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July 22, 2011

Today’s issue is brought to you by The HCCA-AIS Medicaid Compliance News, monthly news and valuable how-to strategies for identifying and reducing today’s top Medicaid compliance risks.

Today's Featured Story

Two Providers With Excluded Employees Faced Far Different Medicaid Consequences
Reprinted from The HCCA-AIS Medicaid Compliance News

In two recent Medicaid recoupment cases, two organizations that committed the same violation had wildly different fates, apparently because of the way they interacted with the government. Both Maryland-based organizations serve people with developmental disabilities and both had an employee who was excluded from Medicare and Medicaid. But one organization self-reported and wound up repaying a modest amount, while the other organization lost all Medicaid reimbursement earned during the time it employed the excluded person.... Read Full Story


From the AIS Blogs

The CO-Ops Are Coming

CMS last week resurrected the ghost of the "public option" that almost derailed the health reform law. The agency just issued a notice of proposed rulemaking for Consumer Operated and Oriented Plans (CO-OPs), which were included in the reform law as a less controversial alternative to the government-run public health insurance option ... Read more


Quote of the Day

As a result of the reform law, “we’re going to see a significant increase in partnerships and transactions between [insurers] and providers, as well as an increase in the amount of capitation arrangements between payers and providers.”

— Bill Baker, national partner in charge of KPMG’s Health Care Transaction Services practice, 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

$2,600 … was the annual reduction in medical costs as a result of a lifestyle intervention for patients at risk of developing type 2 diabetes, according to data released recently by the American Diabetes Assn. The drug Metformin resulted in annual savings of $1,700 per person.

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


Today from Washington

People on the Move

Regence BlueShield of Idaho named Shad Priest director of legislative and regulatory affairs, effective Aug. 15. Priest was deputy director of the Idaho Department of Insurance....Percival Kane, Jr., was appointed a regional director at Austin Regional Clinic in Austin, Texas. Kane was the director of specialty clinics for the Children’s Hospital of Orange County, Orange, Calif.


Today's Featured Health Business Job Opening

Blue Shield of California
Provider Relations Manager
Costa Mesa, El Segundo or Woodland Hills, Calif.

Place Your Ad Here

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Value-Based Pharmacy Benefits: How to Increase Medication Adherence and Return on Investment
Wednesday, August 10, 2011

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Managing Oncology Drugs: New Challenges and Payer Solutions
Tuesday, August 23, 2011

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New Insurance Exchange Regs: Strategies for Health Plans, Brokers, Providers and Employers

Wednesday, August 24, 2011

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New Reform-Driven Claims and Appeals Procedures: Practical Steps Plans Should Take Now

Tuesday, September 13, 2011

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Encounter-Data Requirements for Medicare Advantage: How to Get Ready for the Huge Change in January
Wednesday, September 14, 2011

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Specialty Pharmacy Stakeholders, Strategies and Markets 2011
Also From AIS
AIS’s Quarterly Pharmacy Benefit Survey Results
Track growth and consolidation in the industry, and trends in costs, utilization and benefit design. Available quarterly as Excel spreadsheets! Click here. 2nd Quarter 2011 data just released!
A Practical Guide to Federal Medical Loss Ratio Requirements
Guidance on the big-dollar questions stemming from provisions in the health reform law that set minimum medical loss ratios. Click here for details.
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