Weslaco Independent School District Gets A+ For Health Care Management

May 25th, 2015

mulebriar

The Weslaco Independent School District gets a rare Mulebriar rating of A+ for proactive management of their self-funded health & welfare plan.

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What A Hospital CEO Learned From Nordstrom

May 25th, 2015

nordstrom

….it will take a new skill set and a new mindset to survive in our new retail-driven market.……”

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Memorial Day 2015

May 20th, 2015

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

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Notre Dame Birth-Control Protest Denied Again

May 20th, 2015

birthcontrol

Reacting to a Supreme Court order to reconsider, a federal appeals court refused on Tuesday for a second time to stop enforcement of the federal government’s birth-control mandate against the University of Notre Dame.

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Is Medicaid the Answer to Crushing Health Care Costs for Inmates?

May 20th, 2015

Medicaid will not cover the health care costs of inmates while they’re in jail or prison, with state and local governments often footing the bill. But there is an exception that could save millions of local dollars: If an eligible inmate requires a stay in a hospital outside the corrections system that lasts more than 24 hours, his or her suspended Medicaid coverage can kick in to reimburse the costs. 

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Milliman Report – More Evidence PPO’s Failure To Control Costs

May 19th, 2015

insanity“The total cost of typical employer-sponsored preferred provider organization (PPO) coverage for a family of four has increased 6.3 percent this year, to $24,671.”

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San Benito ISD Seeks TPA, PBM, Stop Loss Insurance Proposals

May 19th, 2015

sanbenitoisd

Specifications for the Employee Health Benefits-Health Products proposal and corresponding information:   http://purchasing.sbcisd.net/category/bids/  If you need additional information you may contact:

Mr. Adrian Garcia, Purchasing Agent

This Article Proves PPO’s Have Failed To Control Costs

May 19th, 2015

GRANDMOTHER

This article proves that managed care has failed. PPO’s drive costs up, not down. Within all PPO contracts there is, among other things, an annual escalator clause that guarantees annual increases in provider reimbursement. The annual compounding effect is enough to make grandma want to go back to the good old days when a dozen eggs would buy a doctor visit in the comfort of your own home, or a bottle of tequila and a jar of honey for that nasty cold Johnny brought home from school.

The table shown in the article leaves out Cost Plus Health Insurance Plans, or Reference Based Pricing models. These plans beat medical trend.

“Medical costs are directly related to what you agree to pay” – William Rusteberg

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Florida Hospitals Tell Scott To Support Medicaid Expansion, Scrap Profit-Sharing Plan

May 19th, 2015

Rick Scott

Florida hospitals to Scott:  “You have suggested that a new tax on hospital operating surpluses might be a way to sustain the existing LIP program. Such an arrangement is not a solution to the challenge we face.”

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Want Free Health Insurance? Must Be Employed To Qualify

May 18th, 2015

free1

The Arizona Legislature has passed a law seeking to force anyone getting Medicaid to have a job…

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Fringe Benefit Group Purchases EPSI

May 18th, 2015

fringe

May 4, 2015 – Austin, Texas – Fringe Benefit Group, an industry leader in the design, implementation and administration of benefits for hourly and part-time workers, today announced it has acquired Houston-based Employer Plan Services, Inc. (EPSI), a Third Party Administrator (TPA). Terms of the transaction were not disclosed.

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Value Based Care Will Drive Aetna’s Future Goals

May 18th, 2015

AetnaBertolini told analysts Aetna is now in contracts with 62 ACOs. “We have almost a million members in patients that are medical homes, which is 38% growth since the beginning of ’14 and over 760,000 members in what we call our high performance networks,” the Aetna CEO said.

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When Did Primary Care Physicians Stop Becoming Doctors?

May 18th, 2015

candid

Paul searched around the room thinking he was on a candid camera show. But he found no cameras, no laughing audience, or genial host.

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Weslaco ISD vs Aetna

May 17th, 2015

tellme

The Weslaco ISD lawsuit against Aetna is a fascinating read. The pleadings provide clues for those who are curious about various revenue streams found (or not found) within some administrative contracts for third party administration of group medical plans.

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More Government Diktats (Obey or Go To Jail)

May 16th, 2015

bath

This week the government released new diktats requiring, among other things, that preventative care benefits extends to transgender individuals………………

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Drug Costs Exceed $100,000 A Year For More Hyphenated-Americans

May 16th, 2015

drugdealer

“Really? Our drugs are cheaper!”

Research estimates that the number of Hyphenated (pick Mexican, African, Anglo, Latino, German, Irish, etc.) Americans with six-figure drug bills jumped from 49,000 to 139,000 from 2013 to 2014.

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Molina Profits Surges – Fueled By Medicaid

May 16th, 2015

molinaMolina Healthcare recorded booming revenue and net income figures in the first quarter, a direct result of the Affordable Care Act’s expansion of Medicaid and private health coverage.

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Dog Bite Is worth $32,000

May 15th, 2015

dog111

Dogs are man’s best friends, especially lawyers………….

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4 Of The Wealthiest Families Who Lost It All

May 15th, 2015
From these tales of loss, we can learn a lot and not repeat their mistakes.

May 15, 2015 | By Lynette Gil

From these tales of loss, we can learn a lot and not repeat their mistakes.

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Code SixFour

May 15th, 2015

codesix

A strategic ‘think-tank and back-office’ for brokers and benefits advisors

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The Texas Approach to Emergency Treatment

May 15th, 2015

erroom

Free standing emergency rooms which by law cannot accept Medicare or Medicaid, are located in wealthy suburbs. It’s better than driving into the city and waiting for hours to see a doctor…….

“A typical bill at a free-standing emergency center is about $1,400, compared with about $200 at urgent-care centers.”

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Health Care Revolutionaries – First of A Series

May 14th, 2015

pinder

Health care revolutionaries are unusual people. Information nomads never rest, never quit, until their quench is satisfied. Sharing truths enlightens all.

Jeanne Pinder is a Health Care Revolutionary. She is one of the ten most disruptive health care anarchists in this country.

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First Capital Consulting Inc.

May 14th, 2015
acaFirst Capitol has mastered utilization of its ACA, tax, payroll, and HR expertise, data collection infrastructure and technology to support clients in implementing an optimal ACA action plan.

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Simple Sells Reveals Proven Selling Strategy

May 14th, 2015

simpleBy Simple Sells

“I have made a small fortune using this simple, soft shoe approach.”

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Aetna To Purchase Humana?

May 12th, 2015
bluelight130x130Louisville-based insurance giant Humana Inc. is having a good day on Wall Street today amid speculation it could be purchased by competitor Hartford, Conn.-based Aetna Inc. (NYSE: AET)

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Amended Version of Texas HB 3453 Passes

May 12th, 2015

cankick

An amended version of Texas House Bill 3453 passed yesterday. The original version would have allowed Texas school districts to opt out of the TRS ActiveCare health plan. Instead, the amended version creates an Interim Committee to study the issue for future consideration.

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New Machine To Replace Anesthesiologists?

May 12th, 2015

hammerThe new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old………

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PPO Discounts – Shell Game

May 11th, 2015

shellgamessss

It turns out that one of the reasons workers have been paying more for their coverage is allegedly a common practice among insurers:  charging their employer customers unlawful hidden fees.

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Rx Encounter In Victoria – Cuero Texas

May 11th, 2015

mulebriar

This visit was going to be another learning experience. As I drove up to the ranch house, there he was, beer in hand, waiting. “What took you so long! I have something to tell you and it’s a god damn disgrace!”

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Order Your Own Lab Tests – What Could Go Wrong?

May 11th, 2015

doitLabCorp, one of the largest outpatient lab providers in the USA, is soon going to let you skip the tedium of a doctor’s visit to get lab work done. Want some tests? Come on down!

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City of McAllen Seeks Competitive Proposals

May 8th, 2015

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Government Defaults On PPACA Obligation

May 8th, 2015

promise What Promise!

“Our government is so dysfunctional that no one can trust it to honor any commitment of any kind.”

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Pharmaceutical Companies Buy Rivals’ Drugs, Then Jack Up the Prices

May 6th, 2015

scalper

When companies hold calls discussing drug costs with investors and analysts, “I’ve heard them ask, ‘Why didn’t you price it higher.’ I’ve never heard anybody say, ‘Why don’t you price it lower?’” Mr. Kolassa said.

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Update On HB 3453 – Postponed

May 6th, 2015

Session ends in less than 30 days. Will HB 3453 see the light of day?

Session Title/Description Last Action
2015-2016
84th Legislature

(Introduced)
Relating to participation in and rates for coverage provided under the uniform group coverage program for active employees.
[HB3453 2015 Detail][HB3453 2015 Text][HB3453 2015 Comments]
2015-05-06

Postponed

Overkill

May 6th, 2015

Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.

Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.

” Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation.”

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Assurant Changes Commission Structure Prior to Market Exit

May 6th, 2015

agentinsu

Important information for our sales partners from Assurant Health 

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The Case of The Missing Leg

May 5th, 2015

leg

Homicide detectives knocked on his door and asked him why his leg was found in the garbage.

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The Financial Advantages of Provider-Sponsored Health Plans

May 5th, 2015

mulebriar

“Provider sponsored health plans are gaining traction in the market” – Molly Mulebriar

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HB 3453 – Will TRS ActiveCare Survive? Floor Vote Wednesday….

May 5th, 2015

seriously

We received an email this morning regarding the upcoming vote on HB 3453 which will allow TRS ActiveCare participating school districts to opt out of the program.

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United Healthcare Launches Virtual Health Care Visits

May 5th, 2015

virtual1

The Tennessean  (5/4, Fletcher) reports that United Healthcare is launching “a network of virtual visits for its commercially insured consumers as a way to provide more affordable health care for simple issues like colds.”

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Don’t Ask & We Won’t Tell

May 4th, 2015

dontt

“Don’t Ask and We Won’t Tell” brings clarity to the issue of undisclosed kickbacks paid by some carriers/TPA’s to “independent” insurance consultants.

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32% of Employers To Offer Only High Deductible Health Plans

May 4th, 2015

sense   In 2015, 32% of employers plan to fully replace their existing options with a choice of only high-deductible options……

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Oklahoma-Based The Holmes Organisation Acquired by Hub

May 4th, 2015

May 4, 2015

Hub International Limited (Hub) subsidiary Hub International Midwest Limited (Hub Midwest) has acquired the assets of The Holmes Organisation (Holmes), a Tulsa, Okla.-based multi-line property and casualty, employee benefits and personal lines brokerage.

Terms of the acquisition were not disclosed.

The Holmes team will continue to operate from their existing offices in Tulsa and Little Rock, Ark., and will become part of Hub Midwest, establishing Hub Midwest’s fourth location in Oklahoma. Stuart F. DeSelms, president of Holmes, will join Hub Midwest as executive vice president and chief sales officer.

Source: Hub International Limited

 

RIMS Report: Uber Touts Ridesharing Insurance Solution

May 4th, 2015

pixxaThe gist of the concept is, a company buys the insurance to cover liability arising from vehicles used in the course of its business. A common example is a pizza delivery business.

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PPACA – Game Changer For Health Care Financing

May 3rd, 2015

parking   “ACA is the fuel which fires the self-funded engine of employee health and welfare plans, providing flexibility, control and lower costs. It is the parking brakes of fully-insured plans.” – Bill Rusteberg

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America Has A Long-Term Care Crisis

May 2nd, 2015

oldpepole

“By 2030, nearly one fifth of our population will be over the age of 65 and 70 percent of them will require some form of long-term care.”

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Rural Hospitals Struggle to Stay Open, Adapt to Changes

May 2nd, 2015

rural

This article is about tough times for rural hospitals. Many are closing their doors because they can’t make ends meet. One solution to keep doors open are hospital-run Community Health Plans providing revenue for empty hospital beds – a win win business proposition.

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Teledoc Sues Texas Medical Board

May 1st, 2015

telephone123The Texas Medical Board has gutted Teledoc’s business model. Teledoc fights back…..

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Ethics Case Against Former School Board Member Tied to Insurance Consultant

May 1st, 2015

Lafayette Parish School Board/KPEL Staff Photo Mark Cockerham

School Board member accused of soliciting favor and accepting gift from school district insurance consultant.

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Shifting From Commissions To Fees

May 1st, 2015
businessmodel
Commission compression is causing advisors to rethink their business model – especially looking a few years out. One option is to shift to a more consultative fee-based approach.

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Texas Lawmaker Gathers Support To Repeal Health Insurance Fee

May 1st, 2015

dontmesstexas

As health care costs continue to climb, the last thing Texans need is a $145 billion health care tax that translates into higher premiums for themselves and their families.

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What Uber Drivers Can Teach Health Care

April 30th, 2015

uber

“When I asked him what he thought of this, his response was a resounding “Hell no!” and he said he would find something else to do if this ever happened.”

“While doctors may be losing the battle for autonomy, I hope that the enterprising and fiercely independent Uber drivers never do.”

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Assurant To Quit Medical Market

April 29th, 2015

goodby

“Insurance giant Assurant is looking to sell its health insurance division……. Regardless if a buyer is found, it will pull out of the health insurance marketplace by 2016…”

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Continental Benefits

April 29th, 2015

continentalWouldn’t it be a relief to find a partner that can help you successfully navigate the health care system?

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Montvale Surgical Center v. New Jersey Health Benefits Commission

April 29th, 2015

onesixtyThe issue in this case was whether a New Jersey government agency should pay an ambulatory surgical center out-of-network health care benefits at 160% of the Medicare rate, rather than, as required by statute, a rate determined by a “nationally recognized database.”

“There are very few market forces that limit what an out-of-network provider can charge. For that reason, non-participating providers are often reimbursed significantly more than their in-network counterparts.”

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Do Fee Based Consultants Earn Kickbacks From Carriers They Recommend?

April 26th, 2015

kickback111

One of the best kept secrets of the insurance industry is the practice of paying kickbacks to insurance consultants which are never disclosed to clients who pay them.

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Insurance Agent Found Guilty of Racketeering and Money Laundering

April 26th, 2015

Randall Petersen

Operating under multiple business names, Randall Petersen, 49, conducted a fraudulent insurance scheme that involved his theft of several hundred thousand dollars of commissions and bonuses from American National Insurance Company and Liberty National Insurance Company.

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Wellness Programs & Global Warming

April 23rd, 2015

gore

Wellness programs are popular these days. Who wouldn’t be against healthier lifestyles? But according to this study exercise does not help in reducing obesity. Eating less does. The myth follows the same pattern as the global warming myth – both are politically correct but scientifically flawed – Molly Mulebriar

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Fugitive Ends 40 Years On The Run To Get Healthcare

April 23rd, 2015

fugitive Moore before and after

A fugitive in Kentucky has turned himself in to authorities after decades on the run, so he can get medical care.

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Medical Consolidation Continues In San Antonio

April 23rd, 2015

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Brownsville Blogger Investigates BISD vs HealthSmart Settlement Terms

April 22nd, 2015

ham

 

Suing a Ham Sandwich has never been easier, especially in Brownsville, Texas. All is needed is $150 for the filing fee………….

EL RRUN RRUN: BISD TRIES TO KEEP LID ON MULTIMILLION HEALTHSMART SUIT

Need A Second Opinion On Your Self-funded Medical Plan?

April 22nd, 2015
riskmanager.us
If you wish to continue operating your self-funded plan the old fashion way this post will not be of interest to you……….

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Texas House Bill 3453 – A Flicker of Life?

April 21st, 2015
trsactivecare
Texas House Bill 3453 (H.B. No. 3453), if passed, will allow participating school districts to exit the program. Currently they are prohibited from leaving. 

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88-Year-Old Mississippi Doctor to Continue Practicing From His Car

April 21st, 2015

old doctor

By Jeff Amy | April 20, 2015

An 88-year-old Mississippi physician, who has faced scrutiny because he was practicing medicine from his car, said after a meeting with regulators that he now expects to be able to continue seeing patients.

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Cost Plus Insurance: New Reality In Provider Payment Models

April 19th, 2015

cost plusProviders across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans……….Given their growing popularity, Providers need to be proactive in understanding and managing these types of programs.

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Was There Health Insurance In 1912?

April 18th, 2015

Theodore Roosevelt. Click image to expand.

“Roosevelt’s Progressives were the first major American party to pick up the baton of health care reform”

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Republicans Surrender

April 18th, 2015

surrender

The only difference between Democrats and Republicans is Republicans take longer to get there. Remember Medicare in 1966? Republicans opposed it, now they support it. Standing up for one’s principles is a fleeting, temporary and convenient emotion in politics” – Don Pedro

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Six Ways AMPS Is The Leader In Price Transparency

April 17th, 2015

aaaaa “We have been on a RBR/Cost Plus platform for five years. We changed to AMPS several years ago and highly recommend them. AMPS provides a quality product at a competitive price” – E. Juarez

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It’s Cheaper To Fly Your Employee To Europe for their Appendectomy

April 16th, 2015

germanbeer34

 

John, der irrt! Deutsch Bier und deutschen Frauen sind die besten!

“There are plenty of reasons to brag about living in America, like the fact that we have the most innovative beers on the planet (sorry Germany)”

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Will Accountable Care For Medicaid Work In The Ghetto?

April 16th, 2015

smoker121

Patients might only be able to get to a doctor during the day on the weekends because it’s too dangerous in the neighborhood to be going out at night……The patient goes to the pharmacy but is told the new medication requires pre-approval.  The patient doesn’t know what to do so the patient goes to smoke a cigarette…………...

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Free Market Healthcare Whole Foods Style

April 15th, 2015

wholeWhole Foods CEO John Mackey argued in the pages of the Wall Street Journal that the solution to America’s health care crisis was to be found in “less government control and more individual empowerment.”

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Methodist Healthcare Strikes Deal With Eagle Ford Shale hospital

April 15th, 2015

pakman

San Antonio’s Methodist Healthcare System has entered into an agreement with the Frio Hospital District Board of Directors and will take over administration and management of Frio Regional Hospital in Pearsall in the Eagle Ford Shale area.

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Are You Ready For Your Department Of Labor Audit?

April 15th, 2015

dol

DOL has ramped up its audit efforts on health plans.  And  now the audits include requests for documentation based on Health Reform (PPACA).  Could you come up with this list of 30 items DOL Audit

ERISA – Fiduciary Duty: Proposed Exemption to Engaging In “Self Dealing”

April 14th, 2015

erisa

” The exemption allows fiduciaries to receive compensation when plans and IRAs enter into certain insurance and mutual fund transactions recommended by the fiduciaries as well as certain related transactions.”

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San Antonio Runs Off Uber, Now Texas Uberizes Telemedicine?

April 14th, 2015

seriously

The City of San Antonio, through punitive restrictions on free trade has run off Uber from the city effective April 1. Now the State of Texas, through special interests, runs off telemedicine companies too? What has happened to traditional Texan values of hard work, innovation and freedom to conduct commerce?

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