Alison Young Investigates

Feds accuse Michigan Blue Cross of violating antitrust laws

The U.S. Justice Department on Monday sued Blue Cross Blue Shield of Michigan, accusing the giant insurer of driving up health care costs by using anticompetitive tactics. The nonprofit insurer, the suit alleges, has put "most favored nation" clauses in its contracts that require hospitals to charge competing insurers as much as 40% more than they charge Blue Cross. In effect, Blue Cross is purchasing protection from competition, the suit contends, and a Justice official warns that any similar behavior in other states will also be challenged. Blue Cross says the suit is without merit. Read the full USA TODAY story at: Feds accuse Mich. Blue Cross of anticompetitive contracts

Healthcare.gov posts pricing, application denial rates

Millions of consumers who shop for health insurance policies in the individual market will get a tool today that will help them compare prices and see inside information on how often insurers deny applications for coverage. Consumers have never had access to information about how often insurers deny individual applications or add surcharges to base plan prices, said Karen Pollitz, deputy director of HHS' Office of Consumer Support during a preview Thursday for USA TODAY of the new features at www.healthcare.gov. Read more at: New website shows prices for individual health plans

'Grandfathered' health plans exempt from parts of law

As more consumers focus on the details of the new health law's benefits, such as free preventive care provisions that took effect this week, some may question why their health plan doesn't have to comply immediately. Some of the law's key consumer protections don't apply to certain insurance plans in effect before March 23. Seeking clarity on 'grandfathered' health plans

New health law protections begin this week

Insurers can no longer set a dollar limit on the amount of care they'll provide over a person's lifetime or deny coverage to sick children. Young adults can stay on their parents' health plans until age 26. And consumers get greater rights to appeal insurers' decisions. Those are among the provisions of the nation's new health care law that begin taking effect Sept. 23. Many people, however, will have to wait until Jan. 1 for the changes to help them. That's because most of the new provisions apply to insurance policies that begin on or after Thursday and many plans operate on a calendar year. And there are other items in the fine print as well that are detailed in this story and chart: Health consumers to start feeling effects

Blue Cross of North Carolina must refund nearly $156 million

Because of changes coming in 2014 under the nation's new health law, Blue Cross and Blue Shield of North Carolina today announced it will refund nearly $156 million to more than 215,000 policyholders. Similar refunds may be owed to consumers with with policies through other health plans across the country, North Carolina Insurance Commissioner Wayne Goodwin tells USA TODAY. He's urging insurance regulators in other states to check whether other plans are overcharging for a certain type of reserve fund. The health care law will dramatically change how health policies are sold in 2014, and many plans in effect now will cease to exist that year in their current form. Yet when North Carolina regulators scrutinized a recent rate increase request by by Blue Cross and Blue Shield they say they discovered the insurer was collecting reserves to pay claims beyond 2014. Read the full story at: Blue Cross to refund $156 million in N.C.

New rules seek to catch Medicare fraud early

To help cut an estimated $55 billion in improper billing to federal health programs each year, proposed regulations being unveiled today would rate types of medical providers and suppliers by their risk of engaging in fraud or waste. Those deemed at highest risk would be required to undergo fingerprinting and criminal background checks to participate in Medicare. The proposed rules -- part of the nation's new health law -- also would give federal officials the power to suspend payments as soon as there's a "credible allegation" of fraud that merits investigation. The rules will end the current "pay and chase" enforcement in Medicare, Medicaid and the Children's Health Insurance Program, Peter Budetti, director of the new anti-fraud office at the federal Centers for Medicare & Medicaid Services, said in an interview with USA TODAY on Sunday. Feds gain power over billions in Medicare fraud

Why didn't USDA's egg graders see rodents, filth?

Outbreak investigators for the Food and Drug Administration this week released details of what they found at two Iowa egg processing firms implicated in a nationwide salmonella outbreak. It was the FDA's first time inspecting Wright County Egg and Hillandale Farms and they found mounds of manure, rodents, rodent holes, flies and other vermin. Yet the U.S. Department of Agriculture has had egg graders on site at both firms at least 40 hours a week -- including before the outbreak began. According to USDA's Regulations Governing the Voluntary Grading of Shell Eggs, the agency's workers were supposed to enforce rules against rodents and vermin. Why didn't they see the problems found by FDA?

Check out USA TODAY's report: USDA egg graders on site before recall come under fire

Member of Congress wants answers on egg recall delay

U.S. Rep. Rosa DeLauro, who is a top food safety watchdog as chair of the House Appropriations Agriculture Subcommittee, has sent a letter to federal health officials asking why it took so long for the public to be warned about the massive egg recall and outbreak. DeLauro cited a USA TODAY report Thursday that detailed how state and federal health agencies had identified Wright County Egg as a likely source of the outbreak at least  two weeks before the Aug. 13 recall.  Congress seeks answers on egg recall delay

Egg outbreak company identified 2 weeks before recall

By the end of July, state and federal health officials had identified Wright County Egg as a supplier to eight restaurants with separate illness clusters in two states. Yet the first recall wasn't announced -- and the public wasn't informed of the growing salmonella outbreak -- until Aug. 13. During most of that time the U.S. Food and Drug Administration was gathering invoices and other paperwork to further confirm the earlier findings. "Every day you delay a recall you're risking additional illnesses," says food safety advocate Caroline Smith DeWaal. Read the two USA TODAY articles about the delay at: Public alerts on egg risk delayed  and  Finding an outbreak's source not easy

States get millions to watchdog health insurance rates

To help curb health insurance rate hikes, states plan to use $46 million in federal grant money to seek new regulatory powers, hire actuaries and post rate filings on the internet, according to documents obtained by USA TODAY. Forty five states and the District of Columbia will get $1 million each under the nation's new health law. But some consumer groups question whether states have the political will to be aggressive watchdogs. "The track record shows they dont," said the Consumer Federation of America's Robert Hunter, a former Texas insurance commissioner. Grants to aid states vs. health rate hikes