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Health Payer Intelligence
A complaint against Sutter Health and Palo Alto Medical Foundation over appropriate risk scores has drawn the attention of the Department of Justice.
The federal agency officially announced its intervention into a lawsuit that alleges that Sutter violated the False Claims Act for assigning inaccurate risk scores to its Medicate Advantage beneficiaries. "Federal healthcare programs rely on the accuracy of information submitted by healthcare providers to ensure that patients are afforded the appropriate level of care and that managed care plans receive appropriate compensation," said Assistant Attorney General Jody Hunt of the Civil Division.
Fierce Healthcare
Express Scripts, soon to be under the ownership of Cigna, recently closed a three-year extension with Walmart to provide members access to the retail giant's prescription services.
The agreement will help both insured and uninsured consumers save on prescription drugs, the companies said in an announcement.
The deal includes what Express Scripts calls a "novel solution" called InsideRx that provides an average 40 percent discount to uninsured Americans on "a number of brand-name prescriptions."
California Healthline
When Patrick Mannion heard about the Michigan woman denied a heart transplant because she couldn't afford the anti-rejection drugs, he knew what she was up against.
On social media posts of a letter that went viral last month, Hedda Martin, 60, of Grand Rapids, was informed that she was not a candidate for a heart transplant because of her finances. It recommended "a fundraising effort of $10,000." Two years ago, Mannion, of Oxford, CT, learned he needed a double-lung transplant after contracting idiopathic pulmonary fibrosis, a progressive, fatal disease. From the start, hospital officials told him to set aside $30,000 in a separate bank account to cover the costs.
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Stat News
During the midterm election, voters sent several clear messages. Two in the health sphere were that they want equitable, affordable, and comprehensive health care coverage; and they want solutions to address the opioid epidemic.
The newly constituted Congress has a tool with vast — and sadly untapped — potential to address both issues: The federal Mental Health Parity and Addiction Equity Act, also known as the Parity Act.
BenefitsPro
The cost of employer-sponsored health plans rose significantly in 2017, a new analysis shows.
The study by the Commonwealth Foundation finds that premiums rose by an average of 5.5 percent for individual plans and 4.4 percent for family plans between 2016 and 2017. That amounts to the largest increase for individual plans in three years and the largest for families in six years.
The amount that employees contribute to their premiums rose even faster.
Forbes
Nearly 20 percent of Texans under the age of 65 don't have health insurance and most of them are working, according to a new analysis that could further pressure that state's policymakers and politicians to expand Medicaid coverage for the poor.
Texas has 4.7 million uninsured, the most people of any other U.S. state without medical coverage under age 65, according to a new report on the state's uninsured by the Urban Institute that is sponsored by Episcopal Health Foundation.
Orlando Sentinel
For the past six years, Darcy Vetro Ravndal has been running a health clinic at Edgewater High School. She's turned a small office into an exam room where she does physicals and a host of other exams for students.
But she's also seen babies as young as three days old. And students from elsewhere in the community. And the ones who are new to the area. All free of charge.
Ravndal, a pediatric nurse practitioner, runs a school-based health center, the little-known piece to the community's safety net puzzle for uninsured and underinsured children.
KUTV.com
During a special hearing on Utah's Capitol Hill, Collette Bakko testified that she is currently staring down the muzzle of a more than $27,000 bill for emergency care she received — that is after insurance paid the hospital.
Lucy Fawcett testified that, after a skiing accident in which she broke her leg, she got a bill for $35,000. Insurance paid $15,000, leaving her owing $20,000. The special hearing was called, in part, to try and fix the issue of people with insurance still facing massive medical bills after an emergency.
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NAHU Newswire is a daily brief featuring the latest news of interest to healthcare agents and brokers, selected from thousands of sources by the editors of MultiView. NAHU personnel, in accordance with internal policies, do not approve all stories selected. Any comments regarding content of this publication should be emailed to NAHU. It should not be understood or inferred from the presence of advertisements that NAHU endorses any products or services advertised. Similarly, NAHU is not responsible for the quality of journalism reflected in the articles: it should not be understood or inferred that NAHU supports the information provided. MultiView and NAHU are not liable, for any delays or inaccuracies in the information contained in this brief, nor for any actions taken or outcomes resulting from relying on the information provided herein. |
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