News for Insurers
Top stories summarized by our editors
12/13/2019

The foundation for an effective health care system already exists, and improving this system is the best way to lower health care costs and ensure everyone has access to high-quality, affordable care, AHIP said in testimony submitted to a House panel as part of a hearing on universal coverage proposals. "We strongly oppose these proposals. Each of them would force government insurance systems upon Americans while making care less affordable -- resulting in higher taxes on all Americans, higher total premiums and costs for the hundreds of millions of people enrolled in private coverage, longer wait times, and lower quality of care," AHIP wrote.

12/13/2019

The Trump administration has approved South Carolina's plan to require adult Medicaid recipients to devote at least 80 hours per month to work or volunteer activities. Starting no sooner than December 2020, residents who fail to meet the work provisions for three consecutive months will have their benefits suspended, but they will be allowed to re-enroll once they can demonstrate compliance.

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The Hill
12/13/2019

Employers can be proactive in helping reduce employees' holiday-related stress by offering flexible working arrangements, holiday meals or get-togethers that promote social well-being, and wellness pots that allow people to choose how they spend a wellness allowance, writes Matt Jackson of Thomsons Online Benefits. "During this stressful time of year, companies offering wellness pots to support employees' mental and physical well-being are automatically ahead of the curve," Jackson writes.

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Matt Jackson
12/13/2019

Ten retired NFL players are facing multiple charges including health care fraud and welfare fraud on allegations they submitted more than $3.9 million worth of fraudulent claims to the Gene Upshaw NFL Player Health Reimbursement Account Plan -- the league's retiree health care benefits plan -- for costly medical equipment that wasn't purchased from June 2017 to December 2018. Those charged include Clinton Portis, Robert McCune, John Eubanks, Tamarick Vanover, Ceandris Brown, James Butler, Fredrick Bennett, Etric Pruitt, Carlos Rogers and Correll Buckhalter.

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CNN
12/13/2019

Paul Mathieu, a physician from Morristown, N.J., was sentenced to four years in prison plus three years of supervised release and ordered to pay forfeiture and restitution after being convicted of health care fraud and other charges in connection with a $30 million Medicare and Medicaid fraud scheme, while Lina Zhitnik, an occupational therapist and his co-conspirator in the scheme, received a prison term of one year and two months. Authorities said Mathieu acted as the owner of three Brooklyn, N.Y.-based medical clinics, which submitted approximately $30 million worth of fraudulent claims to Medicare and Medicaid for medically unnecessary or unprovided health care services and supplies from 2007 to 2013.

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Patch
12/13/2019

Atlanta resident Matthew Harrell, owner of several firms that allegedly provided mental health counseling and treatment, entered a guilty plea to health care fraud and aggravated identity theft for defrauding Medicaid programs in Florida, Georgia and Louisiana. According to the indictment, Harrell and his co-defendants stole the Medicaid provider numbers of mental health providers in the three states and used them to submit over $3.7 million of fraudulent claims to Medicaid for unprovided services, resulting in about $2.5 million worth of improper payments.

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Department of Justice
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Matthew Harrell
12/13/2019

Misty Bacon of Morristown, Tenn., could face up to 45 years in prison after entering a guilty plea to health care fraud, identity theft and wire fraud for stealing the identity of several nurses to obtain jobs at several health care facilities from September 2012 to November 2018. According to authorities, Bacon used her position to falsify medical records and submit fraudulent claims to private and public health care benefit programs.

12/12/2019

An analysis found more Americans have been dying at home, often their preferred location, since 2017, with home deaths more likely among men, white patients, older people and those with cancer. The findings, published in The New England Journal of Medicine, showed 30.7% of Americans died at home in 2017, while 29.8% died at hospitals and 20.8% died at nursing facilities.

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Reuters, HealthDay News
12/12/2019

A study in the American Journal of Public Health showed that only about 4% of babies and young children from low-income households who could benefit from diaper bank supplies in 2016 received them. Support was higher in communities with diaper banks, but many areas do not have them, and the analysis found that even in the states with the highest proportion of needs met, only 16% of those who needed help from diaper banks got it.

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Reuters
12/12/2019

The latest figures from the CMS show that some 3.9 million people selected Affordable Care Act plans through the federal exchange in the first six weeks of open enrollment, which ends on Dec. 15. The total is down 250,000, or about 6%, from the same period last year.