Healthcare/PBM

Medco Health Solutions Inc (MHS.N) will lose a major pharmacy benefit contract to CVS Caremark Corp (CVS.N) starting next year, a setback that sent its shares down by as much as 12.5 percent on Friday and sparked further concerns about its ability to retain business.
Medco shares tumble after losing contract to CVS

The surprise decision on the Federal Employee Program account, for which Medco has been providing mail-order and specialty pharmacy benefits, follows closely on Medco losing a contract with Calpers, the biggest U.S. public pension fund.

The FEP move stands to hit Medco's profits next year by an estimated 8 percent while also reigniting concerns over whether the large U.S. pharmacy benefit manager will be able to hang onto another big contract that could be decided later this year. Chief Executive Officer David Snow only a couple weeks ago expressed confidence to Reuters that Medco was well-positioned to retain the FEP contract.

"It's a big loss because it's a high profitability contract with a lot of mail," Jefferies & Co analyst Arthur Henderson said. "The gold standard supposedly in the PBM business for mail is Medco."

snip
Wall Street is concerned that Medco may further lose a contract with insurer UnitedHealth Group Inc (UNH.N), which represents 17 percent of revenue and high single-digit percentages in earnings. That contract is set to lapse at the start of 2013, and some analysts expect UnitedHealth to move more of its drug benefit services in-house.

Investors also have been worried that Medco's ability to retain business might suffer because of a controversy involving Calpers, the California Public Employees' Retirement System.

Earlier this year, Medco received a subpoena from U.S. securities regulators involving a probe into a former Calpers board member whom Medco paid as a consultant to help secure a lucrative contract with the pension fund. Medco has said the Calpers issue has not been a significant business distraction.
http://www.reuters.com/article/2011/05/27/us-medco-idUSTRE74Q3AI20110527

HUGE!!! CVS is looking like a prime medicare fraud candidate.

HCA to acquire full ownership in HCA-HealthONE


Nashville-based hospital operator, HCA, has signed a non-binding memorandum of understanding with the Colorado Health Foundation to purchase for $1.45 billion the foundation’s 40 percent stake in HCA-HealthONE in Denver.

HCA-HealthONE, created as a joint venture between the foundation and HCA in 1995, is the largest healthcare system in the Denver area, with seven hospitals, 13 ambulatory surgery centers, more than 30 occupational medicine/rehabilitation, specialty, and outpatient diagnostic imaging clinics and AirLife Denver, which provides critical care air and ground transportation for an eight-state region. The system has 8,700 employees and 3,000 affiliated physicians.
http://www.healthcarefinancenews.com/news/hca-acquire-full-ownership-hca-healthone

HCA is on the move!

WellPoint to buy Medicare Advantage plan provider

Health insurer WellPoint Inc. said Wednesday it will buy CareMore, a California company that offers coverage in what WellPoint sees as a key growth area: Medicare Advantage plans. Terms of the deal were not disclosed.

The New York Times reported that the Indianapolis insurer will pay about $800 million for CareMore, but WellPoint spokeswoman Kristin Binns declined to comment on the price or how the deal will be financed.

CareMore, based in Cerritos, Calif., is owned by the private equity firm CCMP. It provides coverage and coordinated care for about 54,000 people in California, Arizona and Nevada. Most of its customers have several chronic conditions, and the company helps manage and coordinate care for patients who take many prescriptions and see several specialists, Binns said.

CareMore runs 26 clinics staffed with doctors, physical therapists and case managers, among other health care professionals.

WellPoint runs Blue Cross Blue Shield plans in 14 states and is the largest health insurer based on membership. It has about 1.3 million Medicare Advantage and Medicare supplement customers.

Medicare Advantage plans are privately run versions of the government's Medicare program, which provides health coverage for the elderly and disabled. Subsidized by the government, the plans offer basic Medicare coverage topped with extras like vision or dental coverage or premiums lower than standard Medicare rates.
http://www.businessweek.com/ap/financialnews/D9NNPJJG1.htm

medicare fraud alert!!!!

Check out CCMP its a LOL for sure.
http://www.muckety.com/CCMP-Capital-Advisors-LLC/5011399.muckety

Oops! Flaw in Obama healthcare law means millions of middle-class retirees set to receive Medicaid meant for poor

An anomaly in Barack Obama's controversial healthcare law will allow millions of relatively well-off people to qualify for Medicaid, it emerged today.

The loophole, which was only discovered after the complex bill was signed, will give some couples earning four times the federal poverty level entitlement to nearly free insurance meant for the poor.

It means a married couple who have both retired early could have an annual income of about $64,000 and still get Medicaid, according to officials who make long-range cost estimates for the Health and Human Services department.
After initially downplaying any concern, the Obama administration said late yesterday that it would look for a fix.

Up to three million people could qualify for Medicaid in 2014 as a result of the anomaly.
That's because, in a major change from today, most of their Social Security benefits would no longer be counted as income for determining eligibility.


snip
But states have been clamouring for relief from Medicaid costs, complaining that just these sorts of federal rules drive up spending and limit state options.

The program is now one of the top issues in budget negotiations between the White House and Congress. Republicans are pushing for a rollback of federal requirements that block states from limiting eligibility.


Read more: http://www.dailymail.co.uk/news/article-2006464/Obamas-healthcare-law-means-millions-middle-class-retirees-set-receive-Medicaid-meant-poor.html#ixzz1Q0K7dssr

A loophole for sure. The states are responsible for Medicaid costs. Will this get fixed?

no lol

UPDATE 1-HealthSouth gets subpoena for possible claim fraud

Says could not predict timing or outcome of investigation

* Shares down 6 pct in after-market trade (Follows alerts)

June 29 (Reuters) - HealthSouth Corp said it received a subpoena from the U.S. Department of Health and Human Services (HHS) in connection with an investigation of possible false or improper claims submitted under Medicare and Medicaid.

In a regulatory filing, the U.S. operator of rehabilitation hospitals said the HHS is seeking documents and materials relating to patient admissions, length of stay, and discharge matters in its HealthSouth Hospital of Houston -- a long-term acute care hospital.

Last year, two former employees of its Houston hospital sent a letter to HealthSouth alleging that the company wrongfully terminated them for refusing to commit various wrongful acts, including Medicare fraud, the company said.

HealthSouth said it does not know if the subpoena it received was related to the letter.

However, the company refused to engage in settlement discussions and informed the relevant authorities of the letter.

Shares of the company were down 6 percent at $24.50 in after market trade. They closed at $26.03 on Wednesday on the New York Stock Exchange. (Reporting by Anand Basu in Bangalore; Editing by Prem Udayabhanu)
http://www.reuters.com/article/2011/06/29/healthsouth-idUSL3E7HT3G620110629

hmmm, a repeat?

looks small but very interesting

Welcome to the Biggest Junk Bond Sale Since the Financial Crisis

Hospital operator HCA today clinched a $5 billion bond deal, in the biggest junk-bond sale since the financial crisis, according to people familiar with the deal.

The previous record was Chrysler’s $3.5 $3.2 billion bond sale earlier this year to repay its government-bailout loans.

Initially, HCA had sought to sell $1 billion in high-yield bonds to replace more expensive loans from its 2006 buyout led by private-equity firms KKR and Bain Capital. The private-equity firms launched an initial public offering of HCA earlier this year.

Strong appetite from junk debt funds is also helping KKR raise financings for new deals like its purchase of Capsugel Holdings Inc. Barclays Capital took advantage of surprising demand for the $1 billion loan backing the buyout to slash the interest on the debt by half-a-percent.

Why you might ask are high yield investors snapping up relatively risky debt on the eve of potential deficit destruction? It’s all in the flow.

After a dismal patch in June, high yield bond mutual funds have taken in $2.5 billion from retail investors in the past three weeks. That, compounded by the cash the funds get every June and July when a high concentration of bond interest payments come due, created a surge of liquidity looking for a home.

Apparently, not even the threat of the U.S. defaulting on its debt or simmering fears of Europe imploding can cure bond investors of their zeal for yield.

http://blogs.wsj.com/deals/2011/07/26/welcome-to-the-biggest-junk-bond-sale-since-the-financial-crisis/

HCA knows how to play the game.

Amerigroup hit by Georgia record-keeping issue

Georgia adjustment hits Amerigroup's earnings, may have broader industry impact

--Amerigroup shares plunge, competitors also trade lower

--Medicaid insurer sees "emerging signs" medical-cost trends are rising


Amerigroup Corp.'s /second-quarter profit dropped 34% as the Medicaid insurer said it had to return money to the state of Georgia because of a record-keeping problem there that also may affect the company's rivals.

The state of Georgia created too many Medicaid member records and believes it overpaid companies that manage the health program for the poor, Amerigroup said. The resulting "retroactive premium adjustment" knocked 16 cents off Amerigroup's per-share earnings in the second quarter, although the company indicated it may get some money back as state and Medicaid insurers continue sorting out the issue.

Shares of the Virginia Beach, Va., company plunged on the news Friday, recently falling 19% to $54.64. In its earnings report, Amerigroup also said it expects to use a higher percentage of revenue than previously thought to pay for patient care because of pressure on premiums and signals that medical costs may be rising.

Meantime, shares of Amerigroup's two competitors in the Georgia Medicaid market--WellCare Health Plans Inc. /quotes/zigman/341770/quotes/nls/wcg WCG -8.44% and Centene Corp. /quotes/zigman/292665/quotes/nls/cnc CNC -6.66% -- also fell Friday. WellCare declined comment ahead of its earnings next week; meanwhile, Centene noted the issue in its quarterly report filed Tuesday with the Securities and Exchange Commission but didn't mention Georgia by name.

snip
According to Amerigroup, it raised the duplicate-records issue with Georgia officials, and a state review "uncovered systemic membership record problems impacting contracted health plans as far back as the start of the program in 2006." Although it's common for the state to wind up with duplicate records, it usually tries to fix them in a timely manner, Amerigroup said.

Because these overstated membership files push down the premium rates paid to companies, Amerigroup expects later adjustments that will boost those per-member rates. But the company said it hasn't established a receivable for this because it can't make a precise estimate at this time.
http://www.marketwatch.com/story/amerigroup-hit-by-georgia-record-keeping-issue-2011-07-29

hmmm and this is JUST NOW being found? Doubt it, sounds like a debasement tool to me.

Georgia Medicaid move hits insurers hard

A move by the state of Georgia to eliminate duplicate billing on Medicaid payments took a severe bite out of the shares of Amerigroup Corp. and other health insurers in trading on Friday.

In reporting its second-quarter earnings, Amerigroup /quotes/zigman/265070/quotes/nls/agp AGP -18.41% said it told state officials it found “anomalies” in its membership records in Georgia, prompting the state to investigate the matter. The state discovered it had made duplicate payments for patients with more than one Medicaid case number, and called for Amerigroup to return those payments.
http://www.marketwatch.com/story/georgia-medicaid-move-hits-insurers-hard-2011-07-29?link=MW_latest_news

Amerigroup Directors.
Directors
Thomas E. Capps
Retired Chairman and Chief Executive Officer, Dominion Resources, Inc.

James G. Carlson
Chairman of the Board, President and Chief Executive Officer, Amerigroup

Jeffrey B. Child
Chief Financial Officer of a family office. Retired Director, U.S. Equity Capital Markets, Banc of America Securities, LLC.

Emerson U. Fullwood
Retired Corporate Vice President, Xerox Corporation

The Honorable Kay Coles James
Member, U.S. Department of Health and Human Services' Medicaid Advisory Commission. Former Director, U.S. Office of Personnel Management and Former Assistant Secretary, U.S. Department of Health and Human Services.

William J. McBride
Retired President, Chief Operating Officer and Director, Value Health Inc. Retired President and Chief Executive Officer, CIGNA Healthplans, Inc.

Hala Moddelmog
President of Arby's Restaurant Group, Inc. Former President and Chief Executive Officer of Susan G. Komen for the Cure and former President of Church’s Chicken.

Admiral Joseph W. Prueher, USN (Ret)
James R. Schlesinger Distinguished Professor at the University of Virginia’s Miller Center of Public Affairs, Former Ambassador to China, 17th Commander-in-Chief of the U.S. Pacific Command

Uwe E. Reinhardt, Ph.D.
James Madison Professor of Political Economy, Princeton University

Richard D. Shirk
Retired Chairman, President and Chief Executive Officer of Cerulean Companies, a subsidiary of WellPoint Health Networks, Inc. Mr. Shirk serves as the Lead Independent Director of Amerigroup Corporation.

The Honorable John W. Snow
President of JWS Associates LLC, Chairman, Cerberus Capital, Former U.S. Secretary of the Treasury, Former Chairman and Chief Executive Officer, CSX Corporation
http://phx.corporate-ir.net/phoenix.zhtml?c=122199&p=irol-govboard

http://www.muckety.com/Amerigroup-Corporation/5018803.muckety

Insurers Will Supply Health Data

Several major health insurers have agreed to provide their claims data on a regular basis to academic researchers, in an unusual agreement that they say will open a window onto the rising costs of health care.

Aetna, Humana, Kaiser Permanente and the UnitedHealth Group plan to supply information on more than five billion medical claims, representing more than $1 trillion in spending, to a newly created nonprofit group, the Health Care Cost Institute.

While Medicare has made its data available to researchers, with certain confidentiality restrictions like prohibiting identification of individual doctors, information from private insurers has been largely piecemeal.

“Our perspective is that the nation needs greater transparency about what is driving health care costs,” said Simon Stevens, an executive vice president for the UnitedHealth Group.

The insurers say they will not have access to the aggregated pool of private data and the data will not be accessible to the public. The new institute will provide claims information to qualified researchers seeking to analyze the data, and it will make public twice-a-year summaries that identify changes in health care prices and use of medical services. These summaries might examine specific areas like maternity care or orthopedic claims, according to Martin Gaynor, a health economist at Carnegie Mellon University who will be chairman of the new institute’s governing board.
http://www.nytimes.com/2011/09/20/health/policy/20health.html

lol, yeah sure they are not looking at private data. That is exactly what they are doing, to determine who is not worthy of healthcare. Cost/Benefit analysis. IF they are interested in transperancy, they should analyze the cost of insurance premiums, the small portion that actually goes to healthcare the huge portion that goes to CEO/CFO salary/bonus.

WellPoint to Vie With State-Run Health Markets

WellPoint Inc. (WLP), the largest insurer by enrollment, is buying a private health-insurance exchange to compete for employers with the U.S. state-run marketplaces set to open in 2014 under President Barack Obama’s health-care overhaul.

WellPoint and two nonprofit health insurers purchased a 78 percent stake today in Bloom Health, a closely held benefits company in Minneapolis, for an undisclosed sum, WellPoint said. Bloom is a two-year-old online marketplace that offers a menu of health plans to about 20,000 workers at almost 50 companies.

Using a private exchange such as Bloom would limit an employer’s costs and provide consistency compared with separate state-run exchanges, each with their own regulations, said Ken Goulet, chief executive officer of Indianapolis-based WellPoint’s commercial business unit.

snip
The idea of the private health-care exchange and its defined contribution model is similar to the trend in retirement benefits in which employers have been abandoning defined benefit pension plans for the relative financial safety of a 401(k) that allows companies to control how much they spend.

WellPoint’s partners in the Bloom purchase are Chicago- based Health Care Service Corp., the largest U.S. customer-owned insurer, and Blue Cross Blue Shield of Michigan, based in Detroit, which already held a minority interest in the private exchange. They bought the stake from Sandbox Industries Inc., a Chicago-based venture capital fund, and a joint venture of Blue Cross Blue Shield plans that invests in start-up health-care companies.

Health Care Services currently operates in Texas, Illinois, New Mexico and Oklahoma. It now will be able to offer employers choices of health plans in the 19 states where Bloom operates, said Martin Foster, president of plan operations at HCSC. The markets covered by Bloom represent about 60 percent of the U.S. population, Goulet said.

http://www.bloomberg.com/news/2011-09-20/wellpoint-buys-health-exchange-to-compete-with-state-run-insurance-markets.html

this is huge, and will have massive fraud opportunities...

we got our own medicare fraud down under now..

WellPoint gets $273M Medicare-Medicaid contract

WellPoint Inc.'s /quotes/zigman/362231/quotes/nls/wlp WLP +1.28% national-government services business, was awarded a Medicare administrative contract by the Centers for Medicare & Medicaid Services potentially valued at $273 million over five years.

The managed care provider and its rivals have been diversifying their businesses into areas beyond employer-sponsored health insurance and increasing their presence in plans that cover senior citizens in the wake of U.S. health-policy changes.

"This award is an important signal of CMS' continuing confidence in National Government Services and a key step in our efforts to further grow our business," said Sandra Miller, head of the national-government services business.

The unit currently contributes a relatively small part of WellPoint's overall revenue.
http://www.marketwatch.com/story/wellpoint-gets-273m-medicare-medicaid-contract-2011-10-06

medicare contracts ARE NOT about the money, they are about the opportunity to commit fraud!!!!

HCA Holdings Inc Investor Lawsuit and Deadline on December 27 Announced by Shareholders Foundation

The Shareholders Foundation, Inc. announces that a lawsuit has been filed in the U.S. District Court for the Middle District of Tennessee on behalf of certain investors in shares of HCA Holdings Inc (HCA) against HCA Holdings over alleged Violations of Federal Securities Laws.

Investors with a substantial investment in HCA made pursuant or traceable to the HCA Holdings' Registration Statement and Prospectus issued in connection with its March 9, 2011 initial public offering or shortly thereafter should contact the Shareholders Foundation by e-mail at mail@shareholdersfoundation.com or call +1 (858) 779-1554.

According to the complaint the plaintiff alleges that HCA Holdings Inc, certain of its officers and directors and the underwriters of its March 9, 2011 initial public offering violated the Securities Act of 1933 in connection with the March 9, 2011 IPO.

On October 1, 2011, a media article raised questions concerning the accounting for over $15billlion of HCA Holdings 2006 going private transaction worth over $20billion. The article said that "Simply put, after HCA was taken private, it was loaded with debt used to hand out billions of dollars to insiders. Then HCA was sold to public shareholders, whose investment's performance will be weighed down by that huge indebtedness for years."

Shares of HCA Holdings Inc (HCA) fell from as high as $34.88 during July 2011 to as low as $18.81 per share in October 2011.

http://www.marketwatch.com/story/hca-holdings-inc-investor-lawsuit-and-deadline-on-december-27-announced-by-shareholders-foundation-2011-11-14

HCA is corrupt. History repeating.