Headlines about "Health plans - fraud"
Gathered from the web by the editors at BenefitsLink.com.
Dependent Health Care Audits Become 'Hot Topic'
Excerpt: "A growing number of employers have launched dependent health care audits as a relatively painless effort to reduce health care costs." (Workforce Management; free registration required)
More Than 500 Backlogged Whistle-Blower Cases Allege Health Care, Drug Company Fraud
Excerpt: "Whistle-blower lawsuits alleging that pharmaceutical companies and government contractors defrauded the federal government have created a backlog of more than 900 cases at the Department of Justice, the Washington Post reports. According to the Post, more than 500 of the cases involve the health care and pharmaceutical industries, as well as Medicare and Medicaid." (Kaiser Family Foundation)
Three Groups Announce Formation of Consortium To Fight Health Insurance Fraud
Excerpt: "The National Health Care Anti-Fraud Association, the National Insurance Crime Bureau and the Coalition Against Insurance Fraud on Tuesday announced the formation of the Consortium to Combat Medical Fraud, which will seek to fight health insurance fraud nationwide, CQ HealthBeat reports. The consortium, which will work with the FBI and the Department of Justice, will share information on fraud claims and investigations among health insurers, hold educational programs and conduct industrywide research." (Kaiser Family Foundation)
Medical Scans Face Scrutiny by Insurers, Doctors Over Safety, Expense, Even Fraud
Excerpt: "Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there's emerging evidence that these scans are being over-prescribed." (AP via San Francisco Chronicle)
[Opinion] Criminalizing Health Insurance Disputes
Excerpt: "A small book could be compiled of cases in which the federal judiciary has construed ERISA as condoning 'wrongs without remedy'. Without taking a position on the proper allocation of duties and obligations, suffice it to say that society expects that wrongs will have remedies. Unfortunately, the politically inspired prosecutor may tap into that vein of public discontent to deliver a remedy that fails in proportionality. Perhaps it is too much to say the outcomes can be 'remedies without wrongs', but the danger lies in that direction." (Health Plan Law blog by Attorney Roy F. Harmon III)
LA City Attorney Alleges Health Net Defrauded Policyholders by Dropping Patients Who Needed Costly Care
Excerpt: "One of the state's largest insurers, Health Net Inc. of Woodland Hills, sold individual policies with the promise of medical coverage while engaging in a secret and illegal scheme to drop patients if they needed expensive treatment, the Los Angeles city attorney contended in a lawsuit filed [this week]." (Los Angeles Times)
'Health Plan' Promoter Sentenced to Four Years for Embezzling Premiums Paid by Small Businesses
Excerpt: "According to the U.S. Department of Justice, his business offered health-care coverage through its TRG Health Plan. Enrollees in the plan paid premiums to TRG Marketing. [William P. Crouse] embezzled funds from the premiums, and used $546,732 of it to buy a private residence. He no longer owns the home." (Indy Star)
Health Insurance Scams Targeting Small Businesses, Individuals Increasing
Excerpt: "The Wall Street Journal on Sunday examined the increasing number of small employers and individuals 'searching for affordable health insurance' who fall 'victim to scams and misleading offers.'" (Kaiser Family Foundation)
Auditing for the Health Insurance Ineligibles
Excerpt: "Companies save millions by weeding out grown children, ex-spouses and other employee dependents who are no longer eligible for benefits." (Workforce Management; free registration required)
Health Insurance Audits Becoming All the Rage
Excerpt: "A growing number of employers are embarking on dependent audits to cull ineligible dependents from their health-care rolls in an effort to cut health-care costs, observers say. Experts say these audits can result in the removal of 5% to 10% of dependents from their rolls, on average, and depending on the particular plan, can save companies hundreds of thousands, if not millions, of dollars. They also remove potential liability under the Employee Retirement Income Security Act and Sarbanes-Oxley, observers say." (Financial Week; free registration required)
Proposed California Rescission Regulation Could Mean New Expenses for MCOs
Excerpt: "The California Department of Managed Health Care (DMHC) and the California Department of Insurance (DOI), which jointly proposed parallel sets of regulations, say the rules, if enacted, will be the nation's 'strongest protection for consumers against the illegal rescission of health insurance.'" (AISHealth.com)
Calif. Agencies Release Proposed Regs to Prevent Improper Cancellations of Health Insurance Policies
Excerpt: "The California Department of Managed Health Care and Department of Insurance on Tuesday proposed new regulations intended to prevent insurers from improperly canceling individual health insurance policies, the Sacramento Bee reports . . . . The agencies said the new rules reinforce existing laws prohibiting insurers from rescinding coverage unless they can prove policyholders intentionally omitted information or lied on a medical questionnaire . . . ." (Kaiser Family Foundation)
Overview: IRS Goes After Abusive IRC Sec. 419(e) Schemes
Excerpt: "From Spencer's Benefits Reports: In two notices and a revenue ruling issued on October 18, the Internal Revenue Service has provided a series of warnings and cautions in an attempt to curtail the growing use of certain trust arrangements under IRC Sec. 419(e), which are being sold to professional corporations and other small businesses as welfare benefit funds." (Wolters Kluwer Financial Services)
Benefits Audits Turn Up Signs of Anger in Workers
Excerpt: "It's the hot topic in benefits, and no one is hotter about it than workers: employers demanding proof that family members qualify for insurance coverage. Workers often are offended that their company seems to be questioning their honesty. Others are just irritated at having to dig out old tax returns, birth and marriage certificates, or college transcripts. Some don't respond to requests for documents." (Chicago Tribune)
Opinion: EHRs' Place in Fraud Management Focus of Report
Excerpt: "[The target page is a letter written in] response to Joseph Conn's 'RTI report includes controversial EHR requirement': The article cites the report recently released by the Office of the National Coordinator for Health Information Technology in which a panel of experts selected by RTI International under a contract from ONCHIT crafted recommendations for requirements of electronic health records that could assist in fraud management and improve data quality." (Modern Healthcare; free registration required)
Identifying and Eliminating Internal Theft and Abuse in Health Care
Excerpt: "This article presents significant points to consider when examining an organization's internal accounting systems and offers real-world examples of fraud that have taken place in the health care industry." (International Foundation of Employee Benefit Plans)
The Real Obstacles to Health Care Reform: A Checklist
Excerpt: "[The author of this blog offers two points to consider:] Lack of Accountability For Public Funds [and] Outpatient Treatment Centers and Physician Self-Referrals." (Health Plan Law blog by Attorney Roy F. Harmon III)
Guarding Against Employee Fraud and Theft in Health Care Organizations
Excerpt: "Although in previous EBN issues I have offered advice to employers on SAS 70 audits, I recently have been fielding calls regarding health care fraud. What follows is a sampling of the questions I've received, and my advice to employers to protect themselves." (Charles Denyer via Employee Benefit News)
BenefitsLink Named 'Best of the Web' by Human Resource Executive Online
We're the only site in the 'Benefits' category! Thanks for letting us share this news with you. Excerpt: "With that in mind, we considered it fitting to present in this anniversary issue 10 of the best HR Web sites and 10 of the best HR blogs for your browser's Favorites/Bookmarks list. . . . [I]f it's about benefits, you'll find something about it on BenefitsLink. Just a cruise down its left side navigation/links bar, and you quickly get the idea how they chose the site's name back in 1995." (Human Resource Executive Online; free registration required)
Benefits Fraud & Abuse: Ten Danger Signs
Excerpt: "[The target page provides] some simple lists that identify important warning signs." (Health Plan Law blog by Attorney Roy F. Harmon III)
Blame-the-Lawyer Stratagem Fails in ERISA Suit Against Fund Trustees
Excerpt: "A New Jersey federal judge's dismissal of legal malpractice and breach-of-fiduciary-duty claims against counsel in an ERISA case shows that trustees sued for misfeasance can't easily pass the buck to their lawyers." (New Jersey Law Journal via Law.com)
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