MEDICARE
Judge sides with SCAN Health Plan in dispute with CMS over Medicare Advantage star ratings
SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services (CMS) inappropriately calculated its star ratings for the 2024 plan year.
SCAN filed suit in late December, arguing that CMS’ star ratings calculations violated the Administrative Procedure Act. CMS rolled out a number of changes to the methodology used to determine stars’ scores, and multiple payers saw a significant decline in their ratings as a result.
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Blue Shield of California Warns Consumers About Medicare Scams and Fraudsters
Healthcare fraud in the U.S. is an enormous, expensive problem — costing up to $300 billion, according to the National Health Care Anti-Fraud Association. Additionally, the FBI’s Internet Crime Complaint Center reported that in 2023, almost half of the victims of call center schemes were over 60 years old. These scams target older adults, who accounted for 40% of complainants and 58% of losses, or nearly $770 million. Older adults lost more money to these scams than all other age groups combined.
To reduce instances of phone scams for Medicare recipients, Blue Shield recommends that seniors avoid sharing personal information in situations like these example scenarios:
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COMMISSION PROTECTION
Agency owner solves succession plan
Father with two sons and an agency with subagents builds a plan to cross cover individual commissions so all are protected in all life events. Dad has the exit plan he needs while sons success is bound together to grow the agency as joint Successors.
Meeting ID:812 8787 5675
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GROUP BENEFITS
Get your health care through Covered California? Beware of this tax peril
IN SUMMARY
- Every year thousands of Californians are shocked to learn they owe the IRS for their subsidized health plan. Here’s how to avoid it.
- Every tax season hundreds of thousands of Californians are hit with an unexpected bill: They owe hundreds of dollars or more to the IRS because they accepted more money in subsidies for health insurance than they were allowed.
The chargeback can sting. Collectively, 415,000 California households owed the IRS close to $690 million in 2021 in charges related to the health care subsidies, according to agency data from the most recent year available. That is roughly $1,662 per person or family. Many people who end up owing money live in lower-income households.
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5 steps to improve employee satisfaction with benefits
The key to maximizing your benefits offering is to actively engage with, and listen to, the needs of your employees, offer them flexibility and education, and don’t be afraid to make changes.
Employee benefits are crucial to the satisfaction and productivity of any workforce. Research has consistently shown a direct link between the perceived quality of benefits employers offer and overall employee job satisfaction. For example, a study by the Society for Human Resource Management (SHRM) found that 92% of employees say benefits are critical to their overall job satisfaction.
However, despite their importance, there is often a gap between the benefits 0employers offer and the benefits employees value most. According to research from MetLife, employee satisfaction with their benefits fell to 61% in 2023, down from 64% in 2022 and the lowest point in the past decade.
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COMPLIANCE
GLP-1s: Transforming Obesity Treatment and Insurance Coverage
By Misty Baker
Discover the groundbreaking potential of GLP-1 agonists in tackling obesity. From reshaping insurance coverage to revolutionizing workplace wellness, explore how these medications are transforming the fight against excess weight and its associated health risks.
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Lawsuits are flying over generic-drug disputes
Five of the suits were filed by Esperion Therapeutics, which seeks to stop competitors from selling generic versions of the company’s cholesterol drug Nexletol.
New Jersey’s federal courts are in the midst of a surge in patent litigation, driven by pharmaceutical companies’ claims of infringement against generic-drug producers.
Plaintiffs filed seven patent suits in the District of New Jersey from May 20-26, representing a major escalation when compared with the average rate of one new patent suit per week. And the surge continued in the period from May 26-30, when another three patent suits were filed.
All but one of the 10 cases were brought by holders of drug patents seeking to stop the production of generic versions of their products.
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INDUSTRY CALENDAR
We are enhancing our Calendar of events!
We are adding more events, and in 2024 we will begin to get these events to you in all Cal Broker media. Our monthly magazine and eNewsletter, Insurance Insider, have been the methods by which we have shared events for 42 years. Now we can help you with links in our traditional media that lead to our website, www.calbrokermag.com/calendar, where the California Broker Event Calendar will be posted.
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California Broker eDirectory— GET listed and Join today.
Learn More: www.ca-brokerdirectory.com
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