From Georgia Health News: Georgia doesn’t meet federal requirements on consumers’ ability to get a third-party review of their appeals against an insurer’s coverage decisions. That may mean Georgia by 2012 will have to contract with an independent review organization to handle consumer complaints or with the feds to oversee the process.
Last week, both the Los Angeles Times and The Nation put the spotlight on a little-known but influential conservative nonprofit that creates “model” state legislation that often make its way into law. The American Legislative Exchange Council has helped craft some of the most controversial — and industry-friendly — legislation of recent years.
Gov. Nathan Deal this week vetoed a bill that would have barred the state from paying a contingency fee to a contractor to recover Medicaid overpayments. Doctors’ groups had resisted paying auditors on a contingency basis as “perverse” and “burdensome,” but Deal said the state needs every tool available to identify Medicaid fraud.
Six years ago, a group of lawmakers and aides crafted Medicare Part D, the prescription drug program for seniors that has produced billions of dollars of profits for pharmaceutical companies. Today, at least 25 of those key players are back, but this time they’re lobbyists, trying to persuade their former colleagues to protect the lucrative system during the health care reform negotiations.