Medicare pays San Diego doctors $12.33 less for a 15-minute office visit than it pays their peers in San Francisco. A broken arm set in Orange County brings a doctor $47.99 more, despite the work being exactly the same. This disparity, caused by Medicare designating San Diego County a “rural” locality, has long been a thorn to the region’s 7,000 or so doctors.But not for much longer. As of next year, Medicare payments to San Diego health providers will rise between 6 percent and 9 percent.
Calling the former Bergen County physician a "Robin Hood," a federal judge Monday sentenced Albert Ades to three years in jail for systematically billing public and private insurers for medical care he did not give. U.S. District Judge Esther Salas rejected a defense request to sentence Ades, 61, to home confinement, even while acknowledging the outpouring of support Ades received — including a courtroom packed with supporters — and the free care he had given over a decades-long career. Ades, she said, apparently decided to make up the losses on his free care by creating phony bills and seeking reimbursement from big insurance companies and the government.
Doctors at the University Hospitals of Cleveland see an immediately recognizable symbol pop up alongside certain drugs when they sign in online these days to prescribe medications for patients: $$$$$. The dollar signs, affixed by hospital administrators, carry a not-so-subtle message: Think twice before using this drug. Pick an alternative if possible. The Zagat-like approach is just one of the strategies hospitals nationwide are using to try to counter drug costs. It was inspired in part by Shawn Osborne, the University Hospitals system’s vice president of pharmacy services, who saw unexpected price hikes wreak havoc on his budget last year.
Last summer, just shy of its 65th birthday, East Texas Medical Center filed a lawsuit in state district court in Smith County alleging that Aetna Health, Cigna Healthcare and, especially, Blue Cross and Blue Shield of Texas have plunged the hospital into financial jeopardy by repeatedly shutting it out of the most common and popular group health insurance networks. Hospital executives say it makes no sense and feels oddly personal.The 502-bed main hospital in Tyler, which serves as the mother ship in a system of rural hospitals and clinics, is the only full-service, nonprofit hospital in all of Texas that has been involuntarily shut out of statewide preferred provider networks, the hospital contends. The exclusion carries a big toll to the entire region, its executives say.
The Affordable Care Act's health insurance co-ops absorbed deep financial losses last year, and 2016 is shaping up to be a make-or-break year for these nonprofit alternatives to traditional insurers. But it's too late for the Knoxville-based Community Health Alliance, which shut down at the end of 2015 after state officials said its "financial success could not be guaranteed." "Ultimately, the risk of CHA's potential failure in 2016 was too great and would have caused substantial detrimental effects on the market as a whole if it were to collapse," TDCI Commissioner Julie Mix McPeak said in October when announcing the co-op would "wind down."
Rejecting critics and community concern, voting members of Seattle’s Group Health Cooperative have overwhelmingly agreed to join with the California health-care giant Kaiser Permanente. Voting 8,824 to 1,586 in mailed-in ballots, the members approved the move that essentially dissolves the iconic, home-grown cooperative, founded nearly 70 years ago with the mission of providing integrated health care and health coverage to Northwest residents. The results of the vote were announced Saturday at a meeting at Seattle’s Smith Cove Cruise Terminal that was attended by about 300 co-op members out of an expected 1,000.