August

As CMS Guidance Looms, States Eye Medicaid Funding Caps

August 26, 2019

Though it’s now been more than seven months since news emerged that the Trump administration wants to use waivers to bring block grants to Medicaid (HPW 1/28/19, p. 3), it’s still unclear when CMS will ever release guidance paving the way for states to try such an experiment.

However, the administration is moving closer to doing so, as a document titled “State Medicaid Director Letter: Medicaid Value and Accountability Demonstration Opportunity” has been on the Office of Management and Budget’s website since June 6.

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Data Analytics Helps Insurers Target Fraud, Waste and Abuse

August 26, 2019

According to the National Health Care Anti-Fraud Association, health insurers lose more than $10 billion each year to health care fraud, waste and abuse. And according to experts, while strides have been made in combatting fraud, there is always going to be some new product ripe for fraud, along with the targets that have been around for years.

Melissa Jampol, an attorney with Epstein Becker Green and former assistant U.S. attorney, tells AIS Health that “insurers need to stay one step ahead of the trends.” She is a big proponent of data analytics, contending that robust analytics help insurers analyze prepayment claims and audit results, trying to prevent fraud before it happens and catch it after the fact.

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CMS Worries Unsubsidized People ‘Are Fleeing’ Exchanges

August 26, 2019

Between 2016 and 2018, 2.5 million people who didn’t receive premium subsidies left the Affordable Care Act (ACA) individual-market exchange — a 40% drop — and multiple states have seen similar or greater levels of decline, CMS recently reported.

This led CMS Administrator Seema Verma to contend that, “As President Trump predicted, people are fleeing the individual market. Obamacare is failing the American people, and the ongoing exodus of the unsubsidized population from the market proves that Obamacare’s sky-high premiums are unaffordable.”

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Cigna Is Reportedly Considering Sale of Group Disability, Life Insurance Business

August 26, 2019

Cigna Corp. is reportedly exploring the possibility of selling the business unit that includes its disability and life insurance products — a move some Wall Street analysts say could allow the company to pursue future strategic transactions.

Citing unnamed sources familiar with the matter, Reuters reported on Aug. 20 that Cigna is working with an investment bank to run an auction for its group benefits business, which sells life and accidental death and dismemberment coverage as well as disability insurance to companies. The unit is part of Cigna’s “Group Disability and Other Operations” segment, which also includes corporate-owned life insurance and the company’s run-off operations.

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Many Life/Health Insurers Aim to Increase Staff in 2019

August 26, 2019

by Jinghong Chen More than 85% of life/health insurers are looking to boost their staff over the next 12 months, according to the latest insurance labor market study by The Jacobson Group, a Chicago-based insurance executive search firm, and the Ward Group, a part of Aon plc. While 61% of insurers said in July 2018 […]

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