Daily Insurance Report

Friday,  03/12//21

Walt Podgurski



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Press Releases

Houston pharmacy CEO arrested in disturbing $134M Medicare fraud scheme
Alison Medley / CHRON / / Read Article

A Ferrari, a Bentley and a lavish $1.5 million mansion in Houston were just a few luxury items that were uncovered when federal officials busted a Medicare fraud scheme, according to the U.S. Department of Justice.

A Houston pharmacy CEO and his accountant have been charged and arrested in a $134 million health fraud scheme. 4M Pharmaceuticals CEO Mohamed Mokbel, 56, and his accountant, Fathy ElSafty, 62, were both charged on one count to commit healthcare fraud, three counts of healthcare fraud and four counts of money laundering, Acting U.S. Attorney Jennifer Lowery announced.

It was an elaborate scheme that preyed upon the most vulnerable individuals—those over the age of 55, federal investigators say. In an eight-count indictment, officials claimed 4M Pharmaceuticals operated as an outbound telemarketing call center that solicited Medicare, Medicaid and commercial insurance patients.

Obamacare’s About to Get a Lot More Affordable. These Maps Show How.
By Kevin Quealy and Margot Sanger-Katz / New York Times / / Read Article

The American Rescue Plan broadens the subsidies available under the Affordable Care Act for comprehensive health insurance — increasing them for people who are already eligible, and providing new assistance for people with incomes previously too high to qualify. The top set of maps, drawn from calculations made by the Kaiser Family Foundation, show how much the changes will reduce what people pay for health insurance around the country, depending on their location and age.

The changes mean small adjustments for some Americans and very substantial ones for others. For anyone earning around $19,000, subsidies will now be generous enough to sign up for a typical plan with no monthly payment. For someone earning over $51,000, new subsidies could lower premiums by as much as $1,000 a month in the country’s most expensive markets.


GOP lawmakers push to permanently eliminate estate tax
There's little chance the legislation becomes law with Dems controlling Congress
By Megan Henney / FOXBusiness / / Read Article

A group of Republican senators unveiled legislation this week to permanently repeal the federal estate tax, a move that's almost guaranteed to fail in the Democratic-controlled Congress.

The legislation, introduced by Sens. John Thune, R-S.D., and John Kennedy, R-La., and endorsed by Senate Minority Leader Mitch McConnell, R-Ky., would eliminate the federal tax levied on estates worth more than $11.7 million after the death of the owner.

Reps. Jason Smith, R-Mo., and Sanford Bishop, D-Ga., introduced the bill in the House. Bishop is the lone Democrat sponsoring the legislation.

Critics slammed the measure as a handout to the rich: In 2020, just 1,900 estates (out of the roughly 2.8 million people who died that year) owed estate taxes, according to a recent estimate published by the Tax Policy Center. The tax raised about $14.9 billion in federal revenue in 2018, the nonpartisan group reported.

How Can The US Fix Long-Term Care In A Post Covid-19 World?
Howard Gleckman, Senior Contributor / Forbes / / Read Article

The Covid-19 pandemic has been a catastrophe for frail older adults. More than 170,000 residents and staff of long-term care facilities have died from the virus, and adults over age 65 living in all settings have accounted for about 80 percent of the nation’s deaths, or about 400,000 fatalities.

But what lessons have we learned? And how can we build on this public health disaster to repair a long-term care system that has been broken for decades? Last fall, the Urban Institute brought together 31 experts in long-term care to discuss how the US can fix the fractured system, given the hard lessons of covid-19.

While participants brought many different perspectives, they agreed on several critical areas for reform. They broadly agreed on the importance of fundamentally redesigning Medicaid; expanding home- and community-based services (HCBS); integrating medical care with long-term services and supports (LTSS); enhancing pay, benefits, and training for direct-care workers; reimagining nursing homes; and supporting older adults along the full continuum of care.

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Unison Risk Advisors Announces Launch of New Pooled Employer Plan
BUSINESS WIRE / Valdosta Daily Times / / Read Article

Unison Risk Advisors, the combined holding company of Oswald Companies and RCM&D, has launched a Pooled Employer Plan (PEP). The PEP, titled Unison Risk Advisors Pooled Employer Plan, will deliver retirement plan services to clients in collaboration with: Oswald Financial, Inc., as the ERISA 3(38) Investment Manager; The Platinum 401k, Inc., as ERISA 3(16) Plan Administrator and the Pooled Plan Provider; and Voya Financial serving as the plan recordkeeper.

This solution was created in response to the Setting Every Community Up for Retirement Enhancement (SECURE) Act legislation, signed into law Dec. 20, 2019, and the provision that allowed Pooled Plan Providers to establish Pooled Employer Plans effective Jan. 1, 2021. It is designed to provide a pooled plan to one or more unrelated employers, broadening the access of retirement plans for companies of all sizes.

New Federal 'Surprise' Medical Bill Law May Be Tricky to Implement
by Allison Bell / Think Advisor / / Read Article

Many No Surprises Act provisions take effect Jan. 1, 2022.
The law applies mainly to enrollees in self-insured plans.
One worry is patient notice form overload.

The No Surprises Act is part of the Consolidated Appropriations Act, 2021, package, which former President Donald Trump signed Dec. 27, 2020.

It includes many provisions designed to protect people from getting big bills for care from expensive, out-of-network providers at in-network hospitals, big bills from out-of-network emergency care providers, and out-of-network air ambulance services providers.

States typically impose anti-surprise billing rules on health insurers that are working with doctors and hospitals that have patients with insurance from an insurance company. States can’t regulate surprise billing at self-funded employer health plans. The new federal law will apply mainly to employers’ self-funded health plans, Smith said at the AHIP conference, which was presented through the web.

Guardian Life Partners with Nayya to Enhance Benefits Enrollment Experience
PRNewswire / / Read Article

The Guardian Life Insurance Company of America (Guardian Life) and Nayya, a leading insurance benefits experience and management platform, have announced a joint partnership to provide employers and employees with a personalized, online data-driven benefits experience during the open enrollment process.

"Employers have been expanding their benefit offerings to meet the evolving and diverse needs of their workforce over time, resulting in the need to improve and digitize benefits education as part of the enrollment strategy," said Chris Smith, Head of Group Benefits, Guardian Life. "By integrating Nayya into the Guardian Life enrollment experience, we will harness the power of data to help educate and guide employees through the benefits selection process."

According to Guardian's Workplace Benefits Study, one in four employees feel open enrollment is overwhelming and not very helpful. The research also found that a positive benefits experience – one that is efficient, engaging, and helps employees make better benefits decisions – contributes to an increase in workforce loyalty with 79 percent of employees saying they will stay with their employer five years or more.

Employee engagement startup Centrical raises $32M
Kyle Wiggers / VentureBeat / / Read Article

Centrical, a startup developing an employee engagement and performance management platform, today announced that it raised $32 million in funding led by Intel Capital. CEO Gal Rimon says that the funds, which bring Centrical’s total raised to date to $64 million, will be put toward product R&D as Centrical looks to acquire new customers.

During the pandemic, as shelter-in-place orders and office closures force employees to work from home, companies are increasingly experimenting with or adopting work quality monitoring products. According to a June study by Gartner, 26% of HR leaders report having used some form of software or technology to track remote workers since the start of the health crisis. It’s an uptick driven in part by concerns over performance dips that could arise from work-from-home setups. A survey by global recruitment firm Robert Walters found that 64% of businesses are concerned about remote employees’ productivity.

LIMRA/LOMA Conference to Focus on Compliance and Fraud Prevention
LIMRA / / Read Article

Learn from experts in compliance and financial crimes services at the first ever Compliance & Financial Crimes conference. The event, hosted jointly by LIMRA and LOMA, will be held virtually March 23-25.

Other sessions include fraud prevention techniques, assessing a company’s financial crime risks, the role of special investigations units, diversity and inclusion from a regulatory perspective, what’s next in regulatory trends and much more.

“The COVID-19 pandemic has brought a whole new set of challenges and financial fraud schemes. It’s critical that those of us in the financial services industry stay up to date on compliance and regulatory issues,” says Anderson.

For more information and to register online, please visit: https://www.limra.com/en/events/conferences/2021/2021-compliance--financial-crimes-conference/.

Photo Of The Day

Monday, 03/08/21 - - Health Insurance Hassles Aggravate Employees, Cost Employers Billions of Dollars

Tuesday, 03/09/21 - - Can we keep Medicare from being insolvent by 2024?

Wednesday, 03-10-21 - - Cyberattack cripples communications at Pan-American Life Insurance Group

Thursday, 03-11-21 - -  Medicare agency completes $100M round of funding

Friday, 03-05-21 - - Sign-ups for Biden's Obamacare special enrollment period nearly triple
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Editorial Mission Statement: The goal of this publication is to provide readers a broad selection of what is being written about the insurance industry and related issues. Some articles may have a “tilt” towards a particular perspective one way or another. Inclusion in this newsletter is not an endorsement of any views or content; but report the various and differing views appearing in media.