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July 23, 2008

Guarding Against HIPAA Violations

Les Masterson, Senior Editor-Managed Care

Although technology is a tool health plans are using to help lower costs and improve quality, it can also pose serious security risks and potentially lead to HIPAA violations. [Read More]

Editor's Picks
California governor signs ban on rescission reward practice
Stories about health insurance rescissions have been all over the news this past week. On Tuesday, California Gov. Arnold Schwarzenegger signed legislation that bans health insurers from rewarding employees with bonuses for cancelling or limiting a patient's coverage. The bill was filed after Health Net reportedly paid bonuses to an employee partly on how many policies she cancelled. Check out the next two Editor's Picks for more articles about rescissions. [Read More]
Insurance cancellations of sick to be investigated
A U.S. congressional committee has health plan rescission practices in its crosshairs. Opponents have bashed health plans cancelling individual member policies, while health insurers say rescissions are needed to keep costs in check. America's Health Insurance Plans claims that insurers have cancelled the policies of only 0.2% of the 18 million Americans who buy health coverage directly from health plans. [Read More]
California fines two health plans $13 million
Over the past two months, five California health plans have reinstated health insurance coverage to more than 3,300 Californians after the state's Department of Managed Care investigated the companies' rescissions. Most recently, two of California's largest health plans (Anthem Blue Cross and Blue Shield) agreed to pay a total of $13 million in fines and will offer health coverage to more than 2,200 former members whose coverage were dropped. Earlier this year, Kaiser Permanente, Health Net, and PacifiCare made similar arrangements (and paid lower fines than Anthem Blue Cross and Blue Shield). [Read More]
Study defends Florida Medicaid pilot
A new report suggests that Florida's Medicaid managed care pilot program should be expanded statewide and that previous studies that criticized the program were flawed. The pilot, currently being run in Broward, Duval, Baker, Clay, and Nassau counties, requires all Medicaid beneficiaries who aren't in institutions to enroll in an HMO or other managed care network. The new report says the Medicaid program has reduced costs by 7.2%, increased access to specialists, retained primary care doctors, and reduced patients' out-of-pocket costs. [Read More]
Health insurance industry launches reform drive
In preparation for a new president taking office in January, America's Health Insurance Plans kicked off a nationwide drive to promote its healthcare reform ideas. The health insurers' major trade group is planning events and TV ads as part of its "Campaign for an American Solution." The organization is asking that any healthcare reforms get built onto the current system. [Read More]
Managed Care Headlines
UnitedHealth profit drops but tops estimates
AP/Yahoo News, July 23, 2008
How changes in Medicare affect patients
Wall Street Journal (subscription required), July 17, 2008
At Pennsylvania hearings on Blues, views of new system
Philadelphia Inquirer, July 21, 2008
Health plan from Obama spurs debate
New York Times, July 23, 2008
MN-based Fairview Health Services could leave Blue Cross
Chicago Tribune, July 22, 2008
Amerigroup near settling Medicaid fraud damages
San Francisco Chronicle, July 11, 2008
LA city attorney sues insurer over policy cancellations
Los Angeles Times, July 17, 2008
Blue Cross of Michigan insurance rate increase approved
AP/Chicago Tribune, July 21, 2008

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Listen Up
Healthy Anxiety
Author Robert Rosen explains how leaders can turn anxiety into productivity. [Listen Here]
Consumer Corner
Tech tools drive CDHP enrollment
There's no substitute for the personal touch, no matter how good your technology is or how sophisticated your workers are. Just ask the people at A.D.A.M., an Atlanta-based provider of health information and benefits technology. [Read More]
From HealthLeaders Media
CMS: We Pay Dead People
As much as $90 million was paid to fraudulent billers who used dead doctors' ID numbers between 2000 and 2007, adding to the nearly $400 billion CMS pays to hospitals, doctors, and other healthcare providers each year. [Read More]
From HealthLeaders Magazine
The Politics of Healthcare
Both parties' presidential hopefuls have offered plenty of sweeping proposals for fixing the nation's healthcare ills. But will either candidate be able to follow through? [Read More]
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