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Self-insured health plans nationwide should look to recover $30 to $45 billion in Plan Asset refunds from the past 10 years of successful plan assets TPA/ASO anti-fraud recoupments and managed care savings in both the public and private sector As we have written before, ERISA as well as other federal and state regulations have continued more »
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Originally Published by By ROI-NJ, By Anjalee Khemlani; Trenton | Jul 1, 2019 at 10:00 am : http://www.roi-nj.com/2019/07/01/healthcare/third-party-auditor-bill-signed-into-law-despite-insurers-opposition/ Third-party auditor bill signed into law A bill that some insurers lobbied quietly to quash made its way through the Legislature and was signed by Gov. Phil Murphy on Sunday. The bill calls for a third-party auditor more »
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Originally Published by By ROI-NJ, Anjalee Khemlani Trenton | Apr 30, 2018 at 6:55 am : https://www.roi-nj.com/2018/04/30/healthcare/sarlo-in-letter-to-muoio-asks-n-j-to-look-into-details-of-health-insurance-contracts/ Budget and appropriations chair has questions about reimbursements, audits. State Sen. Paul Sarlo has asked Treasurer Elizabeth Muoio about the state heath plans’ third-party administrators. Reining In health care costs continues to be a challenge for many corporations more »
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California’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care. Original story Story by Wayne Drash, on CNN California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript more »
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OFFICE OF INSPECTOR GENERAL- U.S. Dept. of Health and Human Services FY 2017-Work-Plan -The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan for fiscal year (FY) 2017 summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal more »
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EBSA Offers Guidance For Denied Health Care Benefit Claims After OIG Reports EBSA Did Not Have the Ability to Protect the Estimated 79 Million Plan Participants in Self-Insured Health Plans from Improper Denials of Health Claims On November 18, 2016 the Labor Department’s Office of the Inspector General (OIG) Office released an audit conducted in more »
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Get A Copy Of The Full Health Plan– The complete Plan usually will not be a SBC, SPD (benefit summary) or a print-out from a website. It will be, on average, at least 25-50 pages long. The insurance company or claims administrator will likely not have a copy of the full Health Plan. You can more »
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By Mary Agnes Carey and Jenny Gold KHN Staff Writers Nov 08, 2012 Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track. Some analysts argue that there could be modifications to reduce federal spending as part of a broader deficit deal; for now, this more »
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Self-insured health plans should seek to recover significant share from the billions of dollars in successful TPA’s anti-fraud recoveries according to recent federal court orders and public records from health insurance industry anti-fraud strategies. Despite the fact the U.S. Healthcare Insurance industry is moving to re-classify premium dollars spent on anti-fraud expenses as medical care under PPACA more »
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A recent case may help out of network providers, which have complete valid ERISA assignments regarding appeal and reimbursement rights, receive checks directly from insurers. For the first time federal courts have rendered the clearest answers to date: managed care network participation is immaterial, ERISA assignment is the critical controlling factor to health-care benefits reimbursement. more »
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