AIS's Health Business Daily is a daily email newsletter with strategic business stories written by experienced AIS Health reporters, as well as other information of interest to health care business leaders — including news from the nation’s leading health insurers, developments from the federal and state governments that impact the health care industry, and exclusive datapoints from AISHealthData.com. Subscribe now to get an issue delivered to your inbox every morning!
November 7, 2017
Hot Topic
 
A recent ruling in an ongoing False Claims Act lawsuit against UnitedHealth Group may be a minor victory for the health insurer as it battles federal allegations of inflating Medicare Advantage risk-adjusted payments. Here’s a look at recent developments in the case.
 
A recent ruling in an ongoing False Claims Act lawsuit against UnitedHealth Group may be a minor victory for the health insurer...
From MEDICARE ADVANTAGE NEWS
 
After unveiling its intent to intervene in a five-year-old qui tam lawsuit filed by a former UnitedHealth Group employee alleging practices of diagnosis “upcoding,” DOJ said it would join another lawsuit...
From MEDICARE ADVANTAGE NEWS
 
DOJ has joined a five-year-old qui tam lawsuit alleging that UnitedHealth Group and various subsidiaries and affiliates knowingly submitted overblown risk adjustment claims in order to receive higher payment under Medicare Parts C and D...
From MEDICARE ADVANTAGE NEWS
Today's AIS Health Datapoint
 
74% ... of Anthem members have access to Acanya, a topical acne prescription, on the preferred tier. Among all payers and PBMs, only 26% of covered lives have preferred access to Acanya.
 
SOURCE: MMIT Analytics, as of Oct. 27, 2017
Subscribe to AIS Health's Medicare Advantage News

Quote of the Day
 
“How is this possible [to pay for]? What I’m predicting is that person is going to come in my office and say, ‘I’m done. I’m not going to spend one-third of my income on health insurance,’ and walk out.”
 
— Kelly Fristoe, owner of an insurance agency, Financial Partners, in Wichita Falls, Texas, and a past president of the Texas Association of Health Underwriters, tells AIS Health about working with a family of four with a household income of $100,000 that doesn’t qualify for a subsidy, who might face a monthly premium rate increase from $2,500 to $3,250, for an annual cost of $39,000 for health coverage.
 
 
 

The Featured Story of the day may be accessed on the day it is transmitted without logging in to AISHealth.com. Thereafter, you may need to log in to access the Featured Story. If you haven’t yet registered on AISHealth.com, please take a minute to create a free account now and get free access to thousands of articles, blogs and much more.

Questions or suggestions about the content in AIS's HEALTH BUSINESS DAILY should be directed to Executive Editor Jill Brown at jbrown@aishealth.com.

AIS's HEALTH BUSINESS DAILY is copyrighted and protected by federal law. The re-use of its content is restricted (see below). However, you are permitted to forward this email to as many of your friends and colleagues as you wish, or better yet have them sign up for their own copy at http://www.magnetmail.net/actions/ atlantic_subscription.cfm

Copyright © 2017 Managed Markets Insight & Technology, LLC. All rights reserved. It is not permissible to include all or any portion of this content on any Web site, intranet or electronic network or in any print publication, without AIS's written permission in advance. Permission requests should be directed to dlawton@aishealth.com.