CalChamber Celebrates Contributions of Hispanic Businesses
Latinos in the United States are an economic powerhouse, contributing trillions in gross domestic product (GDP) each year.
In fact, if U.S. Latinos were a standalone country, they would rank as the fifth largest GDP in the world—larger than India, Russia, Canada, England and other major economies, according to the latest report by the Latino Donor Collaborative (LDC) in partnership with Wells Fargo. Projections show that the U.S. Latino economy will surpass Germany’s GDP by 2027.
Economic Contributions
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California to require physician oversight of AI-driven health insurance decisions
Over the last month, California Gov. Gavin Newsom has signed 17 bills pertaining to the deployment and regulation of generative AI technology, including legislation that will require health insurers to ensure that physicians supervise the use of AI tools that make decisions about services and insurance claims.
The bill establishes requirements for health plans using AI or other software tools for utilization review and management decisions. The tools must rely on a patient’s medical and clinical history and not override provider decisions — any violations could result in legal consequences. The bill also prohibits AI, algorithms, or software tools from making decisions based solely on group data or discriminating against patients in violation of state or federal laws. Tools must also be open for audit or compliance reviews.
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How one AI solution is aiming to help tackle insurance fraud
As insurance carriers increasingly incorporate artificial intelligence into different aspects of their operations, one California-based data company is hoping its technology can be used to help fight insurance fraud across the industry.
Carpe Data, founded in 2016, leverages data, analytics and AI to generate proactive counter-fraud alerts on claims. Geoff Andrews, COO, Carpe Data, said this helps carriers identify previously undetected fraud, reduce loss expenses and accelerate and improve their claims resolution process overall.
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The growing cost of health care continues to vex state policymakers
In a sign of the times, Capitol Weekly’s annual health care conference on Thursday focused broadly on expenses and efficiency, befitting for an American health care system that has become one of the most expensive in the world.
Keynoting the event was Assemblyman Jim Wood (D-Healdsburg), the former longtime chairman of the Assembly Health Committee, who noted that there are some estimates that 20 to 30 percent of health care spending is wasted.
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MEDICARE
CMS faces another star ratings lawsuit, this time from UnitedHealthcare
Another significant legal headache related to star ratings is on the table of the federal government just days before open enrollment begins.
UnitedHealthcare companies in various states are suing the Centers for Medicare & Medicaid Services (CMS) for decreasing the insurer’s star ratings unfairly. They are looking for an injunction and corrected ratings before Oct. 15.
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CMS to increase oversight on exchange brokers
The proposed rule comes after the CMS reported a growing number of complaints about ACA health plan applications submitted by brokers.
Dive Brief:
The CMS is continuing to crack down on health insurance agents and brokers who fraudulently enroll beneficiaries in Affordable Care Act marketplace plans.
In a proposed rule released Friday, the agency could suspend brokers beginning next year from the exchange entirely if they violate marketplace rules, in a bid to prevent agents from switching consumers’ plans without their consent.
The proposal comes months after the CMS said agents couldn’t make changes to a consumer’s enrollment unless they’re already associated with that beneficiary, following increasing complaints about unauthorized plan changes.
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