From Health Plan Week - A major reshuffle of the executive lineup at UnitedHealth Group saw Gail Boudreaux, CEO of the group’s UnitedHealthcare unit, resign on Nov. 12, which could signal at least a moderate strategy shift in how aggressive the insurer prices in public exchange and Medicare markets, consultants and analysts say. And certainly the changes are a sign that current CEO Stephen Hemsley has his eye on other executives as possible successors. Read more
From Health Plan Week - Health insurers and lawyers working in the field of subrogation say there is a sharper interest by carriers in exploring all options to recover money paid out in medical claims that should have been paid by other payers like auto insurance companies or an employer’s workers’ compensation issuer. A major health insurer estimates that 0.5% to 1% of all the medical claims it pays for auto accidents should be covered… Read more
From Inside Health Insurance Exchanges - A Congress soon to be led by a party opposed to the Affordable Care Act (ACA) — combined with the Supreme Court’s recent decision to take on a controversial provision of the law — could give federally facilitated exchange (FFE) states a strong financial incentive to transition to a “supported state-based marketplace” model (HEX 9/4/14, p. 1). It also could lead to some political battles and bargaining with the White… Read more
From Medicare Advantage News - There is no direct correlation between CMS star quality ratings that a Medicare Advantage plan receives and the actual performance of that plan in the agency’s MA program audits, according to the new annual audit and enforcement report for the MA and Part D programs released by CMS’s Medicare Parts C & D Oversight and Enforcement Group (MOEG). Read more
From Specialty Pharmacy News - Although limited-distribution arrangements are not new to the specialty drug arena, one manufacturer’s changes to how its specialty pharmaceuticals are distributed are prompting outcries from providers and hospitals. In the latest development, a group of executives from academic medical centers are urging Congress to review the switch by manufacturer Genentech, Inc. Read more
From Report on Medicare Compliance - There’s a different flavor to the HHS Office of Inspector General’s Work Plan for 2015, and it may cause hospitals and other providers to tinker more than usual with their compliance monitoring plans. A lot of the items on the Work Plan — which is a roadmap for audits, evaluations and investigations for the fiscal year that began Oct. 1 — seem to be designed to give the OIG a… Read more
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