The Daily Scan

September 4, 2018

Last Updated: 9:00 AM EST

 

Affordable Care Act

  • According to NPR, consumers who buy insurance through the Affordable Care Act markets may be pleasantly surprised this fall as average premiums are forecast to rise much less than in recent years. The price of a 2019 policy sold on the ACA exchanges will increase less than 4% according to an analysis of preliminary filings from insurers in all 50 states by ACASignups.net, a web site and blog run by analyst Charles Gaba that tracks ACA enrollment and insurer participation. (NPR.org)

Medicaid

  • A Medicaid company that terminated its Iowa contract almost a year ago has yet to pay as much as $14.6 million for medical care provided to disabled, poor and elderly Iowans, a Des Moines Register investigation shows. AmeriHealth Caritas’ outstanding bills include nearly 6,000 individual charges totaling more than $1 million at the University of Iowa Hospitals and Clinics and $541,000 at Broadlawns Medical Center, public records obtained by the Register show. Several private and nonprofit medical groups told the Register they have tens of thousands of dollars in outstanding bills that they say are hamstringing their operations and efforts to provide medical care. (DesMoinesRegister.com)

Litigation

  • On Thursday, the Southern District of New York announced  the unsealing of an indictment charging James Spina, Jeffrey Spina, Andrea Grossman, and Kimberly Spina with participating in a widespread health care fraud scheme through their fraudulent operation of Dolson Avenue Medical, a multi-disciplinary medical clinic located in Middletown, New York. The defendants were all arrested and presented in federal district court in White Plains. U.S. Attorney Geoffrey S. Berman commented: “As alleged, these four defendants purported to run a legitimate medical clinic that provides care and rehabilitation to patients. Instead, the defendants allegedly put aside their medical and fiduciary obligations for greed, attempting to bilk insurance companies and federally-funded Medicare out of more than $80 million. Thanks to the coordinated efforts of federal and state investigative agencies, the defendants will have to answer for their alleged crimes.” (Justice.gov)

Government Benefits

  • Politico reported this weekend that immigrants are turning down government help to buy infant formula and healthy food for their young children because they’re afraid the Trump administration could bar them from getting a green card if they take federal aid: “Local health providers say they’ve received panicked phone calls from both documented and undocumented immigrant families demanding to be dropped from the rolls of WIC, a federal nutrition program aimed at pregnant women and children, after news reports that the White House is potentially planning to deny legal status to immigrants who’ve used public benefits. Agencies in at least 18 states say they’ve seen drops of up to 20% in enrollment, and they attribute the change largely to fears about the immigration policy. The Trump administration hasn’t officially put the policy in place yet, but even without a formal rule, families are already being scared away from using services, health providers say. Health advocates say the policy change could put more babies who are U.S.-born citizens at risk of low birth weight and other problems — undermining public health while also potentially fueling higher health care costs at taxpayer expense.” (Politico.com)

 

 

 

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