Two Medicare Advantage Insurers Settle Whistleblower Lawsuit For $32 Million

KHN, 30 May 2017
Author: Fred Schulte
“Two Florida Medicare Advantage insurers have agreed to pay nearly $32 million to settle a whistleblower lawsuit that alleged they exaggerated how sick patients were and took other steps to overbill the government health plan for the elderly.”
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Trump Seeks Delay of Ruling on Health Law Subsidies, Prolonging Uncertainty

NYT, 22 May 2017
Author: Robert Pear
“The Trump administration asked a federal appeals court on Monday to delay ruling on a lawsuit that could determine whether the government will continue paying subsidies under the Affordable Care Act to health insurance companies for the benefit of low-income people — effectively prolonging uncertainty that is already rattling the health law.”
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Gorsuch On Sidelines As Supreme Court Decides Insurance, Legal Sanctions Cases

Forbes, 18 April 2017
Author: Daniel Fisher
“The U.S. Supreme Court issued a pair of decisions today affecting legal sanctions and the power of states to control insurance contracts, noting in each one the non-participation of the court’s newest Justice, Neil Gorsuch.”
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(re Dargan) Amaca Pty Limited v Northern Sydney Area Health Service & Ors [2017] NSWDDT 1

Decision date: 16 March 2017
“Dust Diseases – cross claim – mesothelioma – statutory compensation paid to plaintiff by WorkCover Queensland – agreement between WorkCover Queensland and plaintiff that in proceedings against Amaca Pty Limited, plaintiff may retain 20% of proceeds if proceeds less than compensation received – proceedings by plaintiff against Amaca Pty Limited – plaintiff’s proceedings settled for less than compensation received – whether the agreement resulted in plaintiff receiving double compensation – if so, whether Amaca Pty Limited and cross defendants were not “liable in respect of (the) damage” suffered by the plaintiff within the meaning of s 5 Law Reform (Miscellaneous Provisions) Act 1946 (NSW) such that Amaca Pty Limited could not claim contribution from the cross defendants.”
Find decision here.

What Can US Policymakers Learn About Essential Health Benefits From Israel?

Health Affairs Blog, 23 March 2017
Authors: Rachel Nisanhotz, David Chinitz, Sara Rosenbaum
“US policymakers confronting these complex questions could benefit from a close look at how other health systems approach them. In particular, it may surprise readers to know that Israel has a system very much in line with many US policymakers’ goals of fostering a competitive private insurance market. The Israeli system rests on the concept of competing private health plans selling care in a market of empowered consumers. But one crucial difference is how Israel approaches the question of what it means to be covered.”
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Prisoners are excluded from the NDIS – here’s why it matters

The Conversation, 14 March 2017
Author: Jesse Young, Stuart Kinner
“The National Disability Insurance Scheme (NDIS) is designed to provide access to personalised supports and services for all Australians with a disability. However, the NDIS specifically excludes prisoners.”
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The Loopholes in the Law Prohibiting Genetic Discrimination

The Atlantic, 14 March 2017
Author: Sarah Zhang
“When the Genetic Information Nondiscrimination Act passed in 2008, supporters hailed it as the “first major civil-rights bill of the century.” GINA was unusually forward-looking; it protected against a form of discrimination that was not yet common. Under the law, employers and health insurance companies could not request genetic test results and discriminate based upon them.”
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How Will People Who Are Already Sick Be Treated Under A New Health Law?

NPR, 13 March 2017
Author: Julie Rovner
“The Affordable Care Act (ACA) made it illegal for insurers to deny or charge people more money because of a history of illness. That’s a pretty big deal because an estimated 52 million American adults have such conditions – ranging from serious ailments like diabetes and HIV to more minor maladies like acne or seasonal allergies. Before the ACA, people with these conditions were often denied insurance. If they were offered insurance, it could cost more or didn’t include coverage of their condition.”
Find article here.