News From Around the Web
> An audit of New York's health exchange identified $3.4 million in overpayments since October 2013, the majority of which was attributed to multiple identification numbers issued to several thousand beneficiaries, accounting for $2.8 million in overpayments, according to the Associated Press. Article
> The leader of a $125 million fraud scheme was sentenced to ten years in prison and ordered to pay nearly $14 million in restitution. Hendris Castillo Morales, along with three other co-conspirators, were sentenced for defrauding public and private healthcare insurers, as well as a number of companies that paid claims as self-insured entities. The other three accomplices each received three to four year sentences. Morales's brother, Reynaldo Castillo, fled to Cuba last March to avoid similar fraud charges and is still at large. Release
> The federal government has elected to intervene in three False Claims Act lawsuits against the skilled nursing chain, SavaSeniorCare LLC, which operates in 200 facilities in 23 states. The lawsuits allege that the company exerted pressure on facilities to meet financial goals and billed Medicare for unnecessary and unreasonable care. In some instances, SavaSeniorCare allegedly kept residents longer than necessary in order to continue billing Medicare. Release
Health Payer News
> A report from the Department of Health and Human Services indicates that although insurance premiums are increasing, eight out of 10 enrollees can still find lower-premium plans if they are willing to shop around and take advantage of subsidies, as premiums for the Affordable Care Act's benchmark plan will rise 7.5 percent in 2016. Article
> UnitedHealth Group could end up profiting from two major mergers between Aetna and Humana and Anthem and Cigna. A report from Moody's Investors Services notes that UnitedHealth is still one of the the largest and financially strong companies in the country thanks, in part, to a number of diverse business lines. Article
And finally… How much for a bucketful of Candy Corn? Article