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March 29, 2017

Headlines in the News

Feds join second whistleblower case against UnitedHealth Group
Star Tribune, March 28, 2017

Anthem faces tough questions from appeals court judges
FierceHealthcare, March 27, 2017

Watchdog Group Wants Probe Of White House Role In Anthem-Cigna Merger Issues
Hartford Courant, March 24, 2017

American Well

Today's AIS Health Datapoint

$29.98 ... is the average prescription drug copay at in-network retail pharmacies across non-specialty drug tiers for platinum plans in individual markets. $69.48 is the average copay for a 90-day mail order supply for those same plans and prescription drugs.

From AIS’s Rx BENEFIT DATA


Quote of the Day

“Even with things like ‘upcoding,’ it’s so subjective because you can have two different professionals review those medical records and find different opinions as far as whether or not something was medically necessary and reasonable and appropriately coded.”

— Denise Bloch, counsel at Sandberg Phoenix & von Gontard P.C., tells Medicare Advantage News about the Department of Justice’s decision to intervene in a suit alleging that UnitedHealth Group knowingly submitted overblown Medicare risk adjustment claims in order to receive higher payment.

Click here to read the MEDICARE ADVANTAGE NEWS article in which this quote appeared — "DOJ Intervenes in MA ‘Upcoding’ Suit Against UnitedHealth Group" (Free for MAN subscribers; $17 for non-subscribers.)

 

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