WASHINGTON report
The health care
services division
of Louisiana
State University,
which operates
seven hospitals,
has notified
more than 400
individuals in 12
states follow-
ing the arrest
of an employee
charged with
using patient
information to
make counterfeit
checks, accord-
ing to local me-
dia reports.Capi-
tol News Bureau
in Baton Rouge
reports that a
former billing
employee printed
imaged checks
from a hospital
financial systems
database and
used information
such as patient
names, account
numbers, driver’s
license numbers
or Social Security
numbers to make
counterfeit
checks and use
them at stores.
At least six other
associates of
Reams were
involved in the
scheme.
ID Theft
Scheme
Hits 400
UnitedHealth Group Inc., the
biggest U. S. health insurer, will face a
fragmented regulatory landscape in
2014 under the first state insurance
marketplaces approved as part of
the health care overhaul.
Rules for the six state insurance
exchanges that won conditional approval from the Obama administration in December 2012 are split
evenly between those with strict criteria for companies that want to participate and states that have opened
their exchanges to all comers, a scenario supported by the insurance industry. A high bar for inclusion could
limit the number of insurers offering
health plans in some states.
The exchanges, the heart of the
2010 Affordable Care Act’s plan to
expand health care to 30 million
people, have less than a year to
open online platforms where local
residents, with the help of federal tax
credits, can shop online for insur-
ance. “The challenge is it’s all new,”
said Kim Holland, executive director
for state affairs at the Blue Cross Blue
Shield Association, a Washington-
based trade group that represents
38 state insurance plans. “We have a
really, really short period of time in
order to get everything done.”
Enrollment in the exchanges must
begin by Oct. 1 for plans that will
take effect Jan. 1, 2014. The U.S. gov-
ernment plans to give states that run
their own exchanges a share of about
$2 billion to help get them started. In
Connecticut, regulators are taking a
strict approach by making insurers
meet requirements for patient ac-
cess that exceed those of the Afford-
able Care Act. Insurers will have to
make two-year commitments to par-
ticipate in the Connecticut Health
Insurance Exchange, and include
almost all of the state’s U.S.-funded
health clinics in their networks. “The
board saw its role as being very pas-
sionate about supporting consum-
ers and trying to establish standards
where health plans could reach to a
slightly higher bar than required in
the ACA,” said CEO Kevin Counihan.
—Alex Wayne, Bloomberg News
REFORM
Insurers Face Jumbled
Market Amid Varying Health
Exchange Rules
The Centers for Medicare and
Medicaid Services has announced
formation of 106 new accountable
care organizations for Medicare
beneficiaries, bring the total to more
than 250 ACOs nationwide serving
up to 4 million patients.
The ACOs are part of the Medicare
Shared Savings program in which
providers and the government share
health care cost savings above certain thresholds while meeting 33
care quality measures. About half of
the ACOs are physician-led organizations serving less than 10,000 beneficiaries, according to CMS.
Fifteen of the new ACOs are participating in the Advanced Payment
Model program. They receive upfront
capital from Medicare to enhance
staff, I.T. and infrastructure, with
Medicare recouping the payments
over time. Applications will be available in the summer of 2013 for organizations wishing to join the program
in 2014. CMS also announced that
Medicaid spending per beneficiary
rose 0.4 percent in 2012, compared
with 3. 6 percent in 2011 A list of new
ACOs is at www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/
sharedsavingsprogram/ News.html.
ACCOUNTABLE CARE
CMS Names
106 New ACOs
for Medicare
Shared
Savings
