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Insurance issues dealing with CMS to private insurance.

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ACA Responds to New United Healthcare Policy Classifying Chiropractic as “Non-essential”
Tuesday, 02 November 2010
(Reprinted from the ACA “Week In Review” of 10/28/2010) You may recently have heard about United Healthcare (UHC) and another flawed policy proffered by this carrier. Like you, we at ACA are not at all happy about it. This unfortunate policy, which offers definitions of “essential, mixed, and non-essential benefits” --chiropractic is listed as non-essential--is just another attempt to jockey around impending non-discrimination mandates. We are developing an appropriate response along with our Chiropractic Summit partners so our message is unified and our actions are focused and effective. We will share the response with you once it is available.
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Insurance Journal Reports: National Insurance Crime Bureau Starts New Florida Effort
Monday, 16 August 2010
           The Insurance Journal reported the following on August 11th: “The National Insurance Crime Bureau (NICB) announced today that it has established its second major medical fraud task force in Florida to counter the increase and spread in acts of medical fraud.
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CFO Alex Sink’s Division of Insurance Fraud Uses New Tool to Combat Insurance Fraud Activities
Monday, 16 August 2010
            Florida CFO Alex Sink announced the acquisition of a new investigative tool for the Division of Insurance Fraud (DIF) to use when investigating insurance fraud crime. The Division is introducing a surveillance vehicle that will assist detectives in undercover and long-term, complex operations. Investigative tools like this offer detectives enhanced surveillance opportunities and provide an invaluable asset to investigators that directly affect investigative efforts.
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BLUE CROSS BLUE SHIELD UPDATE:
Friday, 04 June 2010

JUDGE DENIES BLUE CROSS’ ATTEMPT TO DISMISS ERISA AND FLORIDA INSURANCE EQUALITY LAW CLASS ACTION

      The Florida Chiropractic Association and FCA Member Peri Dwyer, D.C., through Class Counsel and FCA Assistant General Counsel Kim Driggers of the law firm of Brooks, LeBoeuf, Bennett, Foster & Gwartney, joined 18 individual plaintiffs and four other chiropractic associations in a class action against 22 leading Blue Cross Blue Shield (“BCBS”) insurers across the country.  The suit challenges BCBS’ abusive practices in using post-payment audits and reviews and improper payment demands, to pressure providers to repay substantial sums that BCBS previously paid as health insurance benefits for services provided to BCBS subscribers.  The suit also seeks damages and an order requiring Blue Cross Blue Shield of Florida (“BCBSF”) to cease violating Florida’s Insurance Equality Laws.  The Complaint alleges BCBSF violated Florida’s Insurance Equality Laws by limiting coverage for certain chiropractic services by covering only a single physical modality or procedure code per patient per day and limiting the number of spinal manipulations that are covered in a calendar year.

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State Farm's use of Medicare NCCI Edit
Monday, 12 April 2010
           The FCA is aware that State Farm continues to impose the Medicare NCCI (National Correct Coding Initiative) edits on PIP bills.
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