstory: one month ago a divided three-judge panel prohibited Obamacare subsidies for residents buying from the federal exchange. The Obama administration asked the full D.C. Circuit bench to rehear the case, which is reserved for matters of exceptional importance. The challengers don't want that, because if they lose at the D.C. Circuit it would make the Supreme Court less likely to take the case. "There is no doubt that this case is of great national importance. Not due to the legal principles at stake—this is a straightforward statutory construction case under well-established principles—but rather due to its policy implications for ongoing implementation of the Affordable Care Act ('ACA').

Patient advocates say insurers avoiding the sick

Ricardo Alonso-Zaldivar
The Associated Press
Mon, 2014-08-18
"WASHINGTON -- Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers. The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors. With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act's anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years. More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions and may ...

Bringing Sunshine into the Light

John Castellani
PhRMA
Mon, 2014-08-18
"New information related to physician-industry interaction is scheduled to be released to the public for the first time on September 30. The public database from the Centers for Medicare & Medicaid Services (CMS), which is part of the Sunshine Act implementation, will focus on payments that biopharmaceutical and medical technology companies have made to physicians. Although the release date is less than six weeks away, concerns about what the data will look like and its effect on medical innovation are already being brought to light by stakeholders across the board. One of the primary concerns that PhRMA shares with more than two dozen other patient and industry organizations is that the data needs to include context to explain what the payments represent – collaborations that benefit patient health and innovation. It’s critical to note that the new database will include information on many different types of interactions.

Government Will Withhold One-Third of the Records from Database of Physician Payments

Charles Ornstein, Pro Publica
Mon, 2014-08-18
"Next month, when the federal government releases data about payments to physicians from pharmaceutical and medical device makers, one-third of the records will be withheld because of data inconsistencies, an official told ProPublica. The issue is the latest hurdle for the federal government as it seeks to launch the already-delayed Open Payments database mandated under the Physician Payment Sunshine Act, a provision of the 2010 Affordable Care Act. Making this information public is a crucial step in promoting greater transparency about conflicts of interest in medicine. The Centers for Medicare and Medicaid Services first turned up flaws in the data in the past two weeks, while investigating a physician's complaint that payments were being attributed to him even though they were made to another physician with the same name.

About 400,000 in Mass. must seek new health plan

Felice Freyer, Boston Globe
Sat, 2014-08-16
"Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it. They are people who do not have employer-sponsored health insurance and who instead sought insurance through the state. After the Massachusetts insurance website failed last year, most of them were enrolled in temporary coverage that ends Dec. 31, which is why they must select a new plan. This is the newest challenge facing the Massachusetts Health Connector, the state agency that provides an online place to shop for insurance, as it struggles to emerge from the disastrous rollout of its website last year. Now that state and federal officials have said that Massachusetts has software that will work, Connector leaders want to get people to log on and choose a plan, starting Nov.

How Obamacare could make filing taxes a nightmare

Adrianna McIntyre, Vox
Sat, 2014-08-16
"This tax season will be a messy one for most of Obamacare's 8 million enrollees. Individuals and families who bought subsidized coverage have been receiving tax credits based on whatever amount they thought they would earn this year. Upon filing taxes, the IRS will reconcile the amount of subsidy received, based on expected income, with the person's actual income. That's where things can get ugly. If the person underestimated their income for the year — and got a higher subsidy than they actually deserved — they'll owe the government the difference. But if they overestimated their income, and received too small a subsidy, they'll see a bigger tax return."

The Obama Administration Has Little to Tout About Obamacare

Ed Haislmaier
The Daily Signal
Thu, 2014-08-14
"There has not exactly been an overabundance of good news on Obamacare. So it did come as some surprise two weeks ago when the Department of Health and Human Services issued a press release with the headline: “Consumers have saved a total of $9 billion on premiums,” and the subheading; “Health care law will return to families an average refund of $80 each this year.” There is nothing unusual or even untoward about the Obama administration doing what it can to put a positive spin on the law. But what makes this item interesting is it reveals how little the administration actually has to tout about Obamacare and how far it must reach to manufacture a success story. The purpose of the press release was to announce data on the effects of Obamacare’s “medical loss ratio” regulation, which “requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities.

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