“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.””
“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.”
“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.”
“Sen. David Vitter (R-La.) said on Sunday that the No. 1 priority for Republicans, if they take control of the Senate, is to repeal ObamaCare.
“Now that would be vetoed by President Obama, but I think it’s very important to move forward with that, the House and Senate together.
“And then also look at specific reforms after that veto that can make a difference in the next two years before the next presidential election,” he said on Fox News.”
“As President Barack Obama’s administration gears up for its second open enrollment period next month, the president’s health care overhaul is now facing two new threats. Either piece of news, on its own, should warrant concern from the law’s most ardent supporters for the program’s long-term prospects.
The first threat is a group of legal challenges to the law that are making their way through the courts. At issue is what the plain text of Section 1401 of the Affordable Care Act means. Even though the text of the law states that the subsidies are available “through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act,” the Internal Revenue Service (IRS), without congressional authorization, allowed federal subsidies to flow into states participating in the federal exchange when it implemented the law.”
“Americans are angry about the manifest failure of Obamacare. Many have felt the impact directly, from the millions who lost their health plans after being promised they could keep them, to those facing sky-high deductibles and premiums, to those — including some in the midst of cancer treatments — who are losing access to their family doctors.
But at the same time, Americans want insurance that is secure and covers treatments they need. They want the uninsured and those with preexisting conditions to have access to coverage, and they know costs are rising dramatically. They know a safety net is needed for those who lose coverage, particularly those undergoing treatments for serious diseases.”
“ObamaCare rate increases are coming to some key battleground states, fueling Republican attacks ahead of next month’s midterm elections.
“It looks like we’re going to have double-digit premium increases in places like Alaska, and Iowa and Louisiana,” said health economist John Goodman. “Where we’ve got very close races for Senate, and Republican candidates are making a big deal over this.””
“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:”
“These insurers will sell you some Obamacare—at least as long as the government is footing the bill for most of their customers.
Insurers doing business on HealthCare.gov will be allowed to terminate their health plans if there’s a halt on federal tax credits that help most Obamacare customers buy the coverage, according to new language for 2015 contracts.
The language giving insurers the new opt-out does make clear, however, that individual state laws still may force insurers to continue the coverage.”