News for Insurers
Top stories summarized by our editors
6/20/2018

The number of patients visiting community health care clinics increased by 33% from 2010 to 2016, according to a study from George Washington University's Milken Institute School of Public Health. The biggest increases were in states where Medicaid was expanded.

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Healthcare Finance
6/20/2018

Switching EHR systems can improve efficiency and productivity, but the switch can also be costly, according to the Medical Economics 2017 EHR Report. Physicians can predict costs for software and hardware but some unanticipated expenses often result.

6/20/2018

Researchers found that adolescents with the lowest urinary iodine levels had a fivefold increased likelihood of developing speech comprehension-related hearing loss, compared with those with higher iodine levels. However, the findings in JAMA Otolaryngology -- Head & Neck Surgery showed that high urinary iodine levels and any urinary iodine level weren't significantly associated with speech-frequency hearing loss and high-frequency hearing loss, respectively, prompting researchers to conclude the need for more studies.

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iodine deficiency
6/20/2018

Amgen received full approval from the European Commission for its Blincyto, or blinatumomab, to be used as a treatment for adult patients with Philadelphia chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia. The decision was based on overall survival data from the late-stage TOWER study, in which patients who received Blincyto experienced a median OS of 7.7 months compared with four months for standard of care chemotherapy.

6/20/2018

The Medicaid and CHIP Payment and Access Commission on Friday released its annual report urging Congress to implement key changes in the Medicaid drug rebate program in order to reduce medication spending for low-income people. MACPAC said Congress can improve the program by giving the HHS secretary the authority to impose financial sanctions on drugmakers that will fail to provide accurate drug classification data, as well as by removing a statutory requirement permitting pharmaceutical firms to use the prices of authorized generics and branded drugs in calculating the average manufacturer price.

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MACPAC, Medicaid, Congress, HHS
6/20/2018

A total of 39 drugs and biologics were added to the medicines shortage list last year, and though the number of new shortages rose after declining over the previous two years, the number is well below the 2011 total of 251 new shortages, according to the FDA.

6/20/2018

John Holland, a former executive of Tenet Healthcare, filed a motion to appeal a federal judge's decision to allow additional charges to be brought against him for his alleged involvement in a $400 million Medicaid fraud and kickback scheme involving Tenet, which agreed to pay $514 million in October 2016 to settle the accusations. Holland's lawyers said the September 2017 indictment, which charged Holland with wire fraud, conspiracy to violate the federal Anti-Kickback Statute and falsification of books and records, was "legally flawed" because it neglected to allege that the contracts Holland used to pay Tenet weren't for the fair value of the clinic's services.

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Tenet Healthcare, Tenet, John Holland
6/20/2018

Elijah Caldwell, a licensed clinical social worker and owner of Waterbury, Conn.-based behavioral health practices A Prospering Vision and Home of Hope, agreed to pay $200,000 in a civil settlement to resolve accusations that he defrauded the state's Medicaid program by submitting fraudulent claims for unprovided counseling services from March 2013 to December 2016. As part of the settlement, Caldwell's practices will be banned from participating in the Connecticut Medical Assistance Program for 10 years.

6/20/2018

Gary Yelton, a pharmacist from Louisville, Ky., was arrested and charged with obtaining a controlled substance by fraud and unauthorized procurement of a controlled substance over allegations he illegally obtained controlled substances while working for CVS Pharmacy. For about two years, Yelton allegedly created false patient profiles in CVS' database so he could illegally obtain hydrocodone and other controlled substances, an arrest report showed.

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CVS Pharmacy, hydrocodone
6/20/2018

Lacy Baker, a nurse from Kendallville, Ind., was arrested and charged with possession of a controlled substance by fraud and corrupt business influence over allegations she illegally prescribed opioid painkillers to her relatives. Baker allegedly wrote oxycodone prescriptions for her relatives using blank prescription orders that were presigned but not authorized by her employer, an orthopedist, court records showed.

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painkillers, oxycodone