Friday, February 18, 2011

Calif regulator: Malpractice insurance too pricey

Calif regulator: Malpractice insurance too pricey
Associated Press

Medical malpractice insurance rates might be too high because some insurers are spending as little as 2 or 3 percent of premiums to pay out claims, according to the California Department of Insurance.

Insurance Commissioner Dave Jones said in a statement Thursday that insurers should reduce rates paid by doctors, surgeons, clinics and health providers while his staff scrutinizes the numbers.

"We have found that recent loss ratios—the percentage of every premium dollar the insurer spends on claims—of many medical malpractice insurers are low," said Jones. "Low loss ratios are one indication that premiums may be too high."

Medical malpractice is the failure of a doctor or medical professional to operate with an ordinary level of professional care, which can result in injury or death. Medical professionals are liable to pay damages in such instances, and take out insurance policies to cover such costs.

On average, insurers in California spent nearly 23 percent of collected premiums on claims and other losses.

The state's biggest medical malpractice insurer, Napa-based The Doctors Company, spent only 10 percent of the $179 million collected in premiums on claims in 2009. The company handles about 37 percent of the market in medical malpractice in California.

In a statement, the insurer's executive and general counsel David McHale said the company is committed to working with the state's regulator to charge
reasonable rates and reflect the realities of the marketplace.

McHale added the company is the only medical malpractice insurer in the state to reduce rates in the past five years, referring to an average 18 percent rate cut for many of its 19,000 policyholders in 2008.

Doug Heller, president of the Santa Monica-based consumer advocacy group Consumer Watchdog, said the problem ends up hurting consumers who suffer because of malpractice and must too often fight insurers to get claims paid.

"The medical malpractice premiums in California have so much extra padding right now because the companies are taking premiums from doctors and hospitals but don't have to pay much out in claims," said Heller, calling on the commissioner to hold rate hearings.

Health-Care Fraud Sweep Nets 114

FEBRUARY 17, 2011
Health-Care Fraud Sweep Nets 114
Wall Street Journal

A health-care crime sweep Thursday morning netted 114 defendants on charges related to Medicare fraud, in what Attorney General Eric Holder called the largest such takedown in U.S. history.

The defendants—charged in nine metropolitan areas including Los Angeles, Brooklyn, Detroit and Miami—were allegedly involved in more than 40 schemes, almost all of which were unrelated to one another, officials said. Altogether, the schemes attempted to defraud the government of more than $240 million, according to law enforcement officials.

Several of the cases appear to involve doctors or other health-care practitioners acting alone or with few alleged co-conspirators. One of these, Brooklyn physical therapist Aleksandr Kharkover, had been featured in a December Wall Street Journal article on possible financial abuse involving physical therapy, a growing area of Medicare fraud.

Mr. Kharkover, accused of being involved in one of at least three separate alleged physical-therapy rings broken up this morning, billed Medicare about $11.9 million from January 2005 through July 2010, according to the indictment. During that time period, Medicare paid out $7.3 million, according to a person familiar with the investigation. He is accused of having billed for physical-therapy services that were never performed and weren't medically necessary.

Mr. Kharkover's lawyer, Montell Figgins, said his client "looks forward to his day in court where he'll be able to set the record straight. Mr. Kharkover is a good man and a well-respected doctor."

The publisher of The Wall Street Journal, Dow Jones & Co., filed court papers last month to overturn a court injunction that blocks the public from seeing the Medicare billing records of individual doctors.

In 1979, citing privacy rights, the American Medical Association won a suit against the government to keep secret the amounts of money individual doctors get paid by Medicare. The AMA argued that releasing the information would violate physicians' rights to privacy. The court's ruling still stands...

Monday, February 14, 2011

8 Miami-Dade County nurses prison-bound for fraud

8 Miami-Dade County nurses prison-bound for fraud
The Miami Herald
The Associated Press

Eight Miami-Dade County nurses have been sentenced to prison and ordered to pay restitution for helping two agencies fleece millions from Medicare.

The nurses worked for two home health care agencies, ABC Home Health and Florida Home Health Care Provider.

According to the Justice Department, each of the eight nurses pleaded guilty last year to one count of conspiracy to commit health care fraud. The nurses admitted falsifying patient records for Medicare beneficiaries to make it seem like they qualified for services from the two agencies.

The nurses' prison sentences range from five months to 2 1/2 years. Each has been ordered to pay restitution. Those amounts range from roughly $66,000 up to $699,000.

Saturday, February 12, 2011

Issa Watch: Holding the Oversight Chairman Accountable

Friday, February 11, 2011
Meeting Rena
by Rick Jacobs
Issa Watch

...Rena and her son were also both recently diagnosed long-term health problems. Their Congressman’s response was voting to allow their insurance provider to deny them coverage for these “pre-existing” conditions. Facing a spike in her health insurance costs, a choice between her own medication and medicine for her son, and the even the prospect of losing her coverage altogether, Rena decided to contact her Congressman.

Not for the first time, Rena called Issa's office asking to meet with him. Instead of getting a meeting, she was told that she won't ever get one.

Instead of meeting with Rena, Issa did make time for folks who shelled out $125 a pop to attend a Vista Chamber of Commerce event at the posh Shadowridge Country Club Friday night. While Issa was inside vowing to champion the cause of the DC Lobbyists he’s asked to help drive his committee’s agenda, Rena was outside for hours in the chilly night— hoping for just a few seconds to speak to her Congressman.

Tragically, Rena’s experience mirrors that of a growing number of Americans for whom the concept of a truly “Representative” government is almost always out of reach. A few weeks ago, Rena’s Congressman, Rep. Darrell Issa, sent letters to more than 150 corporate lobbyists who aren’t in his district to ask what he could do to make their lives a little easier. But Rena—one of the small business owners who create nearly two-thirds of the new jobs in this country and one of the 331,000 CA 49 residents with pre-existing conditions who are directly impacted by the new healthcare law -- couldn’t even get a meeting...

Tuesday, February 8, 2011

Ex-SAC Employees Are Charged in U.S. Insider Probe

The charges are connected to earlier arrests of eight employees or consultants at Primary Global LLC, a Mountain View, California-based firm that links investors with employees of public companies who work as consultants...

Ex-SAC Employees Are Charged in U.S. Insider Probe
February 08, 2011
By David Glovin, Patricia Hurtado and Saijel Kishan

Former SAC Capital Advisors LP junior portfolio managers Noah Freeman and Donald Longueuil were charged with insider trading while working at the $12 billion dollar hedge fund, part of the latest round of charges in a nationwide crackdown by federal prosecutors.

Longueuil, who worked at SAC Capital unit CR Intrinsic from July 2008 to July 2010, was arrested this morning. Freeman, who worked at SAC Capital from June 2008 to January 2010, pleaded guilty yesterday as part of a cooperation agreement with prosecutors.

The two others charged by Manhattan federal prosecutors were Samir Barai, the founder of Barai Capital Management, who surrendered to authorities this morning, and Jason Pflaum, who worked for Barai and pleaded guilty yesterday as part of a cooperation deal.

“They took the concept of social networking and turned it into a criminal enterprise,” U.S. Attorney Preet Bharara said at a press conference today detailing today’s charges.

The arrests in what prosecutors called a four-year scheme signal an expansion of a 16-month attack on insider trading on Wall Street that U.S. Attorney Preet Bharara said is “rampant.” The criminal complaint refers to six hedge funds, which it doesn’t name, that employed the defendants or executed trades.

‘Egregious Violations’

“We are outraged by the alleged actions of two former employees, which required active circumvention of our compliance policies and are egregious violations of our ethical standards,” Stamford, Connecticut-based SAC said today in a statement.

“The government alleges that their improper conduct together began at their prior firms in 2006 and continued after they joined SAC in mid-2008,” SAC said in the statement. “They were employed at SAC for a short time and were dismissed in January 2010 and June 2010, respectively, due to poor performance. SAC is continuing to cooperate with the government’s investigation.”

The charges are connected to earlier arrests of eight employees or consultants at Primary Global LLC, a Mountain View, California-based firm that links investors with employees of public companies who work as consultants...