All That Political Uncertainty Over The Health Law Gave Insurers Some Of Their Best Financial Annual Performances Yet
Last year stood as the best financially for insurers in the individual market since 2011, with monthly average individual market gross margins per member more than doubling from $78 in 2017 to $167 in 2018. In other health industry news: the Elizabeth Holmes trial, health care claims, the False Claims Act, public health and TV shows, apps and more.
Modern Healthcare:
Obamacare Uncertainty Was Financial Boon For Health Insurers
Insurers selling plans on the Affordable Care Act marketplace are expected to pay consumers $800 million in 2019 as a result of excess premiums, according to a new review of preliminary estimates. The Kaiser Family Foundation on Tuesday released a report that found uncertainty over the future of the ACA's individual health insurance market in 2018 led to spikes in premiums and some of the best annual performances by insurers. (Johnson, 5/8)
The New York Times:
Elizabeth Holmes’s Possible Defense In Theranos Case: Put The Government On Trial
The trial of Elizabeth Holmes, the former Theranos chief executive, and Ramesh Balwani, its chief operating officer, is setting up to be the most extensive corporate prosecutions since executives at Enron were tried in 2006. And if the case gets to trial, one intriguing question is how Ms. Holmes and Mr. Balwani will defend themselves. A recent filing by Ms. Holmes, which was joined by Mr. Balwani, who goes by Sunny, outlines a possible defense: put the government on trial by claiming that regulators improperly brought actions against the company for its blood analysis technology. (Henning, 5/8)
The Associated Press:
Health Claim Rejected? Some Steps To Appeal A Denial
Patients are often shocked when their insurance company denies coverage for a procedure or treatment, especially if that leads to a bigger-than-expected bill. These rejections can be fairly common, and people may not put up their best fight to get the decision reversed. Odds are tough, but denials can be resolved with phone calls or a formal appeal, which health care experts see as more of a last resort. Here's a look at the issue. (5/8)
Modern Healthcare:
Justice Department Sheds Light On Limiting False Claims Act Damages
The Justice Department on Tuesday gave companies new guidance to obtain greater leniency in False Claims Act investigations and limit their potential liability. False Claims Act cases in the healthcare industry grew to 506 in 2018 from 291 in 2008, and companies and physicians shelled out $2.5 billion in FCA settlements and judgments in fiscal 2018, making them a potentially costly concern. (King, 5/8)
Stat:
TV Producers Make Bold Pitches To Health Companies, But Don't Always Deliver
A STAT examination found that producers for shows created by Education Alliance persistently pitch health care and biotech businesses, as well as startups and established companies in other industries, touting sky-high viewership numbers and implicit celebrity endorsements from the likes of James Earl Jones, Laurence Fishburne, and Rob Lowe, all of whom have hosted such public television segments created by the company. (Thielking, 5/9)
Bloomberg:
‘App Store For DNA’ Fizzles As Health Startup Shifts Strategy
Genetic-testing startups are finding that selling consumers insights on their risk of getting cancer may not be as easy as telling them about their Irish roots. 23andMe Inc. and Ancestry.com LLC have capitalized on the public’s insatiable appetite for discovering their family trees. However, consumers have balked at paying other companies for health analysis of their DNA. ...Helix, which launched in 2015 with $100 million from genome-sequencing giant Illumina Inc., had planned to sell tests directly through an “app store’’ for DNA. Instead, it’s now looking to partner with health-care providers. Illumina said on April 25 that it would no longer hold equity or participate on Helix’s board, ending the partnership. (Brown, 5/8)
Chicago Tribune:
The Death Of Michael Kasper, Whose Vision Pushed DuPage Medical Group Toward A National Presence, Leaves It At Crossroads
Faced with mounting costs, shifting regulations and burdensome billing requirements, physicians have been joining larger hospital systems that promise to handle it all for them. ...Over the past decade, DuPage Medical Group has quietly grown from a few hundred doctors to more than 700 today, its signs sprouting up across the west and southwest suburbs. Much of that growth happened under the leadership of CEO Michael Kasper, who died of undisclosed causes on Saturday at the age 46. The DuPage County coroners’ office has said it will not release a cause of death until toxicology tests are complete. Kasper’s family and DuPage Medical Group have declined to comment. (Schencker, 5/8)
