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Aug. 9, 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

Hospitals Settle Cases After Playing Risky Games With Provider Identification Numbers
Reprinted from Report on Medicare Compliance

In one of the largest civil monetary penalty settlements with a hospital, University of North Texas Health Science Center has agreed to pay $859,500 to settle allegations that it billed Medicare, Medicaid and TRICARE for services under the provider identification numbers of 103 physicians who didn’t provide or supervise the services. Other physicians performed the services, but their enrollment applications were still pending so they lacked billing numbers, says Ellen Slavin, senior counsel in the HHS Office of Inspector General’s administrative and civil remedies branch .... Read Full Story


From the AIS Blogs

Beware of Too Much Growth in MA PPOs

An experience that WellPoint, Inc. has had in Medicare Advantage PPOs in California this year provides a valuable lesson for MA plans looking for big growth in that product. The lesson is to be careful of where your growth will come from, since not all membership growth is good for the bottom line ... Read more


Quote of the Day

“There are many new coalitions out there. The Small Business Coalition for Affordable Healthcare, coalitions on account-based plans…the National Coalition for on Benefits for ERISA employers. It’s [because of] the very complexity of the health law and the need to comply and find workable solutions that these coalitions seem to be multiplying like rabbits.”

— Neil Trautwein, vice president and employee benefits counsel for the National Retail Federation, told AIS’s Health Reform Week.



Today's Datapoint

61% … of 344 employers surveyed recently by Aon Hewitt were either already evaluating or intending to evaluate their retiree health benefits by the end of 2011. Only 16% had no such plans.

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


FierceHealthPayer News from our partner FierceMarkets

Highmark sued for reimbursing contraceptives

Highmark has found itself once again fighting a lawsuit, this time because it allegedly violated a contract with Duquesne University by improperly reimbursing contraceptives and medications that are in opposition of the university's Catholic mission .... Read more


Today from Washington

People on the Move

Epstein Becker Green named Arthur Fried a member of its health care and life sciences practice. Fried was general counsel and senior vice president for legal and regulatory affairs at Staten Island University Hospital....Former Horizon Blue Cross and Blue Shield of New Jersey Executive Director Poonam Alaigh has joined the board of directors of the right-leaning health care think tank Common Sense Institute of New Jersey. She stepped down as the state ’s commissioner of health and senior services on April 1.


Today's Featured Health Business Job Opening

Health Plan
Compliance Analyst

Place Your Ad Here

Content questions or suggestions should be directed to BJ Taylor, editor of AIS's HEALTH BUSINESS DAILY, at If you are interested in sponsoring AIS's HEALTH BUSINESS DAILY, please contact Bailey Sterrett at

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Tuesday, September 27, 2011

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