Walgreens agrees to pay $269 million in fraud accord

Walgreens Boots Alliance agreed to pay $269.2 million to settle U.S. claims that the drugstore chain defrauded a federally funded health care program over insulin drugs and a consumer-discount initiative. The two settlements, announced Tuesday, cover allegations over improper billing. In the first one, the company agreed to pay $209.2 million to resolve claims it billed Medicare, Medicaid and other programs for hundreds of thousands of insulin pens it distributed to people who didn’t need them. In the second, Walgreens said it would pay $60 million for overbilling Medicaid by not disclosing lower prices it offered in a discount program. To read more, click here.

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Beware of Phishing Email Disguised as HIPAA Privacy Audit Letter

The Office of Civil Rights (“OCR”) of the Department of Health and Human Services (“HHS”) has posted an alert warning employers, and others, of a fake communication involving the OCR audit program under HIPAA. The email falsifies HHS departmental letterhead and the signature of the OCR Director and directs individuals to a non-governmental website marketing the cybersecurity services of a firm that is not associated with HHS or OCR. This phishing email originates from the email address OSOCRAudit@hhs-gov.us and directs individuals to a URL at http://www.hhs-gov.us. This is a subtle difference from the official email address for the real HIPAA audit program, OSOCRAudit@hhs.gov Phishing is a scam typically carried out… Read More

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Top Five Reasons for ER Trips on Thanksgiving

The Top 5 Reasons for ER Trips on Thanksgiving   Thanksgiving is almost here! It’s a wonderful day spent together with your family and loved ones. People across the Country will be spending hours and hours perfecting their feasts after weeks of careful planning. Family from near and far gather together to give Thanks for the little (and big) things in life. The meaning behind it all is beautiful. So what’s the worst thing that can happen as everyone prepares to enjoy the delicious food? Someone getting hurt. And not just a little hurt, hurt enough to have to go to the ER. Knowing what the top reasons are can… Read More

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Change of Income? When and How to Notify the Marketplace.

One of the benefits of getting your Health Insurance through the Marketplace is the tax credit applied to your premium, which makes your costs much more affordable. However, when determining how much your tax credit will be, you use an estimate on your income for the following year. Life is always changing, so if your income changes, if your Family size changes or even being offered Healthcare in some other way it is IMPORTANT to alert the Marketplace of these changes or you may end up owing money back to the Government when you file your taxes at the end of the year. Here we will talk about which types… Read More

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Ways to Save Money on Your Prescription Drugs

Prescriptions costs are skyrocketing. We all know that. But did you know that there are several ways for people to save money on their monthly medications? As health insurance plans are becoming more catastrophic in nature, that means that people will need to become better health care consumers. Sometimes that means using the tools that the insurance company offers at no charge. Sometimes it means using discounts and other resources that are available outside the health plan. Here are a few ways, some already widely known and others not so much, to help drop down your costs at the Pharmacy. While this is not a comprehensive list of money-saving ideas, it is… Read More

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Important Info! HSA Limits for 2019

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What is an HRA and How It May See A Major Change Soon..

Before we get into how rules for HRAs may be changing, we should discuss what an HRA is and how it works. A Health Reimbursement Account (sometimes referred to a Health Reimbursement Arrangement) is an employer-funded group health plan that reimburses employees, tax-free, for qualified medical expenses up to a certain amount per year. This type of policy does not replace Medical Insurance and is usually coupled with a High-Deductible policy. Unlike an Health Savings Account (HSA), the Employee can not help to fund the account.  Like HSAs though, there are maximum allowed contributions. In 2018, an Employer can fund an HRA up to $5,050 for a Single Employee and $10,250… Read More

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Common Questions: Rules For Your HSA After Becoming Medicare Eligible

Medicare and Your HSA In 2017, over 22 million Americans have a Health Savings Account. Each year that number goes higher and higher as High Deductible Plans become more popular with Individuals and Employers. Once you turn 65 and enroll in Medicare, you can no longer open an HSA or deposit money into it, but what if you already had one with a balance? You don’t have to worry about a “Use It Or Lose It” clause. That money can still be used towards out-of-pocket costs! Here are some very common questions about how you can continue to benefit from your HSA and why keeping funds in it for your… Read More

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President Trump Signs Prescription Drug Gag Clause Legislation

President Trump Signs Prescription Drug Gag Clause Legislation On Wednesday, President Trump signed into law S. 2553, the Know the Lowest Price Act, and S. 2554, the Patient Right to Know Drug Price Act. The legislation was passed by the House and Senate last month with bipartisan support and will ban “gag clauses” that prevent pharmacists from telling customers when they can save money on their prescriptions by paying out of pocket for the retail price of the drug, rather than using their insurance and making the co-payment. These bills comprise portions of President Trump’s “America First” prescription drug initiative that were released as part of a blueprint to lower drug prices in May.… Read More

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5 Affordable Self-Employed Health Insurance Options When You’re on a Budget

5 Affordable Self-Employed Health Insurance Options When You’re on a Budget When you are self-employed, finding affordable health insurance options isn’t easy. There are more types of insurance policies now more than ever; However not all of those choices are affordable.  So, how can you find good coverage when you’re on a budget? Continue reading below for some great options to make sure you get the benefits you need at a price you can afford!   1. Telemedicine Services and Secure Doctor Consultations A budget-friendly health insurance alternative that’s gaining popularity are Telemedicine Services.  Telemedicine services are just like they sound, it’s a medical service that allows you to speak to… Read More

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The History of Medicare

  A brief history of Medicare in America Landmark social program now covers 58.5 million Americans By Steve Anderson Discussion about a national health insurance system for Americans goes all the way back to the days of President Teddy Roosevelt, whose platform included health insurance when he ran for president in 1912. But the idea for a national health plan didn’t gain steam until it was pushed by U.S. President Harry S Truman.On November 19, 1945, seven months into his presidency, Truman sent a message to Congress, calling for the creation of a national health insurance fund, open to all Americans. The plan Truman envisioned would provide health coverage to individuals, paying for such typical expenses… Read More

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New Law Exempts Certain Small Employer HRAs From ACA Market Reforms

New Law Exempts Certain Small Employer HRAs From ACA Market Reforms Gaddiel Gonzalez-Brown & Brown Consulting President Obama has signed into law the 21st Century Cures Act, which, among other things, allows small employers to offer new “qualified small employer health reimbursement arrangements” to reimburse employees for qualified medical expenses, including individual health insurance premiums, for years after December 31, 2016. Small employers are defined as those with fewer than 50 full-time equivalent employees who do not offer a group health plan.   Background Under prior agency guidance, stand-alone HRAs (except for retiree-only HRAs and HRAs consisting solely of excepted benefits) and HRAs used to purchase coverage on the individual… Read More

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Total Benefit Solutions: New Starmark Self Insured Plans for Small Groups

Total Benefit Solutions is proud to announce that we are now appointed with Starmark to provide affordable and predictable self insured medical plans to small businesses. Starmark® administers self-funded health benefit plans exclusively for smaller businesses nationwide. Employers choose from extensive plan design choices to create a self-funded health plan to meet their unique needs and budget, while stop-loss insurance from Trustmark Life Insurance Company provides protection against large covered claims. Click Here To View A Client Testimonial Click here for more information and to watch a short video about these products and how your organization might benefit from a self insured plan.

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Sick Pay Laws to Date

  States are free to draft sick pay laws that uniquely and diversely affect employers. Current sick pay laws may have common characteristics, but varied application. To date, there are six States and twenty municipalities with sick pay laws. In addition, the President signed Executive Order 13706, which requires entities contracting with the Federal government to provide employees with up to seven days of paid sick leave annually. The result is a hodgepodge of regulation that creates burdensome administration and increased expense for employers. Click to Download Sick Pay Laws to Date

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HIPAA Audits to Increase in 2016

On March 21, 2016, Health and Human Service’s Office for Civil Rights (“OCR”) announced the launch of the second round of national HIPAA audits. These audits are focused on covered entities (health plans and health care providers) and business associates (e.g., brokers, TPAs). The audits will target enforcement of HIPAA Privacy, Security and Breach Notification rules.   Click Here to Download HIPAA Audits to Increase in 2016 – 041816R (1)

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Navigate HCR: Excessive Waiting Periods

6.  Dr Kristin Kahle’s Monday Report – Navigate HCR     Welcome back to our series on the ACA Toolkit. Today’s topic is excessive waiting periods. A group health plan or issuer may not impose a waiting period that exceeds 90 days. A waiting period is the period of time that must pass before coverage for an employee or dependent who is otherwise eligible to enroll becomes effective.   Eligibility conditions that are based solely on the lapse of time are permissible for no more than 90 days. However, other conditions for eligibility are permissible, as long as they are not designed to avoid compliance with the 90-day waiting period… Read More

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HR Insights Newsletter March 2016

Click the link to view the March 2016 issue of HR Insights from Think HR    View as web page HR Advice When You Need It Have an HR question that needs the human touch? Call the Live Hotline team for answers and advice at 1-855-775-7750 brought to you by Total Benefit Solutions Inc.. ThinkHR provides expert, practical human resource guidance to businesses of all sizes, helping them avoid costly risk and liability and save time. 4457 Willow Road, Ste. 120, Pleasanton, CA 94588 855.271.1050 © 2016, ThinkHR. All rights reserved.   T

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How do I appeal a Marketplace decision?

  You can request an appeal of any Marketplace decision, including decisions about Your eligibility to buy coverage in the Marketplace Your eligibility for, or the amount of, premium tax credits or cost sharing reductions Your eligibility for an exemption from the penalty for not having health insurance Untimely (late) notice from the Marketplace about a decision To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. So far, in the federal Marketplace, the notice will not provide much detail to explain the reasons… Read More

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New Analysis Finds Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option

New Analysis Finds Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option for People with HIV Among 300 Enrollment Options Examined, an HIV Positive Enrollee Could Save $4,000 on Average by Assessing a Fuller Range of Costs A new Kaiser Family Foundation analysis finds that people living with HIV could benefit from looking beyond premium costs when shopping for a health plan in the marketplace – as plans with the lowest premiums are often not the most cost-effective option. People with HIV can find lower cost plans by conducting a more comprehensive cost assessment that includes other factors such as deductibles, drug costs, and out-of-pocket maximums…   Click… Read More

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New Accident & Critical Illness Options

Total Benefit Solutions now offers multiple complementary policies that will help cover the large deductible and copay gaps in today’s ACA plans. These plans include: Critical Illness Plans ( lump sum benefits for a critical illness) Accident Plans ( lump sum benefits in the event of an accident) Hospital Indemnity Plans ( limited benefits based on a specific inpatient hospital stay) Dental Plans Disability Plans ( benefits to replace lost income due to an illness or injury)   Click the link below to easily quote, compare and enroll today! Call your Total Benefit Solutions account manager at (215)355-2121 if you have any questions or concerns!  

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IRS sets 2016 HSA limits

The IRS said it is raising the maximum allowable contribution to a health savings account by $100 in 2016 — but only for families. The IRS quietly announced last week that the maximum contribution that can be made next year to an HSA linked to a high-deductible plan will be $6,750 for employees with family coverage, up from $6,650 in 2015. The maximum contribution for those with single coverage, however, will remain unchanged at $3,350.

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Millions of Uninsured May Pay More for Coverage Penalty than Coverage Would Cost

Millions of Uninsured May Pay More for Coverage Penalty than Coverage Would Cost   A recent Kaiser Family Foundation (KFF) analysis found that millions may pay more for not having health insurance in 2016 than the coverage would cost. The ACA’s individual mandate penalty is collected with income taxes and was created to encourage people not to wait until they get sick to buy health insurance.   For 2016, the penalty is the greater of two amounts:   •$695 plus $347.50 per child, up to a $2,085 max for a family or •2.5 percent of family income in excess of 2015 income tax filing thresholds ($10,300 for an individual, $20,600… Read More

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