CIGNA Settlement Management – Update 2012

There have been several delays in the CIGNA Settlement proceedings since Judge Davis passed last year. However, the process is now proceeding in a positive direction. Thomas Schultz has been appointed as the new arbitrator. Arbitrator Schultz requested a summary of the settlement to date from both parties. These filings resulted in several hearings last year. During the hearings, we requested discovery and proposed a timeline for resolution.

According to the timeline that MCAG has proposed, all documents and depositions should be gathered and completed by later this summer, with a cumulative hearing in the fall. Arbitrator Schultz gives all indications that he is very engaged in the proceedings, and shares our interest in resolving the arbitration as quickly and efficiently as possible.

Although major updates are not likely until, perhaps, this summer, there will likely be several hearings and discussions over the next few months. Thank you for your continued patience. We realize that the process has been, and continues to be, painfully slow, but MCAG is encouraged that this next round of hearings will propel this matter towards resolution.

Although MCAG has been fighting for claims to be paid under the CIGNA Settlement for the past seven years, we are cautiously optimistic that there will be positive movement forward in the near future.

MCAG certainly understands and shares Class Member frustration with the delays imposed thus far, but please rest assured that resolving the CIGNA Settlement satisfactorily for our Class Member clients remains a priority.

In the meantime, please feel free to contact a MCAG representative if you have any questions, or if we can be of any further assistance.

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UnitedHealth Group UCR settlement fund set to pay out nearly $200 million

Physicians who filed timely claim forms as part of the UnitedHealth Group Usual, Customary and Reasonable (UCR) settlement are scheduled to receive funds from the settlement. In February 2012, the court-approved $200 million for providers from the settlement fund.
The American Medical Association (AMA) led the way in the legal actions to recover these funds.

The AMA and the Medical Society of the State of New York, the Missouri State Medical Association and others alleged that Defendants provided insufficient reimbursement for Covered Out of Network (OON) Services or Supplies by using flawed databases (the Ingenix Databases) that understated the Usual Customary and Reasonable allowance. In addition to this cash payment, the settlement also provides for the elimination of the Ingenix data base and the establishment of the FAIR Health database to create transparency in the calculation and allowance of payments based on Usual Customary and Reasonable (UCR) allowance. Visit www.ama-assn.org/go/litigationcenter for more information about the UHC Class Action and Settlement.

Claims sent through the Managed Care Advisory Group (MCAG)
Most physicians will receive checks from the Managed Care Advisory Group (MCAG) in the next couple of months, but if you have not received your check by April 15, 2012 and filed through MCAG, you should contact MCAG to inquire about the status of your settlement check by:

• Toll-free phone: (800) 355-0466 – press option 4
• E-mail: physicianservices@mcaginc.com

Update your MCAG record
Physicians who filed claims and have moved since filing should provide their updated mailing address as soon as possible to ensure the timely delivery of their checks.
AMA membership also offered its members an opportunity for an additional 15% to 20% savings on MCAG service fees based on the recovery amount obtained from the UHC Class Action. If providers have recently joined or left your practice, please contact MCAG to ensure that your active provider list is accurate. If some or all of your practice’s physicians are not already AMA members, it’s not too late to activate their AMA membership in order to fully leverage your potential savings in the UHC Settlement, in addition to the other AMA membership benefits. Visit www.ama-assn.org/go/join today.

Hold health insurers accountable
Although it is too late to file a claim for damages from this settlement fund, physicians who would like to hold health insurers accountable regarding out-of-network issues may wish to visit www.ama-assn.org/go/psatoolkits to access the Out-of-Network toolkit, which contains detailed information that physician practices can use in their non-contracted dealings with insurers.

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Notable News – January 28, 2011

Here are some recent, notable news stories in the healthcare industry. Skim them before your work week is done or save them for some weekend reading:

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Notable News – December 13, 2010

Here are some more recent, notable news stories in the healthcare industry. Start your week off right by giving them a quick read and stay informed:

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Notable News – December 10, 2010

Here are some recent, notable news stories in the healthcare industry. Skim them before your work week is done or save them for some weekend reading:

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CVS Caremark Sued over Claims of Unfair Business Practices

MCAG recognizes that as healthcare becomes more and more integrated the risk for abuse goes higher and higher. Our AWP/Patient Benefit Plan services have focused on giving clients the information and understanding they need to see how major news can affect even the smallest business and their patients or employees. The following story is a perfect example; MCAG will continue to monitor this case and its impact on our clients and the larger prescription drug market.

CVS Caremark is the target of a new lawsuit filed in federal court last month by a group of independent pharmacists in Texas. They claim that CVS Caremark is creating an unfair and anticompetitive environment by allegedly breaking a number of laws including the federal RICO act, trade secret misappropriation, and HIPAA.

The suit alleges that CVS and Caremark, as a result of their 2007 merger, have not established or have been circumventing a firewall between their retail pharmacy divisions and the prescription benefits manager divisions, which was a key requirement for the merger approval by the Federal Trade Commission. The suit claims that CVS Caremark instead set up a system to share and mine information across all departments in the company including the marketing department. The suit further alleges this information sharing is being used to push patients to use CVS pharmacies and physicians to prescribe CVS Caremark drugs.

Continue reading

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Notable News – December 6, 2010

Here are some more recent, notable news stories in the healthcare industry. Start you week off right by giving them a quick read and stay informed:

  • Appeals court lets West Penn lawsuit proceed (via Modern Healthcare): West Penn Allegheny Health System’s antitrust lawsuit against a rival health system and insurer Highmark will continue after an appeals court overturned a decision to throw it out. The decision by the 3rd U.S. Circuit Court of Appeals rejected an October 2009 decision to dismiss the lawsuit, which alleged the University of Pittsburgh Medical Center and Highmark conspired to protect one another from competition…
  • McKesson’s Horizon Clinicals Receives ONC-ATCB Certification via Drummond Group (via McKesson): McKesson’s Horizon Clinicals ® , the industry’s most comprehensive software suite used by clinicians, patients and healthcare executives to promote high quality, safe care, has received Complete EHR certification — deeming the software capable of enabling providers to meet the Stage 1 meaningful use measures required to qualify for funding under the American Recovery and Reinvestment Act (ARRA). Tested and certified under the Drummond Group’s Electronic Health Records Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB) program, the EHR software is 2011/2012 compliant in accordance with the criteria adopted by the Secretary of Health and Human Services…
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Notable News – December 3, 2010

Here are some recent, notable news stories in the healthcare industry. Skim them before your work week is done or save them for some weekend reading:

  • What new insurance provisions on preventive care mean for your practice (via AMA): The health system reform law requires an increasing number of insurance plans to cover 100% of widely accepted preventive health care without co-pays or coinsurance. Experts say this will complicate collecting the appropriate patient portion. But some preparation of medical office staff combined with patient education may simplify the situation…
  • Appeals Court Overturns Prescriber Data-Mining Law (via MedPage Today): A federal appeals court has ruled that a Vermont law restricting the commercial use of physician prescribing data is unconstitutional. The case involved a 2007 law that bans the sale and use of prescriber-identifiable information for marketing or promoting a drug — including drug detailing — unless a physician specifically gives his or her permission to use the information…
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BCBS Michigan Under Fire for Contract Terms

The U.S. Justice Department, joined by the State of Michigan, filed an antitrust lawsuit in District Court against Blue Cross Blue Shield of Michigan (BCBSM) alleging the healthcare payer is engaging in anticompetitive practices, which require most major Michigan hospitals to overcharge competing healthcare payers. The suit alleges the Most Favored Nation (MFN) clause in their contract is creating an unfair market which guarantees BCBSM with the lowest cost among its competitors essentially creating a monopoly.

This highlights why MCAG takes such a close look at contractual terms when working with clients involved in Claim Review and Recovery and Contract Enforcement. It is not uncommon for insurance payers to use language to ensure the best case scenarios for doing business with practices who may never realize what they are agreeing to in an industry that puts such a large emphasis on the fee schedule portion of agreements.

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Notable News – Week of November 12, 2010

Here are a couple notable news stories in the healthcare industry from the past week. Skim them before your work week is done or save them for some weekend reading.

  • LA expands WellPoint lawsuit while targeting another insurer: The city attorney’s office has expanded its lawsuit against WellPoint and added HealthMarkets to their list of targets alleging the use of deceptive tactics to sell limited coverage to consumers by passing it off as comprehensive coverage. This case could potentially impact the entire industry as a whole and we’ll be watching for the outcome.
  • The Unintended Consequences of $4 Generics: The $4 generic prescription program at a number of pharmacies nationwide may be helping consumers but it’s causing problems for many in the healthcare industry. Many pharmacies don’t want to bother filing a claim on a $4 prescription, which has implications across the industry. This is just another reminder that we need multiple options for managing claims to encourage cooperation on all levels.
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