Comments: 0 - Date: December 31st, 2007 - Categories: Uncategorized
UnitedHealth Group's former CEO and board chair has settled with the company and the Securities and Exchange Commission over allegations that he benefited from an illegal scheme to maximize what he earned in stock options. But legal troubles remain for both William McGuire, MD, and United. On Dec. 5, 2007, Dr. McGuire settled with the Securities and Exchange Commission and with pension funds that had brought a lawsuit against him over backdating of stock options, which was alleged to have occurred from 1994 to 2005. The SEC settlement totaled $468 million, the largest ever resulting from options backdating.
Though Dr. McGuire admitted no wrongdoing, the size of the settlement "reflects the magnitude and scope of Dr. McGuire's misconduct," Linda Chatman Thomsen, director of the SEC's enforcement division, said in a prepared statement. Of that total, $7 million was a civil fine paid to the SEC, another $12.7 million was a return of what the SEC called "ill-gotten gains," and the remainder was a forfeiture of options already issued. The SEC settlement also bars Dr. McGuire from serving as an officer or director in a public company for 10 years. In the lawsuit settlement, Dr. McGuire agreed to reimburse United for $448 million in options and cash, on top of $200 million in options he gave back upon resigning from United in November 2006, after 15 years with the company. The SEC said the lawsuit settlement, which needs to be reviewed and approved by a U.S. District Court judge in Minnesota, was sufficient to cover the forfeiture it had ordered. [...] Copyright 2008 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:Health plan earnings up, but United's woes continue Feb. 26, 2007 SEC takes closer look at United's stock-option grants Jan. 15, 2007 Stock option problems magnifying financial troubles for United Nov. 27, 2006
Comments: 0 - Date: December 17th, 2007 - Categories: Uncategorized
Family physician Don Gibson, MD, isn't too keen on talking about bills with patients. Usually, he said, if a patient asks about the price of a visit or a test, he refers them to "the people at the front desk," who manage the billing for his solo practice in Richland, Miss.
His hesitance to talk about the cost of care or a patient's bill is just the way he was trained, Dr. Gibson said. "I do have to talk about money more. I personally don't like to be a part of it, but at times I have to be a part of it."
The discussion about money is happening more often, in part because some patients now have high-deductible health plans paired with health spending or flexible spending accounts -- also known as consumer-directed health plans. Advocates of such plans say that giving patients first-dollar coverage will get them more involved in their health care, and more involved in discussing the costs. But analysts say those plans are growing more slowly than expected because of a perceived taboo about patients and doctors discussing the cost of care. "There's no question that there will be certain individuals who just don't feel comfortable having this discussion related to their financial situation, period," said Jacque Sokolov, MD, chair and senior partner at health care consulting firm SSB Solutions. It appears many patients and physicians are having a difficult time turning health care into a consumer-retailer discussion. "I'm only concerned about their medical problem," Dr. Gibson said. "I don't like that term, 'consumer,' even though I guess there's some truth to it. I've always considered them my patients, not consumers." [...] Copyright 2007 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:HSA enrollment growth slows but is still high May 14 High-deductible plans seen as risky for kids March 19 Congress adopts measures to boost health savings accounts Jan. 1/8 Insurers offer expansions to consumer-driven health care Sept. 11, 2006
Comments: 0 - Date: December 17th, 2007 - Categories: Uncategorized
Despite deals in New York that insurers pledge will improve their tiered networks nationwide, physicians are not assured that networks based on quality ratings will be to their liking. One of the hottest battles over tiered networks is going on in Massachusetts. It involves the tiered network system mandated by the Massachusetts state employees health insurance program, the Group Insurance Commission. In November, the GIC started accepting proposals from health plans that would set up networks covering not only 250,000 state employees, but also potentially another 330,000 municipal employees as the program expands to cover any state and local public employee.
The commission and its insurers actually released their first networks based on quality ratings in April, but the expansion of its networks, and physicians' dislike of how ratings are established, has the Massachusetts Medical Society speaking out against the commission's tiered networks. In this fight, allies include legislators pushing House and Senate bills governing standards for tiered networks, and, in a case of strange bedfellows, BlueCross BlueShield of Massachusetts, which said it would refuse to submit a proposal. Katherine Atkinson, MD, a family physician in Amherst, Mass., said GIC health plans have sent notices to physicians informing them that they are in low tiers without offering an explanation, and without any chance to appeal their ranking. Worse, she said, the rankings are based largely on cost, but patients don't know that -- they assume the doctor must be incompetent or have committed malpractice. [...] Copyright 2007 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:More health plans agree to New York model for physician rankings Dec. 10 Insurers agree to more transparent physician ratings Dec. 3 New York agreement refines doctor-rating criteria Nov. 19 Resistance builds against insurers' tiered networks Sept. 17
Comments: 0 - Date: December 10th, 2007 - Categories: Uncategorized
North Shore Cardiovascular Associates in Salem, Mass., recently spent $280,000 for an electronic medical records system, or $20,000 for each of its 14 physicians. It figured it had no choice but to spend the money. That's because Partners HealthCare, its hospital partner, mandated that North Shore, and every other practice that refers patients, have an EMR. Otherwise, they no longer can practice at Partners facilities. The hospital system has offered to pay some costs, but not all of them.
"It is basically a loss," said Mario Motta, MD, a cardiologist with the North Shore practice. "I don't get to keep the medical record if I decide to move. The benefit primarily accrues to the system and insurers, who make out royally for this. They should be paying for the bulk of it." Some Partners-affiliated doctors are choosing to retire or leave rather than buy a system. Dr. Motta understands how they feel. "If I was in my mid-60s, I would say 'no way.' " But more physicians soon may well be in the position of being forced to adopt some form of information technology. Frustration with the slow spread of medical technology is driving some payers, hospitals and legislators to consider mandates to require physicians to purchase it. The argument for mandates is one of patient safety and health system efficiency. Technology adoption by physicians is necessary to reduce errors and costs, advocates say. With surveys showing fewer than 10% of doctors using electronic prescribing and only 20% using electronic medical records -- and those numbers stagnating -- too much is at stake to wait for doctors to adopt technology, say those advocating mandates. [...] Copyright 2007 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:AMA meeting: Delegates seek tax credit to help pay for EMRs Dec. 3 Ohio medical society pushes doctor-friendly EMR pacts Nov. 26 Doctors offer views on EMR implementation Nov. 12
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