Archived California Healthcare News

Aetna Wins $37.4 Judgment Against Silicon Valley Area Medical Group

Insurance giant Aetna has won a $37.4 million judgment against a Saratoga-based medical group.

Aetna sued Bay Area Surgical Management in 2012 over what it claimed was systematic overbilling and fraud. 

Denise Johnson works two jobs, but neither of them offers health insurance to part-timers like her. She signed up for a marketplace plan this year, but for routine medical care, Johnson still goes to the free clinic near her Charlottesville, Va., home. The problem is her plan’s deductible of at least $1,000. She can’t recall the precise figure, but it doesn’t really matter. “It’s absolutely high,” said Johnson, 58. “Who can afford that?” She struggles to pay her $28 monthly premium.

Two out of three Californians who went without health insurance in 2014 were actually eligible for coverage, but they did without primarily because they could not afford its cost, according to a new study by researchers at UCLA and UC Berkeley. The study placed the uninsured into four groups: Those who were undocumented (32%), those eligible for Medi-Cal (28%); those eligible to buy subsidized coverage through the state health insurance exchange (31%), and those eligible for coverage but not qualifying for subsidies (9%). Slightly more than a quarter of all of those without coverage had one or more chronic health conditions.

The California Department of Managed Health Care (DMHC) has fined Woodland Hills-based Health Net $55,000 and Oakland-based Kaiser Foundation Health Plan $27,500 for canceling enrollees coverage without allowing for proper grace periods.

Kansas is one of 10 judicial districts nationwide selected to form units to crack down on nursing homes providing “grossly substandard” care, the Justice Department announced last week.

When Ohio tallied what many already knew was an alarming surge in overdose deaths from an opioid known as fentanyl, the state asked the U.S. Centers for Disease Control and Prevention to investigate. The rash of fatal overdoses in Ohio — a more than fivefold increase in 2014 — was not an isolated outbreak. Fentanyl is killing more people than heroin in many parts of the country. And the death toll will likely keep growing, said CDC investigators Matt Gladden and John Halpin at the fifth annual Rx Drug Abuse and Heroin Summit here.

Researchers at UC San Francisco have discovered that depression in older patients is far more likely to lead to cases of dementia as the age. The study tracked nearly 2,500 adults over the age of 70 who did not have any dementia. The cohort was categorized as either having consistent minimal symptoms of depression, moderate and increasing symptoms of depression, and those with high and increasing symptoms of depression.

DMHC Fines Anthem Blue Cross $15,000 Over Handling Of Enrollee Grievance

The Department of Managed Health Care has fined Anthem Blue Cross of California $15,000 for the way it handled the grievance of a 5-year-old enrollee who suffers from autism.

Gov. Sam Brownback signed a bill Monday that will allow insurance companies to avoid paying a privilege fee when they sell health plans that cover only in-network care. The state already allowed insurers to sell network-only plans if they registered with the Kansas Insurance Department as health maintenance organizations, or HMOs, and paid the fee.