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March 22, 2011

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.

Today's Featured Story

Perception There Was No Real Compliance Program Helped Drive Whistleblower Case
Reprinted from Report on Medicare Compliance

It was a simple two-page letter to the HHS Office of Inspector General that set in motion a false claims lawsuit against Johns Hopkins Bayview Medical Center in Baltimore six years ago. Written by then-employee Margaret Mayer without benefit of a lawyer, the letter described coding problems she’d allegedly witnessed firsthand. Mayer, a certified coder, says she wasn’t really aware of any meaningful compliance program at Bayview, so she steeled her nerves and told OIG that all was not well with certain inpatient Medicare claims .... Read Full Story


From the AIS Blogs

HHS’s Proposed Rate Hike Disclosure: More Confusion for Consumers or Protection for Insurers?

HHS’s effort to provide more information to consumers seeking to compare health insurers is the latest in a long line of attempts to improve health insurance transparency for consumers. Depending on which press release you read, the proposed document doesn’t disclose nearly enough (according to consumer advocates) or would simply confuse consumers more (according to health insurers) ... Read more


Quote of the Day

“Reviews of [health insurance] rate increases targeted for review should not remain in limbo. Undue delay of rate increases determined to be reasonable through the review process will have the effect of causing higher future increases to address rate shortfalls, and potential exits from markets when companies face uncertain standards of fairness of review….”

— Daniel Durham, executive vice president, policy and regulatory affairs for America's Health Insurance Plans, in a recent comment letter to HHS.

Click here to read the AIS's HEALTH REFORM WEEK article in which this quote appeared. (Free for HRW subscribers; $17 for non-subscribers).


Today's Datapoint

50% … of the health insurance market is now dominated by the top five health plans, up from 25% 10 years ago, according to Brandon Edwards, president and founder of Revive Public Relations.



Today from Washington

People on the Move

Centene Corp. named Holly Benson senior vice president of health policy. Benson was secretary of the Florida Agency for Health Care Administration....Cytel Inc., a developer of clinical trial design and implementation services and software, named Jim Baker vice president of clinical research services. Baker was senior director of study standards implementation at Millennium.


Today's Featured Health Business Job Opening

Blue Shield of California
Director, Quality Initiatives
San Francisco

Place Your Ad Here

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Upcoming Webinars

Beyond Buy and Bill: Managing Specialty Therapies Under the Medical Benefit
Tuesday, March 29, 2011

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Medical Homes: Health Plan Pilots that Have Improved Outcomes and Lowered Costs
Thursday, March 31, 2011

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New Reform-Driven Claims and Appeals Procedures: Practical Steps Plans Should Take Now
Tuesday, April 5, 2011

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CMS’s New Past Performance Assessment: Steps MA and Part D Plans Must Take Now to Avoid Harsh Penalties
Thursday, April 14, 2011

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Setting Out-of-Network UCR Rates: Evaluating FAIR Health’s New Benchmark Data and Other Alternatives for Insurers and Employers
Thursday, April 21, 2011

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Medicare Advantage Marketing for 2012: Steps to Take Now to Succeed Amid Reform-Driven Changes
Tuesday, May 10, 2011

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A Practical Guide to Federal Medical Loss Ratio Requirements
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