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U.S. health agency weighs
rules on outside payments for Obamacare
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[August 19, 2016]
By Caroline Humer
NEW YORK (Reuters) - A U.S. government
health agency on Thursday said that it was considering new rules to
prevent healthcare providers or related groups from steering patients
into Obamacare individual insurance plans instead of Medicare or
Medicaid in order to receive higher payments for medical services.
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 The Centers for Medicare & Medicaid Services on Thursday said it is
seeking public comment and considering rules including prohibiting
or limiting premium payments or cost-sharing for the individual
marketplace plans, monetary penalties and limits on such payments.
It also sent a letter to dialysis centers that are part of Medicare
informing them of these plans.
"It is improper to influence people away from Medicare or Medicaid
coverage for the purpose of financial gain," Shantanu Agrawal, CMS
Deputy Administrator and Director of the Center for Program
Integrity, said in a statement.
Three of the largest U.S. health insurers have raised the issue of
third-party payments in recent months, including UnitedHealth Group
Inc, Anthem Inc and Aetna Inc.
UnitedHealth and Aetna have decided in 2017 to largely exit the
government-run online marketplaces that sell these subsidized plans
created under President Barack Obama's national healthcare reform
law.
Under Obamacare, individual plans offered by the insurers generally
pay doctors and other medical groups more than Medicare and Medicaid
for their medical services and may cover different drugs and
procedures.
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UnitedHealth filed a lawsuit against American Renal Associates
Holdings earlier this summer that has to do with payments for
dialysis through its exchange plans.
Aetna said during an Aug. 2 conference call with investors that
third-party payers steering patients to the individual market had
contributed to an unhealthy mix of customers in its individual plans
sold on the exchanges.
(Reporting by Caroline Humer, editing by G Crosse)
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