Veterans Day 2024

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

I knew little of my father’s participation in WW2 until after he died. Unlike veterans of today his generation didn’t talk much about it. Their quiet pride was enough, understood by all. The following recounts the Battle of Hatten in which my father was a participant. – Bill Rusteberg

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Healthcare Insurers Take Note: New Federal Whistleblower Program is Coming for You

November 6, 2024 David E. Leach Caroline J. Berdzik Scott R. Green

Key Takeaways:

  • New Corporate Whistleblower Awards Pilot Program incentivizes the reporting of corporate misconduct with the whistleblower possibly receiving upwards of $30 million
  • Healthcare insurance fraud schemes are one of the focuses of the program
  • The program ensures whistleblower confidentiality
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Walgreens Agrees To $100,000,000.00 Settlement

Walgreens agrees to pay $100 mln to resolve lawsuit over generic drug pricing

Nov 4 (Reuters) – Walgreens (WBA.O), opens new tab has agreed to pay $100 million to settle a proposed class action lawsuit accusing it of fraudulently overcharging customers for a decade when they bought generic drugs through private insurance, Medicare or Medicaid.

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DJT To Shake Up Health Care?

Donald Trump returns to the presidency with big ambitions to shake up health care

By Sarah Owermohle 

Republican Donald Trump has won the presidency, marking a new era for federal health agencies and the industries they oversee. The president-elect campaigned on promises to shake up public health institutions, reshape federal health programs, and slash high costs across the system.

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Internal Emails Reveal Carrier’s Pricing Strategy

“UnitedHealth had already reduced payments from 450% of what Medicare pays — the benchmark that many insurers use as a starting point for their own figures — to 250%, and the company planned to drop it further to 150%, according to the email……..Such a cut would have put UnitedHealth below national averages: Employers and private insurers paid on average about 250% of Medicare’s reimbursement in 2022…..”

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Boon-Chapman Announces Appointment of Kari L. Niblack, Esq., as President

Austin, TX, November 5, 2024 — Boon-Chapman, a leading claims administration, cost containment and care navigation company, announces the appointment of Kari L. Niblack, Esq., as President. Niblack brings twenty-five years of expertise in leading and transforming multiple corporations in the self-insurance ecosystem and has a proven track record of driving hyper-growth and innovation.

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Providers’ Winning Streak In No Surprises Act QPA Litigation Ends As Appeals Court Overturns A Prior Ruling

Plan Sponsor Reacts

The TMA is 4-0 in contesting aspects of the No Surprises Act. At the appellate level, the TMA is 1-1 

“The decision means insurers can calculate qualifying payment amounts using factors that provider advocates say should not enter into the equation.”

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Is Snejina Zacharia The Biggest Auto Insurance Broker On The Planet?

SOURCE: MIT Graduate Saw An Opportunity & Seized It.

When a minor accident sent Snejina Zacharia’s car insurance premium skyrocketing, she went in search of a better, cheaper policy. She discovered insurance shopping is too often exasperating, and inefficient, filled with hours of phone calls, and an inbox overflowing with spam.

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Welcome to Plan Stewards

Empowering Health Plans and Their Members

At Plan Stewards, we’re more than just a Third-Party Administrator. We’re your trusted partner in navigating the complex world of healthcare benefits. With over 150 years of collective experience, our team is dedicated to providing cutting-edge cost containment solutions, groundbreaking direct contracts, and adaptable plan designs.

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Seven More Reasons Why Employers Want Out Of the Health Insurance Business

With the passage of the Affordable Care Act (ACA) effectively turning private health insurance plans into a de facto government utility managed by bureaucrats in far away places, plan sponsors have become increasingly subjected to freedom robbing government mandates and punishing sanctions.

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America’s Leading Writer of Innovative Insurance Programs

McGowan Program Administrators (MPA) is America’s leading writer of innovative insurance programs. MPA is a Managing General Underwriter and Program Manager. MPA designs, administers and markets highly-specialized programs of insurance. These programs are available exclusively through MPA. They are offered on “A” Rated, Admitted Paper and are available in all 50 states.

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Stay Tuned… FTC Seeks to Breathe Life Back Into Non-Compete Ban

Sean R. GallagherJason T. Weber and Ross T. Weimer

October 25, 2024

This past week, the FTC appealed a Texas federal court’s August ruling that blocked nationwide enforcement of the non-compete ban. The non-compete ban will remain blocked during the pendency of the appeal process. However, the outcome of the appeal will determine: (1) whether the non-compete ban remains blocked; and (2) the future scope of the FTC’s regulatory authority. There are three court challenges to the non-compete ban. The status of those challenges (including appeals) is detailed below:

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Cutting Waste In Government Controlled Healthcare

SOURCE: Efficiency Commission Would ‘Unburden’ Us from a Federal Healthcare Nightmare

“The American healthcare system is increasingly falling behind as critical funds are funneled into bureaucratic red tape rather than innovation. Administrative costs have exploded, diverting resources that could otherwise fuel groundbreaking medical advancements. Instead of prioritizing cutting-edge research and life-saving treatments, far too much healthcare spending is consumed by paperwork, compliance protocols, and outdated systems. This misallocation of funds stifles research, patient care, and global competitiveness.”

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Here’s The Company Who Decides Whether To Pay For Health Care for 100,000,000 Humans

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.

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Aldeen’s Sunday Morning Bathroom Read

Send Lawyers, Guns and Money Part III

The American Medical Association recently oined the fray and sued Multiplan earlier this week in federal district court in Chicago. At issue is MultiPlan’s business model. Instead of determining their own out-of-network rates, insurers can outsource that function to MultiPlan, which promises to save them money on those claims. In many cases, MultiPlan uses an algorithm-based tool to recommend a payment level — and receives a portion of the difference between the recommendation and the original out-of-network bill, giving the company a financial incentive to recommend lower rates. The majority of U.S. insurers, including the 15 largest in the country, use MultiPlan to determine out-of-network payments.

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BCBS To Remove Houston’s MD Anderson From Medicare, Medicaid Networks

Blue Cross and Blue Shield of Texas to remove Houston’s MD Anderson Cancer Center from Medicare, Medicaid networks

HOUSTON – Blue Cross and Blue Shield of Texas announced it has made the decision to remove MD Anderson Cancer Center in Houston from its Medicare Advantage PPO, Blue Cross Medicare Advantage HMO, and Medicaid networks effective Nov. 1, 2024.

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Frontier Acquistion of Asserta Health Valued At $10,000,000

September 25, 2024

Bell Nunnally Represents Primary Care Network Frontier Direct Care in $10M Acquisition of Health Plan Provider Asserta Health

SOURCE: Bell Nunnally & Martin LLP

Bell Nunnally, led by Partner Ray A. Balestri and Senior Associate Joshua T. Smith, represented Harlingen, Texas-based primary care provider network Frontier Network, Inc. (d/b/a Frontier Direct Care) in its acquisition of Salt Lake City, Utah-based Asserta Health Inc. Asserta offers employers access to a cash-driven health plan, enabling self-insured and level funded employers to deliver health care benefits to their plan members. The deal, executed through stock-for-stock exchange, had an estimated value of $10 million.

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Seattle Hotel Owners Must Provide Employees With Families $20,232 Per Year In Health Care Benefit Access

2025 Seattle Hotel Employees Ordinance Expenditure Rates

SOURCE: 2025 Seattle Hotel Employees Ordinance Expenditure Rates

The Seattle Office of Labor Standards (“OLS”) announced the adjusted rates for 2025 health care expenditures required by the Improving Access to Medical Care Hotel Employees Ordinance, Seattle Municipal Code (SMC) 14.28.

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A Common Sense Alternative To TRS ActiveCare For Region One School Districts?

Most Texas school districts are unaware of a new health plan option that’s quickly fulfilling market demand across the country. “Why haven’t we heard about this? is a common question we get from district officials. “What is it and how does it work?” they ask. Dr. Eric Bricker explains it best in this short informative video.

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Oscar Health Announces 2025 Market Expansion to Put Health Insurance in the Hands of More Americans

NEW YORK–(BUSINESS WIRE)–Oscar Health, Inc. (“Oscar”) (NYSE: OSCR), a leading healthcare technology company, today announced it will bring the Oscar experience to more individuals, families, and businesses through the ACA marketplace in 2025. Oscar is introducing affordable health insurance products that empower people to pursue a healthy life on their terms with:

  • Services built around personal health needs and preferences.
  • Established networks providing multiple paths to high-value clinical care.
  • Technology solutions to help members manage their health and make informed choices.
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Anatomy of Public Entity Insurance Corruption

“The only way that we would be able to get into any school district was to be able to directly have a relationship with the decisionmakers — the school board, the trustees. We wouldn’t waste time on people where we couldn’t make money. We would contribute to the opponent of those (board members) who did not vote for us.” – Criminal Turned FBI Informant

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