A new law passed in the recent Tennessee legislative session should help state officials cast a wider net in going after potential fraud against TennCare, including healthcare providers that charge for services that never took place. Under the law, TennCare would use proceedings before an administrative law judge to pursue cases that involve less than $10,000 of suspected fraud. That would allow the state's attorney general to focus on larger, more serious cases that have to go through the federal court system where the process is more time-consuming.
The Cleveland Clinic and University Hospitals won stable bond outlooks from a credit-rating agency in recent weeks, bucking a national trend in the nonprofit hospital industry. The rating reports provide the most recent indication of the financial strength of the hospitals : Both are reporting increases in operating profit margins for the first six months of the year.
LifePoint Hospitals' earnings fell 5% in the second quarter compared to the same period a year ago, and the stock is trading lower this morning after missing analysts' estimates. The Brentwood, TN-based community hospital owner reported net income of $26.3 million, or 49 cents per diluted share, in the quarter ended June 30, compared to $27.8 million, or 52 cents per diluted share, in the year-ago period.
Congressional Democrats said that they intended to push the Obama administration to back away from its deal with the drug industry to cap its share of the costs in a healthcare overhaul. A spokesman for Speaker Nancy Pelosi said she stood by her position that the House was not bound by any such agreement. Pelosi supports House efforts "to squeeze more money out of the system, including from the pharmaceutical industry," her spokesman, Nadeam Elshami, said in a statement.
Larry Schreiber has been named president of Anthem Blue Cross and Blue Shield in Wisconsin. He replaces Steve Martenet, who was appointed to lead specialty insurance product sales for Anthem's parent company. Schreiber, 46, will be responsible for the management of all sales, marketing, and underwriting functions for small and large group accounts in Wisconsin, and serve as the primary contact for state regulators. Schreiber will also oversee Anthem's social responsibility activities dedicated to promoting health and wellness throughout Wisconsin. He is currently vice president and general manager for UniCare, a health benefits company based in Chicago.
Karen S. Rohan, 46, became president of Magellan Health Services effective Aug. 1. She is responsible for the strategic direction and profit and loss of Magellan's existing business units and, with the close of the acquisition, the company's First Health Services business. Rohan has more than 18 years of experience in the healthcare industry and was most recently president of the Group Disability, Dental and Vision Care businesses of CIGNA Corp. Separately, Magellan has begun to implement its succession plan for the leadership of its ICORE subsidiary. Alan Lotvin, MD, 47, the division's president, will ultimately succeed Raju Mantena as CEO. Having fulfilled his obligations under the ICORE purchase agreement to manage the business for three years, Mantena, 41, announced he intends to leave full-time employment with Magellan when management feels comfortable that the leadership transition is complete.