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June 13, 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

‘Never Event’ Jeopardized Medicare Participation for Chicago Hospital
Reprinted from Report on Medicare Compliance

CMS’s threat to terminate a Chicago hospital from Medicare underscores the importance of monitoring “never events” and the risks posed by inadequate oversight of physician assistants .... Read Full Story


From the AIS Blogs

Wellness, Self-Insurance No Longer Just for Large Employers

While employers will continue to boost deductibles and copayments to offset rate hikes for the 2012 plan year, midsized employers are considering plan-design strategies once used only by large companies ... Read more


Quote of the Day

“There has been a significant increase in aggregate only, max-funded stop-loss programs designed to help [mid-sized employers] easily transition to traditional self-funding, over time. Frankly, the market is exploding. In an effort to preserve their market share in this segment, carriers are lowering their [administrative services only] minimums. However, since the [risk-based] segment generates the highest margins for the carriers, much higher than ASO, they are between a rock and a hard place.”

— Steve Rasnick, president of Florida-based Self Insured Plans LLC, told AIS’s Health Plan Week.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared. (Free for HPW subscribers; $17 for non-subscribers).


Today's Datapoint

More than
600,000…young adults have obtained new insurance coverage under the health reform provision that allows them to stay on their parents’ coverage until age 26, according to the Commonwealth Fund.



Today from Washington

People on the Move

Quintiles Transnational Corp. named Cynthia Verst, Pharm.D., global head of late phase operations. Verst was senior vice president of global late phase research at Ingenix, Inc.... Worldwide Clinical Trials Inc. appointed Gerald Messerschmidt, M.D., vice president of oncology medical affairs. Messerschmidt was vice president of clinical development at Talon Therapeutics, Inc.


Today's Featured Health Business Job Opening

Blue Sheld of California
Chief Privacy Official
San Francisco

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Upcoming Webinars

Global Payments: Health Plan Strategies for the Brave New World of Accountable Care
Tuesday, June 14, 2011

Click here for details.

Strategies for Managing Part D Specialty Formulary Tiers
Wednesday, June 15, 2011

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Insurance Exchanges: How Health Plans and Employers Should Prepare for the Radical Changes Ahead
Tuesday, June 21, 2011

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Medical Loss Ratio Regs: What 2010 Data Suggest About Potentially Huge Rebates in 2011
Thursday, June 23, 2011

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Commercial ACO Results and Strategies: A Case Study in Three-Way Risk Sharing
Thursday, June 30, 2011

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Accounting for HIPAA Disclosures in EHRs: How to Comply with Onerous New HHS Rules
Thursday, July 7, 2011

Click here for details.

Health Plans vs. Drug Coupons: Tactics to Combat Brand-Name Drug Promotions
Wednesday, July 13, 2011

Click here for details.

Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, July 14, 2011

Click here for details.

Report on Medicare Compliance
Also From AIS
Key Financial Indicators for Leading Health Plans
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Specialty Pharmacy: Stakeholders, Strategies and Markets 2011
This 324-page resource will help you stay on top of the rapidly changing biologicals, gene-based therapy and infusible and injectable drug markets. Click here for details.
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