Path: bloom-picayune.mit.edu!snorkelwacker.mit.edu!news.media.mit.edu!americast.com!usa-post Newsgroups: usa-today.insur From: usa-post@AmeriCast.Com Organization: American Cybercasting Approved: usa-post@AmeriCast.com Subject: insur Thu, Mar 19 1992 Date: Thu, 19 Mar 92 05:57:39 EST Message-ID: 03-19 0000 DECISIONLINE: Insurance USA TODAY Update March 19, 1992 Source: USA TODAY:Gannett National Information Network HOSPITALS OVERCHARGING MILLIONS: Hospitals owe the government tens of millions of dollars in Medicare overcharges, according to a national audit released Wednesday. Richard Kusserow, inspector general for the Department of Health and Human Services, criticized hospitals for hanging onto as much as $265 million that the government had overpaid. He also faulted insurers for not attempting to recover excess payments. (For more, see special Medicare package below.) DOCTORS BLAST INSURERS: The California Medical Association on Wednesday criticized insurance companies that are denying health insurance to women with silicone gel breast implants. The CMA's 450-member House of Delegates also passed a resolution urging insurers to pay for immunizations against childhood diseases and to stop denying insurance coverage to people who already are sick or injured. COMMISSIONER WANTS CHANGE: New Jersey Insurance Commissioner Samuel Fortunato said Wednesday he wants to change a component of Gov. Jim Florio's auto insurance reform law to put an end to rate hikes for thousands of motorists. Fortunato told the Assembly's insurance committee that thousands of drivers who want to leave the state's high risk pool next month may be hit with high rates. GOOD DRIVERS MIXED WITH BAD: New Jersey's auto insurance law allows insurance companies to charge the same rates that drivers were paying in the pool, known as the Market Transition Facility. The state is attempting to get motorists out of MTF, which replaced the mismanaged Joint Underwriting Association. The old JUA ran up a $3 billion debt and once included half of New Jersey's drivers, including good drivers. SENATE REJECTS DRUG MEASURE: The Senate recently rejected a proposal aimed at holding down prescription-drug prices by curbing a lucrative tax break for drug manufacturers. The measure, by Sen. David Pryor, D-Ark., was killed on a 61-36 vote. Pryor, chairman of the Senate Aging Committee, proposed to curtail drug makers' claims to a tax credit for their Puerto Rico operations if their prices rise faster than inflation. EMPLOYERS APPROVES MERGER: Shareholders of Employers National Life Insurance Co., Dallas, have approved a proposal to merge the company with a subsidiary of Protective Life Insurance Co., Birmingham, Ala. Under the agreement, each outstanding share of Employers National common stock will be converted into the right to receive cash determined by a formula currently estimated at $45 per share. CYSTIC FIBROSIS DRUG PROMISING: An experimental drug may fight lung congestion caused by cystic fibrosis, suggests research in Thursday's New England Journal of Medicine. The drug, called recombinant human deoxyribonuclease, is a copy of a molecule that breaks up the mucus in lungs. If proven safe in further studies, the drug, manufactured by Crystal and Genentech Inc., may be available in two years, say researchers. RADIATION THERAPY GETS NOD: Women who had breast cancer don't increase their risk of getting another tumor by undergoing radiation therapy, says a study in Thursday's New England Journal of Medicine. Researchers say fewer than 3% of second breast cancers can be attributed to radiation therapy. The study found an increased risk in those treated for breast cancer before age 45, but those women are few in number. SPECIAL PACKAGE ON MEDICARE: HOSPITALS REBILLED MEDICARE: The overpayments resulted from hospitals billing Medicare and a private insurer for the same service or from hospitals rebilling Medicare for services already reimbursed. In some cases, hospitals billed the government for services that were never rendered. As many as 70% of the audited hospitals said they attempted to repay some portion of the Medicare funds but could find no way to do it. OVERPAYMENTS UNDETECTED: The government failed to detect the overpayments, said several officials, because of the sheer size and complexity of the 27-year-old federal health insurance program. Begun in 1965, Medicare provides insurance coverage for 30 million Americans aged 65 and older. Last year, the government spent $108 billion for physician services, hospital care and diagnostic tests. AS MUCH AS $265M OVERPAID: The overpayment problem was first noted in 1986, when the inspector general projected that $164 million had been mistakenly collected by hospitals and not returned to the government. A recent review of Medicare payments made to 76 hospitals in five states, found overpayments amounting to $1.2 million. From that, it was estimated that as much as $265 million was overpaid. (End of package.) Insurance Editor: Michele Coleman. (1-919-855-3491) Making copies of USA TODAY Update (Copyright, 1992) for further distribution violates federal law. This article is copyright 1992 Gannett News Service. Redistribution to other sites is not permitted except by arrangement with American Cybercasting Corporation. For more information, send-email to usa@AmeriCast.COM