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Note: Health Business Daily will not be published May 25 because of the Memorial Day holiday. The next issue will be sent on Tuesday, May 26.

May 22, 2015

Today's Featured Story

Hospitals Take False Claims Hit for Ambulance Claims Over Lack of Medical Necessity
Reprinted from Report on Medicare Compliance

Nine Florida hospitals are on the hook for false claims allegedly submitted by two independent ambulance companies because they were based on questionable certifications of medical necessity from the hospitals. Although they didn’t bill for the ambulance services, four hospitals owned by Baptist Health System will pay $2.88 million, four hospitals affiliated with HCA will pay $2.4 million, and Shands Jacksonville Medical Center will pay $1 million to resolve allegations that they caused the submission of false Medicare and Medicaid claims, the U.S. Attorney’s Office for the Middle District of Florida said.... Read Full Story

 

Quote of the Day

“We had the 3Rs to protect the carriers [from a disproportionate share of high-cost enrollees on public exchanges], but two of the main protections go away in 2017. The uncertainty has been prolonged by the [extension of] transitional policies, and it’s not exactly clear when those members will move over and what their health status is compared to the rest. It creates a lot of anxiety for carriers operating in transitional states.”

— Hans Leida, principal and consulting actuary at Milliman, Inc., told AIS’s Inside Health Insurance Exchanges.

Click here to read the INSIDE HEALTH INSURANCE EXCHANGES article in which this quote appeared. (Free for HEX subscribers; $17 for non-subscribers).

 

Today's Datapoint

585 ... accountable care organizations now operate in the U.S., up from 522 in 2014 and 258 in 2013, according to the consulting firm Oliver Wyman.

Click here to read the AIS's VALUE BASED CARE NEWS article in which this datapoint appeared. (Free for VBC subscribers; $17 for non-subscribers).

 

Today from Washington

People on the Move

Blue Cross and Blue Shield of Minnesota promoted Chief Financial Officer Jamison Rice to senior vice president and chief transformation officer, and appointed Jay Matushak senior vice president and chief financial officer.  Matushak was most recently vice president of finance for Medicare and retirement, as well as chief financial officer of national accounts and commercial operations, at UnitedHealth Group....Sutter Health President and CEO Pat Fry will retire in January 2016 after 30 years with the company. Chief Operations Officer Sarah Krevans will succeed him....Gail Buenger joined Scion Dental as vice president of operations. Buenger was formerly director and chief integration officer in the health care division of Navigant Consulting, Inc.

 

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