Sen. Max Baucus (D-Mont.), the Senate Finance Committee chairman, and Sen. Jay Rockefeller (D-W.Va.) authored a rebuke to the Bush administration over an HHS directive issued last August, which would greatly restrict a states ability to expand its State Childrens Health Insurance Program. Baucus and Rockefeller, who sponsored a bill that would have rolled back the so-called August 17 directive, introduced a joint resolution that effectively states that Congress disapproves of the rule and cites reports from the Congressional Research Service and the Government Accountability Office that it should have been subjected to a broader rulemaking process. The move is the first step toward halting implementation of the directive under the Congressional Review Act, a Baucus aide said. The directive requires states that want to enroll children in SCHIP from families earning more than 250% of the federal poverty level, or $44,000 for a family of three, have to first prove that it covered 95% of children in families earning less than 200% of the federal poverty level. The resolution is backed by 40 other senators, including four Republicans.
Federal antitrust authorities for a second time declined to take issue with the planned merger of Philadelphia-based Independence Blue Cross and Pittsburgh-based Highmark, the two biggest Blues plans in Pennsylvania. The companies, which together cover 8 million residents, have yet to win the blessing of the Pennsylvania Insurance Department and were required to reapply to the Federal Trade Commission and Justice Department because more than a year had passed since the first time the proposed transaction received federal antitrust clearance in May 2007. The two parties announced theyd agreed to combine operations in March of that year. The state Insurance Department held public hearings on the deal this month, and the companies must answer questions from those sessions as well as more than 70 questions from the departments staff, spokeswoman Rosanne Placey said. The public comment period will close at the end of August, and Insurance Commissioner Joel Ario hopes to make a decision by the end of the year, Placey said.
USMD, an Irving, Texas, company that manages and develops physician-owned facilities, said it hired Karen Fiducia as president of its hospital division. Fiducia has more than 25 years of experience in healthcare turnarounds and financial operations. Most recently, she worked for QHR, a hospital management services provider formerly known as Quorum Health Resources, Brentwood, Tenn. Fiducia served as an interim hospital chief executive officer for various QHR hospital clients.
Both Anthem Blue Cross of California and Blue Shield of California agreed to reinstate insurance coverage to a total of 2,220 former members whose policies were revoked and pay up to $15 million in fines. Blue Shield of California, a not-for-profit based in San Francisco, will reinstate 450 former enrollees with individual health insurance plans and pay a $3 million fine. The insurer is subject to another $2 million fine if it doesnt change its policies over individual coverage within 18 months. Anthem Blue Cross of California, a for-profit subsidiary of WellPoint, will pay a $10 million fine and restore coverage to 1,770 Californians. Neither company admits to wrongdoing in the agreements. The agreements came one day after the Los Angeles city attorney filed a lawsuit against Blue Shield of California over its rescission policies, which Blue Shield said was without merit. The Managed Health Care Department has reached similar settlements with other insurers over policy rescissions. Gov. Arnold Schwarzeneggers administration is seeking legislation to put more of a burden on insurers to prove that applicants committed fraud when applying for policies before revoking coverage.
The Doctors Co., a California medical malpractice insurer, is no longer under investigation by federal authorities over its acquisition of SCPIE Holdings, a Los Angeles-based medical malpractice company. The U.S. attorney in Los Angeles advised Doctors Co. that it will not proceed further with its investigation, officials from the Napa, Calif.-based privately held company said. Doctors Co. completed its $281 million acquisition of SCPIE on June 30, after receiving approval from the California Insurance Department. When announcing its approval of the acquisition, the department revealed that federal investigators had opened an inquiry into Doctors Co. and one or more former employees over possible unauthorized access to SCPIEs computer system. The U.S. attorney also confirmed that no action is planned with respect to any current and/or former employee of the Doctors Co., the company said in a written statement. Doctors Co. now has 43,000 physician members.
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