Health Plan & Provider Report Index Summary

FALSE CLAIMS

– Qui tam suits

FEDERAL AGENCIES

See specific agencies and departments

FEDERAL EMPLOYEES HEALTH BENEFITS ACT (FEHBA)

– Preemption of state law claims against FEHBP insurer and removal of case to federal court under federal officer removal statute (U.S., rev grant), 2005

FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP)

– Dental and vision benefits, OPM proposes amended rules, 671
– FEHBA preemption of state law claims against insurer and removal of case to federal court under federal officer removal statute (U.S., rev grant), 2005
– Premium costs for enrollees to rise in 2010, OPM says, 1154
– Prescription drug benefits, lack of transparency cited, hearing, 796
– Specialty drugs, enrollees pay $55 monthly for medications without generic alternatives, GAO report, 670

FEDERAL PREEMPTION

See PREEMPTION

FEHBA (FEDERAL EMPLOYEES HEALTH BENEFITS ACT)

– Preemption of state law claims against FEHBP insurer and removal of case to federal court under federal officer removal statute (U.S., rev grant), 2005

FEHBP

See FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP)

FIDUCIARY DUTY

– ERISA

See ERISA

FIRST AMENDMENT

– Prescription data mining, First Circuit ruling upholding N.H. law banning sale of physicians' information upheld (U.S., rev sought), 412; (rev den), 800

FLORIDA

– Electronic health records

– – Medicaid pilot provides patient access, 437
– – Patient release form development, new law, 776

– Health facilities authorities, new law expands definitions, 776
– Health plan quality website updated, In Brief, 682
– HMOs

– – Identification cards, insurers also required under new law, 44
– – Profits up in 2007 but sustained growth questionable, report, 316

– Hospice care, website data comparison tool, In Brief, 505
– Hospitals

– – Profits up in 2007 but sustained growth questionable, report, 316
– – Quality of care website updated, In Brief, 682

– Medicaid

– – Electronic health records, pilot provides patient access, 437
– – Fraud, WellCare pays $80 million and enters deferred prosecution agreement over Healthy Kids claims inflation, 519
– – Most enrollees satisfied, survey, 385

– Medicare Advantage and Medicare billing, 8 Miami defendants charged in fraud scheme (S.D. Fla.), 775
– Medigap, new coverage law for ESRD, 711
– Out-of-network care, new direct payments law, 711
– PPOs, BCBS and Miami-Dade County launch new product for uninsured, 654
– State university students, house passes bill requiring private insurance use, 503
– Supervising physician, new law, 776
– Unauthorized health insurance, state regulators order 3 companies to stop sales, 1071

FORMULARIES

– Medicare Part D drug plan sponsors offerings will decrease in 2010, CMS official says, 2011

FRAUD AND ABUSE

See also MISREPRESENTATION
– BCBS

– – Clinical laboratories, Horizon BCBS sues over submission of improper claims (N.J. Super. Ct.), 830
– – Mental health, Horizon BCBS terminated benefits arbitrarily over claims for psychiatric services (D.N.J.), 950

– BNA audio conference

– – Feb. scheduled, In Brief, 127
– – Jan. set, In Brief, 8; experts Kusserow and Sheehan to participate, 40

– Cardiologist, multiple-count conviction for improper billing of private insurers and federal programs (W.D. La.), 71
– Chiropractic services, $1.2 million payment for restitution in back pain billing scheme (N.D. Ga.), 348
– Cosmetic surgery clinic, former owner pleads guilty to defrauding insurance companies (S.D.N.Y.), 1068
– Exhaustion of remedies, Medicare law preempts cancer patient's claims against Humana (S.D. Fla.), 288
– Fla. Medicaid, WellCare pays $80 million and enters deferred prosecution agreement over Healthy Kids claims inflation, 519
– Healthy patients recruited for unnecessary surgeries, guilty plea entered (Cal. Super. Ct.), 264
– Hitachi Am. health insurance plan, former manager pleads guilty to money laundering charges (S.D.N.Y.), 313
– Long-term and home health care plans, Minn. attorney general sues Home Health Am., 1193
– Low-cost plan, Minn. attorney general alleges sues Consumer Health Benefits Ass'n, 1193
– Medical transcription company billing, Kaiser Found. claim proceeds (D.N.J.), 461
– Medicare Advantage

– – Bogus treatments, 2 charged in 5-state billing scheme (S.D. Fla.), 590
– – Improper billing, 8 Miami defendants charged (S.D. Fla.), 775
– – Medicare Act, no preemption of claims by persons enrolled by private plan without their permission causing Medicare coverage loss (S.D. Miss.), 774

– N.Y. health insurance, state worker outpatient consultant services and facility fees overpayment recovery $9 million in 2008, report, 315
– Physicians, prison sentence upheld as court rejects ineffective assistance of counsel argument (C.D. Cal.), 217
– Qui tam suits

See QUI TAM SUITS

– RICO

– – No-fault insurance laws abuse alleged by auto insurer, motion to dismiss denied (E.D.N.Y.), 1127
– – Off-label promotions, no cause of action against drug maker (C.D. Cal.), 38
– – Provider suit over alleged insurer mailing of false explanations of benefits properly dismissed (8th Cir.), 290; (U.S., rev sought), 922; (rev den), 1189

– Risk pool for major medical insurance policy, alleged mishandling caused premiums to rise, N.J. claim allowed and Cal. claims dismissed (D.N.J.), 1100
– Staged automobile accidents, scam leader sentenced to 14 years in prison for private insurer billing fraud (S.D. Fla.), 894
– Tests and screening, certification denied in class action alleging improper Quest Diagnostics billing (D.N.J.), 186
– Unions, Cal. regulator shuts down bogus health plan, 829