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Anti-abortion group wants Illinois to enforce parental notice -- now

An anti-abortion group is asking the Illinois Supreme Court to order immediate enforcement of a state law requiring physicians to notify a minor's parent or legal guardian at least 48 hours before performing an abortion. The Parental Notice of Abortion Act of 1995 was blocked from taking effect for more than a decade until the high court in 2006 finally issued mandated rules allowing young women to ask a court to bypass the notice requirement. It would be up to the court to decide if a waiver is in the minor's best interest. After additional litigation, the 7th U.S. Circuit Court of Appeals in July upheld the law's constitutionality in Zbaraz v. Madigan and dissolved a long-standing injunction preventing its implementation. The statute took effect Aug. 4. But concerns from the medical community about compliance prompted the state medical board to delay enforcement of the law by three months. Under the act, any doctor who does not act in good faith to obey the law would face a mis ...

Medicaid claims lack key data that could help find fraud

Medicaid claims information submitted by states to the Centers for Medicare & Medicaid Services is slow in being released to the public and often does not contain many data elements that can assist in fraud detection, according to a report by investigators from the Dept. of Health and Human Services Office of Inspector General. In an Aug. 26 letter to Cindy Mann, the director of the CMS Center for Medicaid and State Operations, OIG states that CMS did not fully disclose or document information about the accuracy of data collected by the Medicaid Statistical Information System. Timely, accurate and comprehensive data can be used to help interagency efforts in combating health care fraud, the report notes. States must submit claims files to CMS within 45 days after the end of each quarter. The system is designed to serve as an accurate database pertaining to standardized enrollment, eligibility and paid claims of Medicaid beneficiaries. In a review of MSIS files, OIG determined ...

California nursing association says insurers reject 22% of claims

California Attorney General Jerry Brown has launched an investigation into insurance companies' claims-processing practices, on the heels of a report that found health plans in the state reject about a fourth of all claims. Based on information from the state's Dept. of Managed Health Care, the California Nurses Assn. in September reported that claims denial rates for the largest plans averaged 22% between 2002 and 2009. The denial rates include any time a claim was not paid -- whether the claim was a duplicate, was sent to the wrong insurer, was made for an ineligible patient or had incomplete information. For the first half of 2009, the group reported that denial rates for the six biggest plans ranged from a high of 39.6% for UnitedHealth Group's PacifiCare to 6.4% for Aetna ( In a Sept. 3 statement announcing his office's inquiry, Brown said, "These h ...