Healthcare Provider Sued in Medical Debt Collection Case

The case stems from the provider’s alleged lack of prior express consent when contacting a consumer that is prohibited under the FCC’s Declaratory Ruling and Order on the TCPA.
California healthcare provider Prospect Medical Group faces allegations in a class-action lawsuit  that include using an auto dialer to call a patient on her cell phone about a past-due bill without prior express consent. The case against Prospect Medical Group’s Southern California Hospital at Culver City stems from the Federal Communications Commission’s Declaratory Ruling and Order, which includes an added layer of compliance changes in the medical debt collection field, last July.

Modern Healthcare reported Friday that a complaint has not been issued against Prospect Medical, and the company issued a general statement that “it follows the necessary practices to obtain consent to call patients on their cellphones.”

Prospect Medical Group is one of the first providers to face a lawsuit of this nature since the FCC released its order in July, according to Modern Healthcare.

The FCC will allow numbers dialed by mistake one time, but collectors could face fines or penalties under the new order after that, ACA previously reported.

ACA and other petitioners filed suit in July to challenge the FCC’s authority […]

By |February 5th, 2016|Industry News|Comments Off on Healthcare Provider Sued in Medical Debt Collection Case

ACA enrollment pleases HHS. Insurers will be a tougher crowd.

Roughly 12.7 million Americans signed up for a health plan on the federal and state insurance exchanges by the end of the Affordable Care Act’s third open enrollment, HHS said Thursday.

The preliminary enrollment numbers fall within the government’s expectations of 11 million to 14.1 million. HHS officials continued to strike a positive tone Thursday, saying the ACA has paved the way for many people to get comprehensive medical coverage, but the government still faces criticism from large health insurers that are losing money on the nascent marketplaces.

“It’s clear that marketplace coverage is a product that people want and need,” HHS Secretary Sylvia Mathews Burwell said on a conference call.

The 12.7 million figure likely will come down a bit throughout the year, depending on how many people pay their monthly premiums or switch to other forms of health coverage, but the CMS already incorporated some plan cancellations into its calculation.

As of Sept. 30, the marketplaces had 9.3 million paying customers. HHS predicts there will be 10 million total paying exchange members by the end of 2016. The Congressional Budget Office recently lowered its estimate of 2016 exchange enrollment to 13 million from 21 million.

During the past several months, insurance executives […]

By |February 5th, 2016|Health Reform|Comments Off on ACA enrollment pleases HHS. Insurers will be a tougher crowd.

CMS bars Cigna from enrolling new members into Medicare Advantage, prescription drug plans

Deficiencies found in an audit of Cigna-HealthSpring operations has prompted the Centers for Medicare and Medicaid Services to temporarily bar Cigna from enrolling new customers to its Medicare Advantage and stand-alone prescription drug plans, and from marketing efforts, according to CMS.

Deficiencies found in an audit of Cigna-HealthSpring operations has prompted the Centers for Medicare and Medicaid Services to temporarily bar Cigna from enrolling new customers to its Medicare Advantage and stand-alone prescription drug plans, and from marketing efforts, according to CMS.

The sanctions went into effect at 11:59 p.m., January 21.

Cigna-HealthSpring offers Medicare Advantage and Medicare Part D plans. The sanctions do not affect the benefits of Cigna Medicare Advantage and Medicare Part D’s current enrollees, according to the report filed with the Securities and Exchange Commission.

CMS imposed the sanctions after finding deficiencies in the operation of Cigna’s Part C and D appeals and grievances. It also found issues with the Part D formulary and benefit administration and compliance program, according to Cigna and the Securities and Exchange Commission.

“Until those items can be resolved, CMS has imposed a suspension of all enrollment and marketing activities to sign Medicare customers,” according to a statement from Cigna.

“Violations resulted in enrollees experiencing delays […]

By |February 4th, 2016|Industry News, Medicare/Medicaid|Comments Off on CMS bars Cigna from enrolling new members into Medicare Advantage, prescription drug plans

 

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