In brief: The Maryland Medical Society and Attorney General's Office have teamed to create a site aimed at helping doctors file complaints against insurers.

The full story

When insurance companies refuse to cover patient care and doctors believe them to be in the wrong, normally they have little recourse and the legal remedies are arduous, to say the least.

Now, in Maryland, doctors can use a new website launched by the Medical Society and the Attorney General of Maryland to file those complaints in a faster, easier fashion.

Called Insurance Watch, it's hosted by the Medical Society and can be thought of as a sort of Better Business Bureau for insurers.

Its primary purpose is to allow doctors to more easily "help patients when legitimate health insurance claims have been denied," according to the attorney general's office. But it also contains information for patients about filing insurance complaints on their own and allows MedChi to track doctors' complaints.

Summing up

The site uses existing infrastructure with the state attorney and insurance commissioner, but makes it more accessible to doctors and patients.

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In brief: The owner and employees of a Miami massage clinic have been indicted on insurance fraud.

The full story

An undercover sting operation against the Flamingo Health Corporation in Miami brought a license massage therapist, a physician\\\'s assistant and 14 patients to arrest on charges of insurance fraud and grand theft.

The owner, Judith Gonzalez, allegedly billed insurance companies nearly $250,000 in fraudulent claims and coached patients, including undercover officers, on how to commit personal injury protection (PIP) fraud, state allegations say.

The Florida Division of Insurance Fraud in conjunction with the Miami-Dade Police Department Public Corruption Investigations Bureau carried out the investigation with help from the U.S. Secret Service.

Investigators claim that Gonzalez directed undercover officers posing as patients to sign blank treatment forms and then coached them on how to answer questions from insurers in order to validate the claims.

Summing up

The investigation was triggered by tipsters calling Florida\\\'s Dept of Financial Services hotline.

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In brief: California legislators have proposed strict limits on self-insurance plans for businesses that do not wish to participate in a registry or insurance market and many are saying they're too restrictive.

The full story

Both business and insurance groups are attacking a proposal by California regulators that would impose heavy limits on a type of insurance currently being sold to small employers. This new type of self-insurance is a hybrid combination of insurance coverage (through underwriting) and self-paid costs.

Under traditional self-insurance plans, companies would create bonds or other instruments to protect against catastrophe in claims and otherwise pay claims out of pocket through an in-house, self-made insurance plan. These options were usually reserved for businesses with a lot of assets and liquidity.

The new hybrid has the insurance backing through a major insurer, but most costs are paid by the business and most premiums collected from employees are kept by the business to cover those payouts.

Regulators see these plans as a threat to the state insurance exchange as many companies with low-risk employees would likely opt out of the exchange in favor of this cheaper alternative, raising risks for others using the exchange.

Summing up

At stake here is insurance choices, which regulators appear unwilling to allow.

_{Photo credits: California Legislature}

In brief: The United States Supreme Court has heard arguments regarding the legality of the "individual mandate" in the law.

The full story

Arguments for and against were closed to the public and will not be known until the 9 justices of the court publish their findings. The press and pundits on both sides have laid out what the arguments likely have been, though.

They center on whether the government can constitutionally require individuals to purchase insurance coverage - or else. At stake is the core of the law, about 4,000 new jobs at the IRS to enforce it, and possibly the 2012 presidential campaign.

If the individual mandate is thrown out, then much of the rest of the Affordable Care Act would be crippled, though some supporters of the law say this is not the case. At the very least, it would severely limit the pool that the nationalized healthcare plan could cover.

Without that individual mandate, there would be no reason to hire more IRS enforcers for the law.

Finally, if the law is struck down, it's very likely it would become ammunition for Republicans during the 2012 Presidential race which will peak at elections this November.

Summing up

The justices are expected to issue findings sometime this summer, probably in July.

_{Photo credits: Supreme Court Building}

In brief: Starting at the end of the month, students at Michigan State University will be required to ahve health insurance coverage or be signed up and billed for a campus plan.

The full story

University officials say that students with health coverage are more likely to seek medical treatment when need and thus tend to stay healthier and do better academically than those who do not. They say that 25% of public universities nationally have the same requirement.

Opponents question that number and say that the insurance requirement is just another added cost for already expensive tuition, with students paying anywhere from $950 to $1,500 per year for coverage.

University officials will be required to testify before the Michigan House Appropriations Subcommittee on Higher Education this week to justify the policy.

Summing up

Several private institutions, some of which are in Michigan require students have health insurance. A few have policies that are lumped into tuition costs for those that cannot prove being covered otherwise.

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In brief: The federal government has rejected a waiver request by the State of Texas to be excluded from the new law limited health insurance profits.

The full story

The law, which began this year as part of the Affordability Care Act, requires insurance companies to spend no less than 80% of their revenue on providing health care or health improvement programs including payouts and no more than 20% on overhead and salaries.

Companies who, at the end of the year, have collected more than paid out are required to issue refunds to their policy holders.

Texas claims that their insurance market will be destabilized by the new law and is part of a lawsuit now in the Supreme Court contesting the Affordability Act as unconstitutional. Despite this, the federal government denied the request for a waiver from the rules for the year, forcing Texas to comply or be in violation of federal law.

Summing up

Texas is the ninth state requesting a waiver that has been denied.

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In brief: As the nation nears requirement, some states are further along than others in exchange building.

The full story

28 states and the District of Columbia are working on establishing healthcare insurance exchanges per the requirements of the Patient Protection and Affordable Care Act, which goes into effect in 2014.

A White House report glosses over where states stand in the program.

Some states are much further along than others, as noted by the Kaiser Family Foundation, which maps that progress. Of the 51 states and D.C., 22 are "studying options" and have yet to implement anything beyond committees. Six have done nothing at all and two have opted out entirely (Louisiana and Arkansas).

The holdouts aren't just Republican-dominant states, however. In fact, 14 of the 28 cited by the White House are Republican-lead states.

Five states have done little or nothing, ten have established exchanges that are live now or will be within a year, five more are planning to establish one, and two are awaiting legislation (Michigan and New Jersey).

Summing up

The vast majority of states are "studying options" or doing nothing, according to Kaiser.

_{Photo credits: Kaiser Foundation}

In brief: Wisconsin health insurers - the 6 largest in the state - have come together to form a new trade association, the Alliance of Health Insurers.

The full story

The alliance was created to advocate for essential and effective regulations within the state of Wisconsin. It will allow for insurers to band together on solutions for innovation and waste reduction within the industry.

The Alliance of Health Insurers includes WPS Health Insurance, Anthem Blue Cross and Blue Shield, Humana, Managed Health Services Insurance, UnitedHealthcare of Wisconsin and WEA Insurance.

"We look forward to doing what we can to improve the marketplace," said Phil Doughtery, senior executive officer of the association. "There may be issues where we have common ground (with the alliance), and there may be departures."

Summing up

The group formed shortly after the governor of Wisconsin announced that work on a state-run health exchange had ended without result.

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In brief: A growing trend is happening where uninsured and under-insured people in America turn to daily deals sites to get coupons for health care.

The full story

Groupon, one of the most popular of the daily deals sites, occasionally has coupons from medical clinics and dentists and says that they are often some of the most popular, selling out fast.

The deals usually offer 50% off to consumers who purchase it through the site and present the coupon to the provider.

Another similar site, LivingSocial, has seen trends that are much the same. A recent posting for a dentist in New York there received overwhelming response and sold out within hours.

The sites often feature everything from Botox injections to spa treatements to Lasik eye surgery, dental cleanings and exams, and even health checkups including one ad for a Department of Transportation health check for professional drivers.

It's a growing trend that is helping some Americans who would otherwise not be able to afford coverage to get basic health care.

_{Photo credits: Groupon - Living Social logos}

In brief: Kaiser Permanente of Colorado is offering cash to anyone in the state who loses weight and keeps it off.

The full story

While companies, some independent health plans, and many insurers offer incentives for clients who lose weight, Kaiser Permanente of Colorado is taking it a step further and offering cash incentives to anyone in Colorado who does so.

Participants in the Weigh and Win program can earn anywhere from $15 to $150 every three months if they lose weight and keep it off.

Kiosks with scales and a video camera to record progress are located in medical facilities, recreation centers, libraries, and businesses throughout Colorado.

The company hopes that the program will take off and has funded it with $500,000 to get started. If it's successful, they hope to pass it on to cities and other health care groups it's working with to expand the program further.

Participants are given grocery shopping lists and healthy meal recipes along with simple exercise advice to help them achieve their goals.

Summing up

So far, about 8,900 Coloradans have signed onto the program since it began in April with the average weight loss being 12 pounds.

_{Photo credits: Stock}