Tenet Healthcare Corp. (THC), the third-biggest publicly traded U.S. hospital chain, and Health Management Associates Inc. (HMA) were accused in a lawsuit of paying kickbacks to a Georgia clinic in exchange for referrals. The two hospital chains were sued under the Federal False Claims Act in a whistle-blower lawsuit brought by Ralph Williams, a former chief financial officer of Health Management Associates, on behalf of the U.S. and Georgia. The lawsuit, filed in federal court in Athens, Georgia, was ordered unsealed yesterday. The clinic recruited pregnant, undocumented Hispanic women who would be eligible for Medicaid benefits when they gave birth and referred them to Health Management and Tenet hospitals in exchange for kickbacks, according to the complaint.
In late June news organizations reported on a practical application in the United States of "reference pricing" for hospital care. The concept has been well known for decades to health policy wonks and already applied to prescription drugs in many other countries, but it is still novel in the United States. In the arsenal now being assembled on the payment side of health care to address rising costs, reference pricing may well turn out to be the sleeper, because it is a potentially powerful method of "putting the patient's skin in the game," the delicate phrase we use for "cost-sharing by patients."
Some give all the credit to Obamacare. Others cite the poor economy or employers forcing workers to bear more of the cost of their medical expenses. Whatever the reason, health-cost increases stayed tame through the first half of the year, insurers say. Thursday's report from Cigna was the last dispatch on second-quarter financial results from major medical carriers. Cigna's results were similar to those of its rivals: higher-than-expected profits thanks largely to moderate increases in medical prices and the number of medical procedures.
AUGUSTA, Maine — The state's insurance bureau met a deadline Wednesday to report on how much some Maine consumers and businesses will pay for health coverage under the Affordable Care Act, often called Obamacare, but the impact of the new federal health law remains unclear. The bureau released hundreds of pages of documents filed by two insurance carriers that plan to offer policies on Maine's health insurance exchange, an online marketplace where consumers and small businesses will be able to shop this fall under the Affordable Care Act. Wednesday was the deadline for regulators in Maine and other states to approve insurance rates for the exchanges and report to the federal government.
Florida insurance regulators unveiled for the first time Wednesday the prices proposed by private insurers for individual health plans to be sold on the state's federally-run exchange, which is scheduled to launch Oct. 1. But the proposed health plans and prices — and the state's analysis that federal healthcare reform would cause premiums to rise — were hardly definitive of the actual costs that Floridians are likely to pay for health insurance next year. That's because the U.S. Department of Health and Human Services has yet to approve the proposed health plans for Florida's exchange, and those plans, including the prices, may change as they have in other states.
West Penn Allegheny Health System posted a $47.9 million operating loss for the fourth quarter ending June 30, a new state filing shows. In May, West Penn Allegheny reported an operating loss of $99 million through the first nine months of the fiscal year, so this past year's losses likely will approach $150 million when those results are released this fall. West Penn Allegheny's net losses for the quarter, budgeted to be $19.2 million, amounted to $41.2 million. It did report that it has 74.2 days cash on hand as of June 30, compared with 62.2 days a year ago.