Department of Managed Health Care's $5 Million Enforcement Action Against Blue Cross of California

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Dear Substance Use Treatment Provider and Other Companies in the Industry:

The following article is a cautionary tale about being organized in how an industry deals with insurers. While Anthem was fined for not addressing client grievances in a timely manner by the Department of Managed Health Care, the lesson is what drove DMHC to act was the fact that subscribers and providers filed grievances. As you know, ATAC has asked your organization to file grievances, now you can see the result of those organizations within our industry that did, as well as of those other providers in other parts of healthcare that were experiencing the same problems. Did you file a complaint with DMHC in 2016 when ATAC requested you to complain?

While ATAC applauds the actions of the Department of Managed Health Care, shouldn't the fact that 70% of denials are eventually overturned be considered an unfair payment pattern as defined by the Health and Safety Code 1371.37? Aren't the denials simply a payment delay tactic?

ATAC will be pursuing further action by the Department of Health Care to ensure that Anthem is held fully accountable for all violations of the Health and Safety Code with respect to their actions. 

Please read the entire article:

https://www.washingtonpost.com/national/health-science/california-fines-anthem-5-million-for-failing-to-address-consumer-grievances/2017/11/15/7744cd34-ca52-11e7-b506-8a10ed11ecf5_story.html?utm_term=.e5051a6eda05 

For those who want to know all the details, here is the actual case:

http://wpso.dmhc.ca.gov/enfactions/docs/2990/1510765385688.pdf

 

What do you have to complain about today? Underpayments, lack of timely response to contested claims, or ever-changing coding requirements? You must complain to call attention to issues!

 

Strength in Numbers,
ATAC Board of Directors
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How Big Pharma Keeps Drug Prices High

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Find out more about the lobbying, games and manipulation the drug industry uses to keep the cost of your prescription drugs rising — and what you can do about it.

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ATAC Letter to New York Attorney General Ed Schneiderman

 

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ATAC's President and Vice President has written a letter to inform New York Attorney General Schneiderman about the Centene & Health Net acquisition and how it has impacted California's substance use treatment community.
Click the button below to read it in detail.

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Google Sets Limits on Addiction Treatment Ads, Citing Safety

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Via NY Times -- By MICHAEL CORKERY

As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.

But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.

This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.

Google has taken similar steps to restrict advertisements only a few times before. Last year it limited ads for payday lenders, and in the past it created a verification system for locksmiths to prevent fraud.

In this case, the restrictions will limit a popular marketing tool in the $35 billion addiction treatment business, affecting thousands of small-time operators.

 

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Insight Treatment Center Struggles with Health Net’s Failure to Pay

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For 25 years Insight Treatment Center’s highly regarded drug and alcohol program for teenagers has kept thousands of kids off the streets, out of the legal system, and back to their families to lead healthy and productive lives. Now this valuable program is threatened by health insurance company Health Net’s refusal to pay legitimate insurance claims.

Insight’s doors are on the verge of closing due to Health Net’s failure to pay claims for almost two years.

In 2008, a New Jersey Federal Judge found Health Net guilty of obstruction of justice for using “scorched earth” litigation tactics to avoid admitting they had been underpaying out-of-network providers by using a database purposely skewed in favor of insurance companies. In 2009, the judge accepted Health Net’s offer to settle the case for a record $250 million. Also in 2008, a California judge ordered Health Net to stop the controversial practice of canceling sick policyholders and to pay more than $9 million to a breast cancer patient dropped in the middle of chemotherapy.

The New Jersey Federal Judge believed she had changed the way Health Net would do business but by 2015 Health Net was at it again. The Addiction Treatment Advocacy Coalition (ATAC) believes Health Net’s failure to pay legitimate bills of hundreds of addiction treatment providers since August 2015 is directly related to Health Net’s successful efforts to merge with the Centene Corporation, ranked number 66 on the Fortune 500. If you agree, contact Insurance Commissioner Dave Jones and Attorney General Xavier Becerra. Health Net needs to pay the claims of Insight and other legitimate facilities without further delay.C\

Click here to see the youtube video about the devastation Health Net's dragnet audit has wreaked on Insight Recovery Center, one of California's premiere addiction treatment facilities for teenagers. 

 

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Riverside County rehab center owner going to jail for insurance fraud

By CITY NEWS SERVICE | via The Press-Enterprise

The owner of a southwest Riverside County drug and alcohol rehabilitation center, who filed fraudulent medical insurance claims that netted her more than $231,000 in ill-gotten gains, pleaded guilty Wednesday, July 5 to insurance fraud and was immediately sentenced to about nine months in county jail.

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Senate GOP Bill Rolling Back Obamacare Would Leave Millions More Uninsured

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Noam N. Levey--Contact Reporter:

"The healthcare bill Senate Republican leaders unveiled last week would increase the number of people in the U.S. without health coverage by 22 million and push up medical costs for millions of other poor and sick Americans, according to a new analysis by the nonpartisan Congressional Budget Office.

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Megyn Kelly - The Florida Shuffle

Watch Megyn Kelly's piece on Florida's SUD treatment system, "The Florida Shuffle".

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Mapping Drug Use in the U.S. Workforce- By Quest Diagnostics

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ATAC wants to bring you Quest's new interactive map illustrates workplace urine drug test positivity by drug type for the past 10 years. Powered by data from the Quest Diagnostics Drug Testing Index™ (DTI), you can search all 50 states for the six of the most common illicit substances: Heroin, amphetamines, cocaine, marijuana, opiates, and phencyclidine (PCP.)

This innovative tool drills down to positivity percentages by 3-digit zip code and helps to depict regional, drug, and time-based positivity rate changes.

by NICOLE JUPE on JUNE 9, 2017

 

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Federal agents searching Sovereign Health rehab in San Clemente

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By  and  | Orange County Register

The FBI, along with state and local officials, executed a sealed search warrant at several Sovereign Health locations on Tuesday, including the company’s offices in San Clemente.

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