health care Archives - The Insurance & Reinsurance Report

August 28, 2014 Life, Health, Disability & ERISA

Health Care Providers Ordered to Pay Insurer $8.4M for Billing Fraud

Three health care providers were forced to pay a judgment for defrauding an insurance company of millions of dollars. A Texas Federal Judge found that the defendant health care providers were wrongfully posing as emergency rooms in order to bill the insurance company at higher rates, in violation of Texas law.

The judge stated that a hospital sold the right to use its license-derived billing codes to various clinics in exchange for 15 percent of each of the clinics’ bills. The clinics then used these …

November 22, 2013 Emerging Issues

President Obama’s ACA Extension – NAIC Response

With the January 2014 effective date under the Affordable Care Act’s (ACA) essential benefits and guaranteed coverage provisions quickly approaching, several million people have received a cancellation notice. Facing wild criticism, President Obama responded with a regulatory fix that will allow Americans to keep ACA non-compliant insurance policies, albeit temporarily.

The extension gives American consumers the option to renew their current non-conforming plans for one year. This extension mostly affects those plans not grandfathered in under the ACA, including those newer policies that were purchased …