Health Plan & Provider Report Index Summary

FALSE CLAIMS

– Hospitals, individual who does not receive benefits lacks standing to bring qui tam suit under Medicare Secondary Payer Act (6th Cir.), 270
– Nursing homes, no insurer duty to defend charges over submission of improper Medicare and Colo. Medicaid claims (10th Cir.), 708
– Part B, whistleblower's FCA claims proceed against carrier (S.D. Miss.), 213

FCA (FALSE CLAIMS ACT)

See generally FALSE CLAIMS

FEDERAL AGENCIES

See specific agencies and departments

FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP)

– Dependent coverage age limit, witnesses urge increase from 22 to 29, hearing, 492
– Hearing benefits and Medicare wraparound option for retirees, OPM seeks, 370
– Part D, millions wasted due to lack of benefits coordination, letter, 518

FEHBP

See FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP)

FLEXIBLE SPENDING ACCOUNTS (FSAs)

– Cards, industry standards, In Brief, 38
– Misleading documents provided, employer breached ERISA fiduciary duties (D.N.J.), 407

FLORIDA

– Chiropractic services, class certification denied in provider suit over PIP claims payment caps (S.D. Fla.), 23
– Clinical pathology services, damages award for practice upheld where BCBS HMO withheld payments from hospital-based practice (Fla. Dist. Ct.), 478
– Developmental disability care and autism, new coverage law, 580
– HMOs and insurers, member identification cards required, 676
– Hospitals, preventable readmission rates Web site, 730
– Long-term care insurance contracts, new law, 729
– Market trends, Aetna opens walk-in office to give insurance information informally, 299
– Medicaid

– – Fraud, WellCare Tampa office replaces CEOs, 150
– – Funding decisions, new implementation law, 676
– – Mental health providers, reform pilot problematic, report, 607
– – Notice, demonstration project patients not informed they could change plans for cause (S.D. Fla.), 127

– Money laundering, medical clinic operators arrested for submitting bogus claims to private insurers (S.D. Fla.), 737
– Provider contracts, new law, 729
– Uninsured persons, coverage reform bill passed, 524; new law, 578

FOR-PROFIT CONVERSIONS

– Group Health/Health Ins. Plan merger, NYC officials urge state to reject plan, 524

FORMULARIES

– Medicare drug coverage

– – Beneficiary costs up since 2006, Kaiser reports, 396
– – Home infusion group Part D drug recommendations, 467
– – Part D reference file, unapproved drugs dropped, 546

– Model guidelines, agreement to update every 3 years, 605
– Submissions format, PBM impact described, report, 449

FRAUD AND ABUSE

– BCBS probes, recoveries exceeded $250 million as identity theft increases, study, 702
– Breast cancer, Los Angeles City Attorney sues Health Net for illegally terminating coverage (Cal. Super. Ct.), 245
– Consortium to Combat Medical Fraud, insurers working with law enforcement officials, 732
– Dependents, plan can recover medical expenses paid for woman who was not participant's legal spouse (W.D. Wash.), 130
– DME, BCBS billing trial postponement denial deprived supplier of right to counsel (Ala.), 452
– Fla. Medicaid probe, WellCare Tampa office replaces CEOs, 150
– Hospitals, ERISA preempts claims based on benefits assignment (N.D. Ind.), 99
– Ill. Consumer Fraud Act, hospital did not violate by charging uninsured patients higher rates (Ill. App. Ct.), 480
– Impermissible factors considered in physician sentencing, overturned (6th Cir.), 431
– Interagency probe involving scheme to defraud federal programs and private insurers, 6 arrests (Cal. Super. Ct.), 429
– MA private plan sales, hearing, 167
– Maternity health insurance, state attorney general sues firm over bogus policy sales (Tex. Dist. Ct.), 505
– Money laundering, medical clinic operators arrested for submitting bogus claims to private insurers (S.D. Fla.), 737
– Neurologist, fine and 5-year probation term for submitting fraudulent claims to private insurers (N.J. Super. Ct.), 682
– Nursing homes, no insurer duty to defend charges over submission of improper Medicare and Colo. Medicaid claims (10th Cir.), 708
– Part B, whistleblower's claims proceed against carrier (S.D. Miss.), 213
– PBM

– – Express Scripts, states' charges over switching patients to more expensive brand-name drugs settled, 607
– – Medco, former worker sentenced to prison for attempted destruction of network data system (D.N.J.), 69

– Prescription drugs

– – Conspiracy, 2-year sentence for pharmacy employee who filed $18 million in false private insurance claims (S.D. Fla.), 557
– – Overcharges, 11 drug firms pay millions to settle multidistrict class action (D. Mass.), 303
– – Physicians urged to change patients' brand-name drugs, CVS Caremark settles state probes, 211
– – Vytorin cholesterol drug prices, multiple suits filed over Zetia-Zocor combination product payments by federal government and private insurers (M.D. Fla.), 183

– Provider reimbursement, RICO class action conspiracy claims against 20 BCBS plans dismissed (S.D. Fla.), 658
– Reconstructive plastic surgeon, ERISA preempts state reimbursement claims for BCBS participant's child (D. Conn.), 534
– TennCare, senate bill increasing penalties passed, In Brief, 500; new law, 728
– Unapproved policies, La. firm to halt sales to Mass. residents, 10

FSAs

See FLEXIBLE SPENDING ACCOUNTS (FSAs)