Archive for March, 2016

FBI Says School District Consultant Helped Insurance Broker Get Contracts

Thursday, March 31st, 2016

William O. Haff leaves the John Wood Federal Courthouse Thursday March 31, 2016. Haff pleaded guilty to conspiracy to commit wire fraud stemming from an F.B.I. public corruption investigation. Photo: John Davenport /San Antonio Express-News / ©San Antonio Express-News/John Davenport

William O. Haff leaves the John Wood Federal Courthouse Thursday March 31, 2016. Haff pleaded guilty to conspiracy to commit wire fraud stemming from an F.B.I. public corruption investigation.

William Oliver Haff, 46, of San Antonio admitted that while working for the consulting company hired by the school districts — Wortham Insurance and Risk Management — he was also getting paid on the side by an insurance agent/broker so its clients would land contracts to provide employee insurance there.

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Will The Anthem-Express Scripts Battle Change The PBM Landscape?

Thursday, March 31st, 2016

battle

After months of public frustration, Anthem sued Express Scripts  Monday for more than $15 billion. Anthem argued the St. Louis-based PBM did not share enough drug savings with Anthem, which led to “an obscene profit windfall” for Express Scripts, according to a copy of the lawsuit (PDF).

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ACA – The Individual Mandate Does Not Exist

Wednesday, March 30th, 2016

what1

SOURCE: Benefitrevolution.com

“You can simply “believe” that Obamacare plans are too costly or experience any of another limitless form of hardship and get yourself out of the law.  So in reality, the 4 million Americans that are estimated to pay this fine should receive an “F” in creative writing and imagination. The individual mandate does not exist.  It is a mirage.”

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How Much are Doctors Paid by Drug Companies and Medical Device Makers?

Wednesday, March 30th, 2016

sunshineThe Open Payments Program creates a national database of payments made by pharmaceutical companies and medical device companies to doctors and academic medical centers.

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Health Savings Act of 2016: Will it change HSAs?

Wednesday, March 30th, 2016

nobrainer“During the past twelve years HSAs have experienced explosive annual growth rates of 25 to 30 percent and are expected to have assets over thirty billion dollars with over 19.7 million Americans currently having accounts.”

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Why Healthcare Costs Bleed Firms Dry

Tuesday, March 29th, 2016

costofhealthcare

 “It is impossible to prove something to someone whose salary depends on believing the opposite.” – Upton Sinclair

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One Hospital Tells You What You Must Pay – BEFORE The Surgery

Monday, March 28th, 2016

shocked

How refreshing to find a hospital that quotes package prices in advance and is willing to compete for patients based on price and quality. Why are they doing it? For the simplest reason of all: to attract patients.

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Free Market Medical Association – TPA Call To Action

Friday, March 25th, 2016

freemarket“Self-funded employers have been forced to rely on PPOs to give a percent off billed charges from these providers.  This has done nothing to curb the rising cost of care as most PPOs are taking a portion of ‘savings’ as an additional revenue stream.  It benefits them if the billed charge is excessive.  In additional to the PPO, many more layers between the patient and the provider further add to the cost. “

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David Returns To Rome – To Start Wellness Initiative

Friday, March 25th, 2016

statue

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Repeal-Obsessed Republicans Don’t Understand Obamacare Is Kind Of A Gift

Friday, March 25th, 2016

angrydoctor1“In Dallas, Texas Blue Cross, in its Exchange plan, is paying 10 percent less than what Medicaid pays. So these are low rates. They take all the doctors who accept that fee—and that typically doesn’t include the best doctors, by the way—and that’s how they get their premiums down. They’re convinced that healthy people buy on price.” – John Goodman

Editor’s Note: Nothing in the ACA mandates the reimbursement levels paid to medical care givers. In this case BCBSTX is paying less than Medicaid on their narrow network If BCBSTX can pay an arbitrary number which is less than Medicaid reimbursement rates, what prevents an employer doing the same thing? The employer could build a Base Plan with reimbursement rates half of Medicaid’s and thus limit risk while complying with the ACA. The employer could then offer a Buy Up Plan for those who want “real” insurance

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The Narrowing of the Network

Wednesday, March 23rd, 2016

sense

“Narrow networks are simply an aggregation of health caregivers willing to earn less. For example, if Dr. Jones wants $250 for a routine office visit while Dr. Smith wants $55, and if Hospital “A” wants 450% of Medicare while Hospital “B” will take 115% of Medicare, guess which providers are invited to join these narrow networks?“- Homer G. Farnsworth M.D.

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Telehealth is Working in Texas. Here’s Why

Wednesday, March 23rd, 2016

telephone123Texas providers and hospitals are taking full advantage of the benefits of technology, and it’s yielding results………….
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Irrational Hospital Pricing

Tuesday, March 22nd, 2016

stop“Hospital prices are almost completely irrational. They bear no relationship to the cost of providing the services, they are opaque, and the prices vary wildly among hospitals and payers.”

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The Redoubtable Chargemaster

Tuesday, March 22nd, 2016

hospitalchargemaster

“Charge-master rates, in reality, serve as nothing more than the starting point for negotiations with the payer”……………….”The ‘full charges’ reflected on hospital Charge Masters are unconscionable”…………………..

“Hospital discounts mean nothing” – Bill Rusteberg

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BCBS Brings Hospital Contract Negotiations Public

Monday, March 21st, 2016

dirtylaundry“We cannot in good conscience agree to terms that would increase the amounts our customers pay…….” – BCBSTX

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Former Hospital President Blows Whistle on Predatory Pricing

Saturday, March 19th, 2016

toodamnhigh

“The price is too damn high!”

Florida attorney Steven I. Weissman agreed to become interim president of a Miami hospital when its founder, a friend and client of 35 years, died. He quickly got an insider’s view of the healthcare system and found it sickening. Risking long-standing relationships, he has gone public.

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Why Hospitals Bill High

Wednesday, March 16th, 2016

lustig Victor Lustig

The scheme behind turbocharged hospital bills is to provide false value and hidden revenue streams………….a Victor Lustig wet dream

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Insurance Company Has A Deal For Utah Employers

Wednesday, March 16th, 2016

aaaaaaaaaam“I gotta a deal for you!”

“The insurance company owned by Intermountain Healthcare is promising employers an annual 4% growth in healthcare costs……”

Is a 4% annual increase in health care costs a good deal? No says Homer G. Farnsworth, M.D. – “That’s outrageous! Under Reference Based Pricing, Direct Contracting, and the Asserta Health Cash Plan our clients are reducing health care costs, not increasing them!”

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Segal Consulting Stop Loss Statistics 2016

Tuesday, March 15th, 2016

segal1Interesting statistics from Segal Consulting. For example, 20% of clients purchase SSL of $500,000 or more.

Segal – Stop Loss Statistics 2016

Finally, a Solution to Poor Physician Penmanship

Tuesday, March 15th, 2016

prescriptio n1

From the founding of the Republic, Americans have joked about the poor handwriting of physicians.  Well, all the Americans except the ones who got the wrong medicine because pharmacists misread handwritten prescriptions.

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Healthcare and Guns; What Do They Have in Common?

Tuesday, March 15th, 2016

gun

Am  I being denied my right to bear arms if I can’t afford the price of a handgun?

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Life Partners – Historic Fraud?

Tuesday, March 15th, 2016

scam“The Life Partners fraud deserves a place in Texas history as one of the largest and longest-standing fraud schemes ever perpetrated in this State”

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Health Care Cash Pricing

Saturday, March 12th, 2016

The largest health care system in Oklahoma publishes transparent cash pricing……

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Big Government To Enter ACA Punishment Phase

Saturday, March 12th, 2016

prisoners111

Government to be quicker to punish free enterprise this year, government officials say……eager bureaucrats gearing up for punishment phase…………..prison farms to be expanded to accept newly minted criminals……..Citizens flee to sanctuary cities…………Canada closes border, says USA must pay for fence………

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ECISD & DHR Establish On-site Health Care Clinic

Friday, March 11th, 2016

ecisddhr

Edinburg Consolidated Independent School District (ECISD) and Doctors Hospital at Renaissance Health System (DHR) are proud to announce the creation of the Edinburg CISD School Based Health Center, a facility dedicated to the healthcare needs of our students, families, and employees.

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Dependent Eligibility Audits Increasingly Important

Friday, March 11th, 2016

fraudInsurance fraud is rampant in health care. For example, we have found numerous instances where nephews, nieces, grandchildren, live-in girl friends and others are added to health insurance policies that are never audited.  Dependent eligibility audits should be performed by plan sponsors.

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How To Build A Sustainable Onsite Clinic

Friday, March 11th, 2016

On-Site_Clinics

Onsite health clinics are rapidly becoming the hottest trend in population health.

Fairfield County School District in Ohio became the first suburban school system in the country to offer health, dental, vision and mental health services in a single location.

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Weslaco ISD To Consider Settlement With Aetna?

Tuesday, March 8th, 2016

mulebriarThe Weslaco ISD vs Aetna & Robert J Garza lawsuit is a fascinating read. The original pleadings are worth reading for those students interested in peeling back the onion of the opaque world of health care costs.

It appears this six year case is winding down through arbitration ………

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Ending Discrimination in Health Care

Sunday, March 6th, 2016

mulebriarEveryone understands there are inequities within our health care delivery system. Will stringent government control be expanded to confront health care discrimination?

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TrumpCare

Thursday, March 3rd, 2016

trumpcare

Donald Trump released a seven-point health care policy paper this week, boasting that his plank would reduce health care costs and dubbing his plan “healthcare reform to make America great again.”

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Fiduciary Rule Will Force Brokers Out

Wednesday, March 2nd, 2016

beggar

Unemployed Broker

“I’m afraid by imposing that DOL ERISA fiduciary duty [on brokers] that you will have people exit that business,” Champ said. “Brokers will say that ‘I can’t deal with this.’” The rule will “drive advice out of that space,” he said.

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Supreme Court Finds ERISA Preempts State Claims Reporting

Tuesday, March 1st, 2016

bam The Employee Retirement Income Security Act’s reporting requirements trump those of individual states, including a Vermont requirement that self-insured employee health plans must report claims data, the U.S. Supreme Court ruled Tuesday in a victory for Liberty Mutual Insurance Co.

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Pay Less With Cash or More With Insurance?

Tuesday, March 1st, 2016

insurancecimopabuesCutting Out The Middle Man

Cash pay health plans are catching of fast. Hospitals are taking note…….

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