News in brief - March 3, 2003

Justice Dept. joins Highmark case - Workers want balance - Wash. HMO relents on alternative health

Justice Dept. joins Highmark case

The U.S. Justice Dept. in February joined a whistle-blower suit against Highmark Inc., the Blue Cross and Blue Shield plan serving western Pennsylvania, accusing the insurer of filing false Medicare claims and demoting a Highmark executive involved in overseeing the company's adherence to Medicare rules.

Highmark paid the government $38.5 million in 1998 to settle claims that its corporate predecessor, Pennsylvania Blue Shield, had violated the False Claims Act by illegally charging the government for bill reimbursements that it should have paid itself as a primary payer.

The government is accusing the Pittsburgh-based company of knowing at that time that it potentially owed the Medicare program millions of dollars more, that its lack of full compliance with the reimbursement agreement was "widely known" among Highmark top executives, and that an executive charged with monitoring Highmark's Medicare payments was harassed and demoted as a result of her efforts to change corporate practices, the government said. The executive filed her civil suit in 2000.

Highmark is refuting all claims made in the current lawsuit.

Workers want balance

The ability to balance work and life priorities ranked as the chief job factor of health care workers, topping salary and benefits, according to a recent survey conducted by CareerBuilder, an online job search and recruitment company.

About 90% of health care workers chose the work-life balance as their priority, followed by salary and benefits. Workers in all other industries chose salary as their top factor, according to the survey.

About 60% of workers in the health care industry said they were satisfied with their jobs, compared with 50% of all workers. About two-thirds of health care workers said they felt secure in their jobs, compared with 52% of all workers, according to the survey.

On the downside, about 59% of health care workers said they worked under a great deal of stress, compared with 52% of workers in all industries, according to the survey.

Wash. HMO relents on alternative health

Group Health Cooperative, which has 600,000 HMO members in the Northwestern United States, has agreed to reimburse patients in Washington state for certain alternative health care it previously had refused to reimburse.

In a settlement of two class-action lawsuits, the managed care company agreed to cover treatment by naturopaths, acupuncturists and massage therapists with fewer restrictions in the future and to reimburse some 100,000 members who already got care from these practitioners between June 1996 and December 2002. The reimbursements are expected to total several million dollars.

Under the agreement, Group Health members won't have to seek traditional treatment from physicians before going to alternative practitioners. They can get reimbursement for two visits to a naturopath without a physician referral, and five visits to an acupuncturist. Visits to a massage therapist will be covered but will still require a referral.

A 1996 state law in Washington mandated that patients be paid by insurers for alternative care, but Group Health had generally required members to get standard care first.