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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...
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...
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...
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
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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.

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