FTC: Florida company made $100M selling fake insurance

https://www.beckershospitalreview.com/legal-regulatory-issues/ftc-florida-company-made-100m-selling-fake-insurance.html

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A federal judge has temporarily shut down Miami-based Simple Health Plans at the request of the Federal Trade Commission.

In a federal complaint against Simple Health Plans, the company’s owner and five other entities, the FTC alleges Simple Health Plans collected more than $100 million by selling worthless health plans to thousands of people. The company allegedly misled consumers to think they were buying comprehensive “PPO” health insurance plans when they were actually purchasing plans that provided no coverage for pre-existing conditions or prescription medications.

Many of the people who purchased plans from Simple Health Plans are facing hefty medical bills for expenses they assumed would be covered by their health insurance plan. In addition, because the limited health plans do not qualify as health insurance under the ACA, some people were subject to a fee imposed on those who can afford to buy health insurance but choose not to.

The FTC is seeking to permanently shut down Simple Health Plans and to have the company return money to consumers.

 

 

Judge: Only time for one insurer merger case in 2016

http://www.fiercehealthcare.com/payer/judge-only-time-for-one-insurer-merger-case-2016?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWldRd1kyUXpNalUwWXpFeCIsInQiOiJaWkJVWkdKWG9DSFJwYytCZmVHV1JKcFhVd1lZbUlHS1JjZTZHZWI2ZDl3dU1XNU5oTWpCY3lSU3BYaWtyZXVyeGZmbDdyTVFHWk5OQUhEQzhlZkdlNm9lTnE3Y2M2elhcLzRrN3F5aXFKXC9RPSJ9

A federal judge said Thursday it is unlikely he would be able to rule on both the Aetna-Humana and Anthem-Cigna antitrust suits by the end of the year, according to Reuters.

Lawyers from Anthem and Aetna argued this week that Judge John Bates should hear their cases before the end of 2016. The Justice Department filed suits in July against both mergers, citing competition concerns that it says would increase prices for consumers and stunt innovation.

Bates said in a hearing Thursday that both requests cannot be fulfilled, but did not say which case would be sent for reassignment.

“That’s my determination: that I can’t do both,” Bates said in the hearing, according to Reuters.

Aetna believes it has a simpler case, the article adds. Further, its deal with Humana was announced first.

Anthem’s lawyers, though, point out that if the case is not settled by the end of the year, Cigna will likely refuse to extend their agreement, thus dooming the merger, Reuters notes.

In an interview with FierceHealthPayer, antitrust lawyer David Balto indicated that the Anthem-Cigna merger is “like climbing Mount Everest,” and that they are less poised to battle the DOJ than Aetna and Humana.

HHS directed to re-examine $220 million hospital pay cut

http://www.capitalnewyork.com/article/albany/2015/09/8577544/hhs-directed-re-examine-220-million-hospital-pay-cut

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A federal judge has ruled that the secretary of health and human services does have the authority to cut Medicare payments for all hospitals, but that she failed to follow the proper procedures for doing so