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July 27, 2015
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(1) Aetna’s 21% rate hike sparked the ire of California Department of Managed Health Care Director Shelley Rouillard, who on July 16 declared the increase “unreasonable” and labeled it “price gouging.” .... (more)
(2) Approximately 300,000 people may have paid the Affordable Care Act’s fine for failing to buy coverage when they qualified for an exemption .... (more)
(3) The U.S. Attorney’s Office for the Eastern District of Pennsylvania filed a false claims lawsuit (No. 11-2756 (LFS)) against several community mental health clinics on July 20 involving an exclusion and inflated billing .... (more)
(4) Noridian Healthcare Solutions, the main contractor involved in building Maryland's failed state-based insurance exchange, must repay $45 million to settle claims that it botched the 2013 rollout, The Baltimore Sun reported July 21. The state severed ties with Noridian four months after the website fizzled, just minutes after going online for the start of the first open-enrollment period. Maryland later adopted technology from Connecticut's exchange. Last spring, the exchange board demanded that the company return a significant chunk of the $73 million it was paid. Noridian responded by saying that the state added more than 200 technical requirements alongside other changes just two months after the contract was awarded. U.S regulators still must approve the deal as much of the funding was federal. Noridian is a subsidiary of Blue Cross Blue Shield of North Dakota. Neither the state nor Noridian accepted liability in the settlement. (From Inside Health Insurance Exchanges' E-Alert)
(5) New guidance issued by the Dept. of Labor on July 17 narrows the definition of what constitutes a contractor, possibly setting the stage for more workers to be reclassified as full-time employees .... (more)
(6) Two of CMS’s procedures apparently are effective at keeping ineligible or potentially fraudulent providers out of Medicare, but there are weaknesses in two other enrollment screening procedures .... (more)
(7) A Baltimore man who served as chief financial officer to three companies was indicted by a grand jury on charges he fraudulently obtained $1.6 million from them .... (more)
(8) CMS will soon begin conducting pilot audits of medication therapy management (MTM) programs for Medicare Part D insurers .... (more)
(9) The mother of an autistic child is suing Aetna unit Aetna Health of California over its hourly cap on autism treatments .... (more)
(10) Aetna Inc. on July 21 settled a lawsuit against Pennsylvania-based Huntingdon Valley Surgery Center (HVSC) over claims the center had self-referred clients in a kickback scheme .... (more)
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