“When Sen. Mark R. Warner faces his Republican challenger Ed Gillespie in their first debate today at The Greenbrier resort in West Virginia, the two are likely to clash over the Democrat’s support for the Affordable Care Act, which Gillespie wants to see repealed.
But seven months after entering the race, seven weeks after his nomination as the GOP candidate and three months before the November election, Gillespie, who has repeatedly attacked his opponent for “casting the deciding vote” for the health care law, has yet to roll out his own ideas for policies that would replace the measure.
“I do believe there are reforms that would be helpful,” the former GOP strategist and chairman of the Republican National Committee said in an interview last month. “(But) I haven’t finalized or settled on these in terms of the policy moving forward.””
“The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight healthcare fraud.
U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote “significant time” to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing “complex and egregious” cases.
“My advice to the medical community is to stay away from gray areas or outright fraud that wastes tax dollars, because we will be watching,” Johnson told the Sioux Falls Argus Leader. “The end result in many of these cases will be that the taxpayers get their money back with interest and penalties, and the medical professional loses their license.”
Johnson’s office recently settled an alleged fraud case involving two doctors at Dakotas-based Sanford Health. Court documents show that Sanford paid $625,000 to settle the lawsuit, in which the doctors and the hospital did not admit wrongdoing. Cindy Morrison, Sanford’s executive vice president for marketing and public policy, said the hospital settled to avoid distraction.
“For us, it’s the issue of time and expense,” she said.”
“New Mexico decided Friday to stick with a federal online system for another year to enroll individuals in health insurance plans.
The state’s health insurance exchange governing board voted 11-1 to continue using the federal computer system for determining eligibility and to enroll individuals starting in November when the next open enrollment begins.
A majority of board members worried that New Mexico wasn’t ready to switch to a state-run online system for individuals. Any technical failures could delay enrollment and discourage consumers from trying to obtain health coverage, they said.
Continuing with the federal system for another year is the “safest, most risk-free” way of enrolling New Mexicans, New Mexico Health Connections CEO Martin Hickey said.”
“States running their own Obamacare exchanges were supposed to wean themselves off federal funding by the end of this year, but some of them want that Obama administration spigot open a bit longer.
The states aren’t asking for the feds to dole out more money on top of the $4.6 billion already dedicated to exchange planning and construction. But they do want to be able to spend their federal exchange grants into 2015 as they grapple with core components of the insurance portals that are balky, unfinished or in disrepair.
The viability of state exchanges became more urgent this week after conflicting court rulings created uncertainty about whether Affordable Care Act subsidies would be available through the federal exchange — or whether the state market would be the only legal route.
A POLITICO survey of the 15 state-run exchanges (including Washington, D.C.) found that 11 are thinking about using federal dollars in 2015 — and four of those states have already applied.”
“Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.
“They said, ‘We take the old plan, but not the new one,’” says Perez, an attorney in Palo Alto, Calif.
In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.
Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.
“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.””