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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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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