In a case with possible national repercussions, the state’s attorney general has sued over alleged price gouging, and other legal and legislative challenges are afoot. Sutter is pushing back hard, denying anticompetitive behavior.
The ‘scary’ findings show a discouraging lack of progress in cleaning the devices, despite more vigorous efforts in the wake of deadly superbug outbreaks, experts say.
The lawsuit is a bold move against Northern California’s dominant hospital chain, whose prices have drawn complaints for years. It has disputed such allegations in the past.
The legislation is intended to curb schemes in which some treatment providers sign patients up for private plans, pay their premiums and then rake in profits from inflated claims.
California health officials do not dispute most of the findings, saying they have already made improvements in determining eligibility.
Norma Díaz y su esposo, Joseph García, han dedicado sus carreras a administrar una aseguradora de salud sin fines de lucro que cubre a residentes carenciados de California. Y en el proceso, han ganado millones de dólares.
How a California health plan’s CEO and her husband, an executive consultant, got rich off the taxpayer-funded program for the poor. Critics see a conflict of interest, the plan doesn’t, and the state has no rules either way.
The Seattle jurist finds that Olympus Corp. failed to properly disclose evidence that it knew of concerns about cleaning problems with its redesigned medical scopes years before they hit the market and were linked to dozens of deaths. The company maintains the devices were not defective and intends to appeal.
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.
De acuerdo con un juez estatal, Sutter Health, el gigante del sistema de salud que gerencia 24 hospitales en California, abusó de su poder para inflar precios y destruir documentación crítica de sus empleados.
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.