By Darrell Smith SACRAMENTO — Sutter Health routinely charged insurers for anesthesia services that never were performed and double-billed for services that were performed, the state’s insurance commissioner alleged Wednesday in joining a lawsuit against the Sacramento-based health network.

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AETNA NEWS RELEASE: We’re pleased to announce that we are broadening our capabilities to better meet the needs of a broad range of customers. We have agreed to acquire Prodigy Health Group, the nation’s largest independent TPA.

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Subject: Califoria Legal Action

Hey Guys, I wondered if you guys ( bloggers supreme ) had seen this case out of California ? Started as an action by an audit firm against Sutter Health and then the California Department jumped in. The interesting detail to me is how PHCS / MultiPlan is being treated as an “ accomplice “ due to the onerous terms of the PPO agreement ( i.e. no audit , no review ).

My opinion is that this case could be huge if it gets legs and other Departments across the country pick up on the logic. While this case is specifically applied to the anesthesia sleight of hand , could the same rationale not be applied to other areas ? How much abusive billing is covered over by the handcuffs placed on plans via PPO contract terms ? Arguably, the entire chargemaster process is driven by the incentive of “ percentage off “. Bill more get more.

CA v Multiplan  (FOR A QUICK REVIEW, READ PAGES 12-18)

LINCOLNSHIRE, Ill.—Aon Hewitt Inc. is developing a health care exchange that would enable employers to offer employees an array of plans provided by participating insurers.

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Dual Compensation – Hide & Seek

Many Texas political subdivisions employ licensed fee based insurance consultants to assist in the competitive procurement of insurance and on-going risk management advice. The Texas Department of Insurance issues two licenses required to act as a fee based insurance consultant in this state.

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This is an URGENT email we received this morning:

We apologize for the late notice but we just received notice that the Texas House of Representatives Insurance Committee is meeting today starting at 1:00 and they will be voting on HB 1534. This is a bill that is aimed at the “Silent PPO” issue but has some unintended consequences that are bad for our industry.

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Many believe that medical stop loss cover is a commodity rather than a value added benefit. There are numerous variations of contract provisions in the market. And, there are many more to come, especially for demanding Plan Sponsors who think out of the box. Here is an example –  Cost Plus Stop Loss Insurance

“We are not going to pay this outrageous medical bill……………take us to court!

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Atlanta Journal article exposes huge hospital markups. A must read for those who blame insurance companies for the high cost of health care (Much like blaming the local gas station for the high cost of gasoline).

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The Cost Plus Revolution in Texas has saved self-funded employer sponsored health plans millions of dollars (See previous postings by typing in “Cost Plus” in the search box on this page).  More Plan Sponsors are realizing that PPO discounts based off inflated medical bills through contracts that they cannot see confounds  their fiduciary duties.

Amps (www.advancedpricing.com) works with self-funded health plans. Their proven track record shows significant plan savings for their clients.

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“A person entitled to compensation is also entitled to group health insurance from the county in which the offense that was the subject of the wrongful conviction occurred as if the person were an employee of the county.”

http://www.legis.state.tx.us/tlodocs/82R/billtext/pdf/SB01686I.pdf#navpanes=0

Editor’s Note: If this bill passes, Texas counties may need to re-evaluate their GASB 45 liabilities.

  Even John could’nt beat the “Big C”

http://click.realtimesecfilings.com/ize/4/14op2noWttnf2vWt4gW076wj3Win3W52b9

Dental insurance is popular – many employees will buy it through payroll deduction. Typical premium is about $18 – $23 per month for single coverage. Family coverage can cost  $50 – $60  but sometimes as much as $75-$85 per month. But is dental insurance cost effective?

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SPRINGFIELD, Mass. (WWLP) – Hard working families are getting a break on life insurance. MassMutual was issuing life insurance policies for free at the Eastfield Mall Saturday, 50,000 dollars worth of term life insurance policies.

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Medical errors and other adverse events occur in one-third of hospital admissions, which is as much as 10 times more than some previous estimates have indicated, according a new study.

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MyHealthGuide Source: John Eggertsen, Esq., Eggertsen Consulting, P.C., www.jhelaw.com

The U.S. Court of Appeals for the Sixth Circuit April 6 reversed an injunction that required Blue Cross Blue Shield of Michigan (BCBSM) to provide a multiemployer health fund with documents detailing BCBSM’s discount arrangements with medical providers (Pipefitters Local 636 Insurance Fund v. Blue Cross & Blue Shield of Michigan, 6th Cir., No. 09-2294, unpublished 4/6/11).

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Collin County is changing its approach to indigent health care services, which for years have been a target of criticism and controversy.

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NASHVILLE, Tenn. – Ask brokers why limited medical coverage is important and there’s a simple answer: it provides choices. So said panelists during Benefits Selling Expo’s day two session, “Limited Medical Panel: It Ain’t Over Yet.”

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This White Paper is a good read for physicians who are interested in cutting out the managed care middle men and directly contract with self-funded employer sponsored health plans – Physician Direct Contracting

See also – http://ajlester.com/public_html/documents/EBN%20Article%20February%202004.pdf

North Carolina House Bill 115, legislation written by the insurance companies, would create a health benefits exchange that is neither accessible nor transparent. Remember the North Carolina State Health Plan fight? For those who need a refresher, North Carolina signed a no bid contract with Blue Cross to manage the State Health Plan. The contract was secret, not even legislators could get a copy until public pressure forced it into the open.

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The federal agency Centers For Medicare & Medicaid Services is hoping to boost enrollment in a public insurance program  (welfare program) for U.S. residents who have been denied private health insurance because of pre-existing illness or disability.

In Texas, less than 1,200 have joined the new plan. Texans must be a damn healthy group of people.

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Best’s Review, April 2011 article “No Remedy in Sight” outlines the declining fortunes of health insurance brokers nationwide.

“Brian Borshoff has watched the annual revenue at his insurance agency plunge from about $1.3 million to $500,000 in just three years.”

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The groundbreaking Express Scripts 2010 Drug Trend Report estimates that the U.S. can cut 33% of the nation’s $403 billion in annual pharmacy-related waste — simply by activating patients’ good intentions to improve common behaviors linked to their prescription drug use.

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For full copy of the report to Congress issued within the past week, write Riskmanager@sbcglobal.net

Medicare officials recently announced  that the Medicare program will pay the $93,000 cost of prostate cancer drug Provenge, an innovative therapy that typically gives men suffering from an incurable stage of the disease an extra four months to live.