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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.
  • ...30 more annotations...
  •  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
Monica Beiser

Alternative Medicine, Insurance, Coverage, Cancer, Therapies| Burton Goldberg - 0 views

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    Most insurance companies do not cover alternative medicine. This article explains the benefits of insurance companies covering alternative treatments.
Lizette Pacheco

Obamacare Facts: What It Is and How It Affects You - 0 views

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    What is Obamacare? It requires you to have health insurance or pay a tax. People have to purchase insurance or if not you get fined a certain amount of money. The U.S has to be insured and then others are charged more.
Corinne Freeman

What is the Health Insurance Marketplace | HealthCare.gov - 0 views

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    This site actually helps you get health insurance that is right for you. It simplifies the process with easy to understand options
Megan Nitka

Why Some Can't Keep Their Current Health Insurance - 2 views

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    This article talks about the reasons people were unable to keep their current health insurances. It also talks about how people were told that they would be able to keep the insurance they had.
veronica evans

Mandatory Arizona Car Insurance - 0 views

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    Arizona has a mandatory state requirement for car insurance, that is meant to protect you and everyone else from paying out of pocket in the event of an accident. Failure to do so could lead to suspension of your vehicle registration, and/or drivers license.
lynnmarie17

healthcare system not being affordable - 0 views

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    Lots of people are suffering from a lack of health insurance. Hard to find good doctors that are able to help your needs. Health insurance is exspenisve and people cant afford it.
Julia Cilley

Health Care Reform: Who will benefit in Arizona? - 0 views

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    Many people that don't have insurance will be able to get affordable insurance. Seniors will be be able to buy their brand name prescriptions at an affordable price. Also pay nothing for preventive care.
Jennifer Seeglitz

Is President Obama's Individual Health Care Mandate Constitutional - 0 views

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    This article discusses whether the health care mandate is constitutional or not. The articles continues by discussing the the difference between state mandated car insurance and federally mandated health insurance.
doucette44

Health Care Fines Press Millennials as Deadline Nears - 0 views

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    This article talks about how millions of young adults are trying to avoid of getting hit with a fine because they do not have insurance. People are getting fined due to not having any insurance. For 2016, the fine nearly doubled being 695$.
anonymous

Facilitating Access to Mental Health Services - 0 views

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    This article details how insurance coverage affects various outcomes for people with mental health issues. One of the interesting things about this article is how it shows that medicaid is more effective for those suffering from mental illness than private insurance.
David Angulo

Health Care and Social Justice - 0 views

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    This article briefly discusses on how in 2013 the Affordable Care Act was going to assist many poor families. It would help these families be able to afford better health insurance at a low monthly premium.
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    Thanks for sharing this. I was surprised with the percentages among minority groups as well as just the overall percentages especially in Texas. This author is really good because she is direct and to the point and has a very clever way of closing the article as well.
Katie Waite

Getting Insurance to Pay for Midwives - 0 views

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    Many insurance do not cover midwife care in their policies.Midwife access is also limited in hospitals and many states limit the access and privileges of midwives. With healthcare costs on the rise, many families are looking at midwifery which is a far less expensive option than that of an OB. In other countries midwives do a majority of the births and maternity care which results in a fraction of the US costs.
Megan Nitka

How to Calculate ObamaCare Penalties - 0 views

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    This article describes the penalty for not having health insurance. If an individual or family does not have health insurance the penalty goes up each year. The article also gives an example of a family having to pay over $2000 by 2016.
con2161029

Should Everyone Be Required - WSJ - 0 views

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    Now that it is mandatory in the US to have health insurance or pay a penalty, people are responding more to the issue. Supporters say that imposing this law makes health care affordable for everyone. People who oppose to these laws say that it violates our personal freedom.
Enrique Vargas

Individual mandate in Obama's health care law: good for freedom, bad for free-riders - 0 views

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    In the article, it states how Obamacare doesn't allow for everyone to receive the right kind of health care. These "free-riders", will end up paying more than they have to on their insurance.
mat2046668

Aetna to Pull Out of Most Obamacare Exchanges - 0 views

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    Many insurance companies- like Aetna, are concerned that the low premiums with Obamacare are too costly. Aetna will still provide individual policies outside the realm of Obamacare but will not participate in federal government subsidies.
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    It is pretty interesting on how Obamacare is beginning to cause problems for insurance companies. This is definitely going to affect families greatly in the coming future.
Katie Waite

American Way of Birth, Costliest in the World - 0 views

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    Charges for delivery have almost tripled since 1996. Women are getting sticker shocked for procedures and tests that they feel should be covered by insurance. The trend is that women are having to pay individually for services that they may not necessarily need. Many insurance providers exclude maternity coverage from their plans, increasing the financial burden for women.
Devon Feagans

New Rules for Individual Mandate of the Affordable Care Act - 0 views

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    New information has been released by the Administration regarding the implementation of new health care laws soon to be put into effect. Included in the release is a list of individuals who will be held exempt from being fined for not purchasing health insurance, as well as the amounts of fines that uninsured citizens will pay when the law goes into effect.
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