News & Insights


UnitedHealth Leads Transparency Charge

UnitedHealth Group Inc. will lead an industry effort to throw a spotlight on the prices paid for health care services, making their costs available to consumers on the Internet. The effort, organized by a nonprofit called the Health Care Cost Institute, builds on steps the Obama administration has taken to shed light on prices charged by health care providers. Read more.

Ninety Charged in $260 Million Medicare Fraud

Law enforcement authorities announced the arrests Tuesday of 90 people, including 16 doctors, linked to alleged Medicare fraud schemes across the nation involving an estimated $260 million in false billings to the taxpayer-funded program. Much of the enforcement action was centered in Miami, where 50 people were charged with fraudulent billings for home health care, mental health and pharmacy services worth an estimated $65.5 million. Read more.

Feds Allow Reference-based Pricing

The feds say they’re still deciding how to handle reference-based pricing but will let plans use it, for now. Officials also said employers can use last year’s templates to create new Summary of Benefits and Coverage notices, and that large-group and self-insured plans can often leave part of the cost of expensive brand-name drugs out of annual out-of-pocket spending calculations. Read more.

New Price Transparency Rules for Hospitals

Hospitals will be required to release a standard list of prices for their medical services under a new rule proposed by the Centers for Medicare and Medicaid Services (CMS). The program was outlined in a wide-ranging, nearly 1,700-page regulation on inpatient hospital payments recently released to lawmakers and the public. Read more.

Report Shows Reference Pricing Could Save Employers $9.4 Billion

If all employers adopted reference pricing for certain health care services, the potential total savings could reach $9.4 billion, according to a new report from the Employee Benefit Research Institute (EBRI). This amount would be 1.6 percent of all spending on health care services among the 156 million people under age 65 who have employment-based health benefits in 2010, EBRI said. Read more.

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