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smurphy6600

Health Net lawsuit reveals the financial engine of drug rehab industry - 0 views

  • 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. 
  • Maricopa County Superior Court lawsuit
  • 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.
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  •  residential “sober homes”
  • headaches for local government officials as they try to determine how to manage the unregulated industry.
  • Prescott, which once claimed more than 100 sober homes, has adopted regulations to provide more oversight of them.
  • Federal and state prosecutors have aggressively pursued cases in Florida and California in connection with fraudulent activities such as patient brokering.
  • There have been no criminal cases filed in Arizona, however. 
  • Six of the rehab facilities that accuse Health Net of improperly withholding payments are in Prescott: Chapter 5 Counseling, Prescott House, Compass Recovery Center, Clean Adventures of Sober Living, Decision Point Center and Carleton Recovery Centers.
  • Three others, T R U Recovery Solutions, North Ridge Counseling and Desert Cove Recovery, list Scottsdale addresses. 
  • The rehab facilities allege that Health Net improperly withheld payments to virtually every rehab center in Arizona and southern California beginning in January 2016. Health Net halted the payments as part of an investigative audit that demanded each center provide detailed records such as proof of patients' residency and assurances that patients did not receive incentives to sign up for rehab. 
  • Health Net said in court documents that claims filed by rehab centers in Arizona soared because of widespread fraud
  • Health Net's PPO plans paid $2.4 million to all Arizona rehab centers in 2014. Those payments soared to $47.4 million in 2015
  • Those plans paid more for rehab care that year than all other types of care in Arizona, including typically expensive medical care such as cancer, heart disease and child births, according to the insurer’s counterclaim.
  • Here’s how the fraud worked, the insurer said in its counterclaim:Brokers would scout out people in 12-step programs, Alcoholics Anonymous meetings, homeless shelters and jails, then refer these clients to the “highest-bidding clinic.”Clinics that were not part of the insurer’s network paid clients’ insurance premiums and out-of-pocket costs such as deductibles and co-payments.The result was that people secured Health Net coverage “arranged and bought for them by financially-interested providers for one purpose only: to obtain coverage for the limited time needed to rack up millions of dollars in substance abuse treatment.” Some clinics misrepresented the home addresses of patients, many of whom lived out of state. 
  • “a sophisticated fraud involving the fraudulent enrollment of non-Arizona residents,” who signed up for Arizona insurance policies. 
  • misrepresenting their home address
  • Clean Adventures staff member told him to list the rehab facility's address on his insurance application.
  • put him in contact with an insurance agent who suggested using Clean Adventures' address on his insurance application
  • The insurer named 10 other examples of people who lived in California, Indiana, New Jersey, New York, Tennessee and Wisconsin but represented that they lived in Prescott or Scottsdale.
  • The insurer also said the rehab centers engaged in fraudulent billing, charging for services that were not medically necessary or in amounts that exceeded what the plan allowed.
  • A 2008 law called the Mental Health Parity and Addiction Act requires insurance plans to provide equitable coverage for substance abuse and addiction treatment. The Affordable Care Act also requires health insurance plans cover essential health benefits, including behavioral health services, and it forbids insurers from denying coverage to individuals based on existing medical conditions. 
  • The unintended consequence was (some) addiction treatments centers began taking advantage of that and over-billing," said Angie Geren, executive director of Addiction Haven, a grassroots and advocacy organization focusing on addiction issues. 
  • House Bill 2333
  • curb the practice of paying referral fees to brokers who steer patients to rehab centers.
  • bill never made it out of committee.
  • Florida
  • "The scam starts with deceptive advertising at the beginning," Aronberg said. "You are lured down to sunny Florida with a free plane ticket, which is illegal. You are given illegal benefits to keep you there."
  • patients often find themselves booted from treatment when their insurance benefits run out.
  • incentive for people to relapse so they can obtain another round of coverage.
  • Sober Home Task Force targeting the practice of buying and selling patients battling addiction
  • Johnson said rehab centers that provide legitimate services are being harmed as insurance companies scrutinize payments and bad actors poach patients away. 
  • ken.alltucker@arizonarepublic.com
chrisfowler94

U.S. Health Care from a Global Perspective, 2019 | Commonwealth Fund - 0 views

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    This article compares what Americans spend on health care to other high-income nations such as Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. Compared to these countries, Americans spend nearly twice as much on health care. The article goes over the causes of this such as obesity and expensive technology as well as affects such as higher rate of death from preventable causes and less doctor visits than average.
bri2213783

Why is health care in the US so expensive? - CNN Video - 0 views

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    This video explains why healthcare is so expensive in the USA. It also contains information on what healthcare will look like in the future.
karlag1308

Unequal Access to Health Care Costs Us All - 3 views

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    This article discusses how corrupt the healthcare in America is compared to other countries. It shares why they make the healthcare expensive & who it ultimately benefiting from it, being the pharmaceutical industry & the rich. Also shares how even though your work may pay for you healthcare, you're still the one getting gyped.
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    I actually wrote a presentation last semester on how the U.S. healthcare system is flawed. In my presentation, I outlined issues such as these. It's refreshing to see others share my views. Personally, this is an interesting read, as I intend on being a part of the healthcare industry. That being said, I believe future generations of healthcare workers need to be educated in matters such as these, so that one day, we may hopefully be able to "fix the system."
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    America's healthcare is the most expensive amongst industrialized nations. But higher costs aren't leading to a healthier population or longer life expectancy. The high cost of healthcare negatively affects the American economy in many ways.
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    I found this article to be very fascinating indeed. I hope that one day we will have a health care system that is excess-able to all Americans. Hopefully a solution will be properly found during our life time.
ale2164926

Healthcare access to everyone? - 1 views

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    Healthcare is an issue that is present today, especially with the election that just occurred. Some believe that everyone should have free access to healthcare and note that if other countries can do it, so can we. The other believe that it is the individuals personal responsibility to figure out how they are going to get it and believe that universal coverage would be too expensive.
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    I agree completely. It is possible and other countries have proven it. It's just a matter of rejecting the lobbyists, insurance companies, and pharmaceuticals that make money off of private citizens. Healthcare should be a basic human right and not something that can cause you to go bankrupt.
alexisullery

Why is healthcare so expensive in the United States? - 0 views

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    Healthcare prices have always been too high. It should not cost as much as it does to treat yourself or get proper medical care. This article shows why healthcare is too high and ways we can combat this price during a pandemic.
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    This is very real in my life. I had to file bankruptcy after being hospitalized for a couple of weeks. It's absolutely traumatic financially to be ill, and that's not right.
gvi1234

Americans are skipping on medical care - 0 views

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    This article is reporting on why Americans are not getting medical care. Oftentimes, health care is too expensive. The medical care system does not help with cost
anonymous

Does the U.S. Need Universal Health Care? - 2 views

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    This advocates for the implementation of universal healthcare in the United States. It also talks briefly about why Americans seem to be so resistant to a new healthcare system.
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    I feel the need for universal health care has been push to the headlines due to COVID-19, since so many people are unable to pay for healthcare.
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    I liked how the article pointed out that people are doing go fund me accounts and that is a good example because many people are unable to afford healthcare and people are depending on other individuals to pay for their medical bills and it is a huge issue.
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    I really liked the article and liked how it gives examples of what is happening due to healthcare being so expensive.
fra2224486

1. Views of the major problems facing the country Views of major problems facing the U.... - 0 views

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    This article started out talking about healthcare, that it's been so expensive. Age differences and race differences and other economic problems
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