Insurer Fines in California

One of California’s largest health insurance providers has distinguished itself, and not in a good way! The following article dives into penalties and enforcement actions of ten California insurance providers. 

 

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Patient Residency Weaponized

The federal government is actively pursuing cases of fraud with respect to ACA/Obamacare policies within the substance use treatment industry. This case is about residency. Where did the patient actually live when treatment was being provided? Some insurers have begun verifying residency of virtually every substance use treatment patient often resulting in denial of the claims based upon their inability to verify the patient resided in a state. 

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PA fines UHC $1M for violations of mental-health law

The Pennsylvania Insurance Department has fined United Healthcare for violations of the Mental Health Parity and Addiction Equity Act. If you have outstanding claims from 2015 forward you should develop a strategy to appeal those claims based upon this news.

United Healthcare fined $1 million by Pennsylvania for violations of mental-health law

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Major Blues insurer sued for denying BH claims

Per Harris Meyer at Modern Healthcare:

The company that runs Blue Cross and Blue Shield plans in five states is unlawfully denying behavioral health benefits to members in violation of generally accepted medical standards, according to a federal lawsuit seeking class action status.

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New substance use privacy rules could hurt, not help addiction patients

Patient advocates cautioned HHS against loosening patient privacy protections surrounding substance use disorder records, warning it could lead people to avoid treatment.

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10 conditions affecting millennials

Although millennials may seem to have a greater investment in health and wellness than generations before them, findings from the Blue Cross Blue Shield Association (BCBSA) suggest millennials will be substantially less healthy as they age.

Follow this link to read the top 10 conditions affecting millennials, ranked by adverse health impact:

https://www.healthline.com/health-news/top-10-health-conditions-affecting-millennials

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Dave Jones for Attorney General 6/5/2018 CA

Some thoughts from Joan and Josie before casting a vote or Attorney General this Tuesday...
Josie Herndon and I, Joan Borsten Vidov, took two important messages away from the "Dave Jones for Attorney General" fundraiser last Friday evening.  
1) Dave Jones has only 6 more months as Insurance Commissioner and there are still many facilities that have yet to be paid by Health Net; probably because their lawyers are waiting to see if the next Insurance Commissioner will be more supportive of Health Net
2) Having an Attorney General who understands the health insurance insurance industry would be a very good thing for the addiction treatment industry.
Our State, unlike let's say New York, is painfully under regulated because oversight is divided between the Department of Insurance (with an elected commissioner) and the Department of Managed Health Care (which reports to the Governor).  Additionally a third agency, the US Department of Labor's Los Angeles office, oversees California employer funded plans.  While Commissioner Jones was eager to explain his position on serious issues like access to addiction treatment for those exiting the criminal justice system, ATAC members were more focused on whether as Attorney General he could find a way to end the regulatory disfunction in California that is impacting all who pay premiums to health insurance carriers, out-of-network addiction treatment facilities and probably the in-network as well.   Jones was well aware of the problem, if not the solution.  He explained the creative ways he found to resolve some of the thorny problems that faced him even when he lacked the legal authority and that gave us some hope.   Thanks to Ken Seeley and Eric McLaughlin from Intervention 911 for sponsoring the event with West Hollywood City Council member John Heilman.  Other ATAC members in attendance were Alex Van Kovn from Alta Centers and Erin Burke from Hansei Billing and a member of the Underpayments Steering Committee.
Joan and Josie


Addiction Treatment Advocacy Coalition
http://atac.nationbuilder.com/

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FOLLOW UP: ATAC CAMPAIGN TO GET CALIFORNIA ADDICTION TREATMENT FACILITIES PAID BY HEALTH NET

ATAC waged a public relations campaign to demonstrate the damage Health Net has done to their insured and addiction treatment facilities in California. this included stories in Kaiser Health Newsletter, in a financial publication, and in the Los Angeles Times.
We also produced two videos demonstrating the impact on the insured and providers of Health Net's long term failure to pay for treatment.  We believe that Health net has settled with over 100 facilities and others are still in negotiation.  
The Insight video got 60,000 views. https://www.youtube.com/watch?v=v5cxwqfTqmg&t=73s
The Patti Mitchell story 100,000.  https://www.youtube.com/watch?v=AoKLX3BOqrw&t=643s
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LAFD Introduces Another New Innovated Pilot Program; The Sober Unit

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In the Los Angeles Fire Department's continuing efforts to meet the challenges of our increasing EMS call load and the increasing number of homeless individuals, our EMS Bureau is in the process of implementing a pilot program called the LAFD SOBER (Sobriety Emergency Response) Unit. This pilot project is anticipated to be staffed by a Firefighter, working alongside a Los Angeles Homeless Services Authority (LAHSA) outreach worker.

 

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Arizona Lawsuit Opens Window into Lucrative Drug Rehab Business and Allegations of Fraud

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Ken Alltucker, The Republic | azcentral.com

The only "Obamacare" health insurer in metro Phoenix and Pima County is ensnared in a legal dispute with several addiction treatment centers over the cost of care amid an Arizona opioid epidemic that is taking an average of two lives each day.

Nine alcohol and drug rehabilitation centers claim in a Maricopa County Superior Court lawsuit that the health insurance company Health Net of Arizona improperly withheld or delayed lucrative payments for treatment of people struggling with addiction.

But Health Net says in a counterclaim that there was widespread fraud among Arizona and California drug rehab centers in 2015 and 2016, when it alleges"teams of brokers" recruited out-of-state clients to fraudulently obtain insurance policies and to seek treatment in Arizona.

Those actions have cost the insurance company — and Arizona consumers through higher monthly premiums — tens of millions of dollars, the Health Net counterclaim says.

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