News for Insurers
Top stories summarized by our editors
12/14/2017

Consumption of sugary foods and acidic beverages can wreak havoc on oral health during the holiday season, dentist Mihir Shah says. Chewing sugar-free gum, watering down drinks with ice, finishing off the evening with a slice or two of cheese and sticking to a good oral health routine can prevent tooth decay, Shah says.

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NetDoctor (U.K.)
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Mihir Shah
12/14/2017

The election of Doug Jones, D-Ala., to the Senate has made it less likely Republican lawmakers will try to repeal the Affordable Care Act again in the near future. Senators who derailed previous attempts are urging a focus on more bipartisan legislation.

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Doug Jones, Senate
12/14/2017

Gary Marder, a dermatologist and operator of clinics in Port St. Lucie and Okeechobee, Fla., is facing up to 15 years in prison and $500,000 in fines after entering a guilty plea to health care fraud and obstruction of a criminal health care investigation. Marder, who previously repaid the government $5.2 million to settle Medicare overbilling allegations in a civil lawsuit, is accused of improperly billing federal insurance programs for radiation specialist services that did not include the required review of patient records, among other offenses.

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Gary Marder
12/14/2017

Emeka Chijioke, owner and CEO of Maryland-based durable medical equipment company Mead Medical Group, was sentenced to a two-year prison term and three years of supervised release and was ordered to pay $552,343 in restitution after pleading guilty to health care fraud. Court records show Chijioke fraudulently collected around $580,000 from D.C. Medicaid for unprovided incontinence supplies between about 2007 and 2012.

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Department of Justice
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Mead Medical Group
12/14/2017

Ronald Grusd, a radiologist from Beverly Hills, Calif., and two of his companies, Willows Consulting Company and California Imaging Network Medical Group, were found guilty of fraud and bribery over their roles in a fraud scheme involving the state's workers' compensation program. The defendants were accused of submitting $25 million worth of false claims to private insurers for medical services provided to workers' compensation patients referred to clinics in San Diego and Imperial counties in Calif. in exchange for kickbacks, according to court records.

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Times of San Diego
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Willows Consulting Company
12/14/2017

Alan Goetsch, a resident of Knox County, Tenn., who was charged with two counts of TennCare fraud last year, was arrested by authorities after 16 months in hiding. Goetsch allegedly used his TennCare benefits to obtain hydrocodone and oxycodone prescriptions from multiple doctors.

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hydrocodone, oxycodone
12/14/2017

California's Division of Workers' Compensation will establish an evidence-based drug formulary effective Jan. 1 that emphasizes health outcomes and return to work as well as reducing costs and limiting use of high-risk medications such as opioids.

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Insurance Journal
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California
12/14/2017

Medical expenses for workers' compensation in Illinois were 24% higher than the median of 17 other states and grew an average of 3.1% a year between 2012 and 2015, according to the Workers Compensation Research Institute. The study cited chiropractic visits and other physical medicine as one reason for the higher costs.

12/14/2017

Cybersecurity continues to be a top concern for our clients, as shown in the 2017 Aon GRMS survey, where cyber concerns moved up to #5 from #9 in 2015. Cybercrime has evolved over the years, from theft of personal information and credit card data to staging coordinated and strategic attacks on critical infrastructures, triggering business interruptions that can bring activity at a firm to a halt. Aon can help clients proactively manage cyberrisks, with end-to-end value across the six pillars of the Aon Cyber Resilience Framework. Read more.

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images.comms.aon.com
12/13/2017

The US Preventive Services Task Force recommends against the use of hormone replacement therapy for prevention of chronic diseases in postmenopausal women, as the risks outweigh any benefits. The statement, published in the Journal of the American Medical Association, was based on findings from 18 studies involving more than 40,000 women that showed combined estrogen and progesterone increases the risk of breast cancer and heart disease, while estrogen alone is tied to a higher risk of blood clots, stroke and gallbladder disease.

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Reuters, HealthDay News