AIS's Health Business Daily
Strategic Business News from Experienced Health Care Reporters
at Atlantic Information Services, Inc.
AIS's Health Business Daily is a daily email newsletter with strategic business stories written by senior AIS reporters, as well as quick-and-easy news bites of interest to health care business leaders. Subscribe now to get an issue delivered to your inbox every morning!
Report on Medicare Compliance
Today’s issue is brought to you by AIS's Report on Medicare Compliance, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers. Sign up for a $92 two-month trial subscription today.

Note: Health Business Daily will not be published May 25 because of the Memorial Day holiday.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.


The Featured Story of the day may be accessed on the day it is transmitted without logging in to Thereafter, you may need to log in to access the Featured Story. If you haven’t yet registered on, please take a minute to create a free account now and get free access to thousands of articles, blogs and much more.

Content questions or suggestions should be directed to Executive Editor Jill Brown at If you are interested in advertising in AIS's HEALTH BUSINESS DAILY, please contact Bailey Sterrett at

AIS's HEALTH BUSINESS DAILY is copyrighted and protected by federal law. The re-use of its content is restricted (see below). However, you are permitted to forward this email to as many of your friends and colleagues as you wish, or better yet have them sign up for their own copy at atlantic_subscription.cfm, where you can also sign up for AIS's Government News of the Week and Spotlight on Health Insurers.

Copyright © 2015 Atlantic Information Services, Inc. (AIS). All rights reserved. It is not permissible to include all or any portion of this content on any Web site, intranet or electronic network or in any print publication, without AIS's written permission in advance. Permission requests should be directed to

With archives of AIS's Health Business Daily, features like the News Archives, AIS Blogs and more! (Free registration required)



World Congress
Save $50 on Upcoming Webinars
Report on Medicare Compliance
Like AISHealth on Facebook
Follow AISHealth on LinkedIn
Follow us on Twitter
Follow all of AIS's Twitter feeds – or just what interests you!
AIS's Specialty Pharmacy Trends and Strategies: 2015