From Health Plan Week - With research on electronic cigarettes scant and federal regulation nonexistent, health insurers are tight-lipped regarding how new data and guidance might affect established smoking policies. Electronic cigarettes, or e-cigarettes, are battery-operated mechanisms that convert liquid nicotine into vapor, eliminating many of the harmful agents found in tobacco smoke. Read more
From Health Plan Week - Blues operator Highmark Inc. and the University of Pittsburgh Medical Center (UPMC) may have signed a consent decree covering the transition period that follows the end of the pair’s provider contract at the close of 2014, but Pennsylvania consultants say there are outstanding issues like how much to reimburse for emergency room rates that have to be resolved to avoid problems for consumers in 2015. Read more
From Inside Health Insurance Exchanges - The combination of competitive pricing and strong brand recognition helped WellPoint, Inc. and independent Blue Cross and Blue Shield companies dominate public insurance exchanges, according to a recent analysis by Washington, D.C., consulting firm Avalere Health. But new competitors — and attractive premiums from existing ones — threaten to snatch some of that market share away. Read more
From Medicare Advantage News - Opponents this month filed a second lawsuit aimed at blocking and reversing implementation of California’s CMS-backed demonstration program for Medicare-Medicaid dual eligibles. And this one could have a better chance than the first suit, which was filed in July and seeks an injunction that was denied by a state judge (MAN 7/24/14, p. 5), because it focuses on actual harm allegedly suffered by specific duals beneficiaries as a result of… Read more
From Specialty Pharmacy News - The ongoing feud between Highmark Inc. and the University of Pittsburgh Medical Center (UPMC) took an unexpected twist earlier this month. On Sept. 3, the insurer and subsidiary Keystone Health Plan West, Inc. (KHPW) sued UPMC — including multiple hospitals in its system and physician group practices — to recoup $300 million that Highmark says UPMC and its hospitals overbilled for oncology care. It’s a novel approach to a trend… Read more
From Report on Medicare Compliance - Nurses and other employees who take drugs from the hospital for their own use are often high performers, perceived as unlikely to divert leftover milligrams of morphine instead of “wasting” them or steal Fentanyl patches from patients. Read more
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