California’s Office of Administrative Law (OAL) approved state Insurance Commissioner Dave Jones’ request for an emergency regulation to give him the authority to enforce the 80 percent Medical Loss Ratio (MLR) in the individual market established under the Patient Protection and Affordable Care Act. According to the rule, insurers must provide rebates when the spending on “non-claims costs” — such as executive salaries, advertising and administrative costs — exceed 20 percent in the small group and individual
Washington’s Department of Labor & Industries’ Fraud Prevention and Compliance Program brought in $137.4 million in 2010 for its fraud fighting efforts. The total includes payments from employers for delinquent or falsely reported premiums. It also includes recovered payments to injured workers or health care providers made on fraudulent claims. Near-record collections in a sluggish economy prove that targeting and enforcement are working, as are programs that assist struggling employers in paying their debts, L&I said.
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