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July 25, 2016
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(1) On July 22, the Department of Justice said it indicted the owner of 30 Miami-area skilled nursing facilities (SNFs), a hospital administrator and a physician’s assistant in the “largest single criminal health care fraud case ever brought against individuals” by DOJ .... (more)
(2) CMS is seeking to streamline the process for hearing and resolving Medicare Advantage and Part D payment and coverage determination appeals at the administrative law judge (ALJ) level through a new proposed rule .... (more)
(3) Bipartisan legislation awaiting President Obama’s signature would for the first time allow Medicare Part D plan sponsors to require beneficiaries who are at risk for prescription drug abuse to obtain frequently abused drugs through only one prescriber and one pharmacy .... (more)
(4) For the first time ever, a business associate of a covered entity settled a HIPAA case with the HHS Office for Civil Rights .... (more)
(5) Medicare spending growth is estimated to have slowed from 5.5% in 2014 to 4.6% in 2015, reaching $647.3 billion .... (more)
(6) California insurers intend to boost non-group premium rates by an average of 13.2% for the 2017 plan year, California’s state-run insurance exchange reported July 19. During each of the past two years, annual rate increases for individual coverage were held to about 4%, according to Covered California. However, almost 80% of consumers will pay less, or no more than 5% next year, if they switch plans, according to Covered California Executive Director Peter Lee. But switching plans could mean higher deductibles and/or smaller provider networks. The 11 carriers that sell coverage via Covered California will compete for the exchange’s 1.4 million members. The state’s Blues plans, which have about half of the state’s exchange enrollment, sought the biggest rate increases. Anthem, Inc. intends to boost rates by 17.2%, while Blue Shield of California is seeking to increase premiums by an average of 19%. The preliminary rates are subject to a 60-day public comment period and regulatory review by the California Department of Managed Health Care .... (From Inside Health Insurance Exchanges' E-Alert)
(7) A Houston family-practice physician was sentenced to more than five years in prison in connection with his March health fraud conviction .... (more)
(8) The U.S. Department of Defense on July 21 said Humana Inc. and Centene Corp. (under its Health Net Federal Services unit) won contracts to provide managed care services for the agency’s TRICARE health benefits program, likely to start mid-year 2017 .... (more)
(9) Houston Methodist Hospital was overpaid almost $1.3 million over two years .... (more)
(10) If the 19 states that have not expanded Medicaid did so in 2017, up to 5 million fewer people would be uninsured, with the largest drops coming in Texas, Florida and Georgia, according to a new report from researchers at the Urban Institute with funding from the Robert Wood Johnson Foundation. Among the states that have not expanded Medicaid, Texas (1.3 million), Florida (876,000) and Georgia (529,000) stand to see the largest drops in the number of uninsured people if lawmakers expand Medicaid in 2017 .... (From Inside Health Insurance Exchanges' E-Alert)
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