An explosive report prepared by a SynerMed executive alleges the California firm, which oversaw care for 1.2 million patients, fabricated documents and violated state and federal regulations for years. The state says it left low-income patients on Medicaid managed care in “imminent danger.”
“‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for,” a staffer wrote after destroying the documents. Sutter, a huge Northern California Health system with 24 hospitals, said it destroyed them by mistake.
The Department of Managed Health Care cited one example in which consumers and advocates had to call the insurer 22 times to contest a decision. Still, the complaint still was not resolved until the department became involved.
State regulators and insurers are looking into SynerMed, which medical groups depend upon to handle their finances and business operations. The groups, serving 1 million patients, fear a messy fallout.
Medicaid is rarely associated with getting rich. But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds their patient care is subpar.
UnitedHealth, a health industry goliath, has its hand in doctors’ offices, surgery centers, technology services and prescription drugs. It is the industry model, and CVS and Aetna, says one expert, are ‘wannabes.’
After regulators questioned Anthem’s forecast for medical costs, the company agreed to reduce rate hikes on its individual and small-business health plans next year, saving customers an estimated $114 million.
Covered California authorized a 12.4 percent average surcharge on silver-tier plans, the second-least expensive option sold on the exchange. It brings the total average premium increase on those plans to nearly 25 percent next year.
Agency says a removable cap will lower the risk of antibiotic resistant infections but some experts see it as a modest step in curbing the sort of deadly outbreaks that occurred a few years ago.
The company’s drug spending prediction, far above other insurers in the individual market, has experts scratching their heads. Anthem cites market volatility.
Fed up with high hospital costs and limited competition, Santa Barbara County sends willing employees out of town for better bargains. Local governments are slowly joining private employers in aggressively seeking out the best care for the lowest price.
Little-known rules require all health insurance companies to help pay claims when any one of them fails. Penn Treaty failed big — and insurers around the country are likely to pass those costs onto policyholders.
The nation’s second-largest insurer is shrinking its presence on Obamacare exchanges and in the broader individual market in response to prevailing uncertainty. California is just the latest — and the biggest — example.
In the first case of its kind in the U.S., the company was ordered to pay damages to the hospital where a patient died of an infection linked to a contaminated scope. But jurors also found the hospital negligent, and it was ordered to pay the patients’ family $1 million.
The failure this week of the U.S. Senate’s ACA repeal effort was one more twist in the ongoing political drama that has complicated routine rate setting for insurers and state officials.
The Seattle case, the first to reach trial in the U.S., offers possible glimpse into fate of some two dozen lawsuits against manufacturing giant Olympus, accused of failing to address scope contamination linked to numerous deaths. The company faults poor hospital cleaning practices.
The legislation would revive the age-old practice of paying providers for every service they perform — a recipe for a busted budget, some experts say. Backers say the bill is a work in progress.
“It’s unconscionable that such a basic, security 101 flaw could still exist at a major health care provider,” says one cybersecurity expert.
The health care industry thrives on ordering up tests and treatments, but some hospitals are urging restraint.
A state Senate panel considering the measure said money for existing public programs could cover half the cost. But the rest might have to come from new taxes — a serious political obstacle.