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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