News for Insurers
Top stories summarized by our editors
8/15/2017

The White House has not yet decided what type of emergency declaration to declare to address the opioid overdose crisis, but the President's Commission on Combating Drug Addiction and the Opioid Crisis has recommended acting under authority of the Stafford Act or the Public Health Service Act. The administration has not made it clear what actions it will take.

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White House, public health
8/15/2017

President Donald Trump criticized Merck's prices after CEO Ken Frazier quit his manufacturing advisory council.

8/15/2017

Drug companies that wait to release full clinical trial data upon publication in journals or during medical conferences can leave investors who have access to only top-line results with an inaccurate picture of a drug candidate's prospects.

8/15/2017

Camilo Primero, a former physician and owner of three hospice and home care companies located in Las Vegas, Nev., and his business partner, Aurora Beltran, were charged with making false statements relating to a health benefit program and money laundering over their alleged involvement in a $7.1 million Medicare fraud scheme. The defendants, both California residents, are accused of submitting false Medicare claims for people who didn't need hospice care or were not terminally ill, authorities say.

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hospice care
8/15/2017

Ibilola Ighama-Amegor, a pediatrician and owner of Quality Pediatrix in Newark, N.J., was sentenced to a three-year state prison term and was ordered to pay $216,000 in restitution after being found guilty of health care claims fraud and Medicaid fraud. An investigation found that Ighama-Amegor improperly billed Medicaid for at least 24 hours of work on 48 dates between April 2008 and May 2011, although Quality Pediatrix operated only for about eight hours per day.

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Quality Pediatrix, Medicaid
8/15/2017

Holly Jean Cox, a former pharmacy technician at the Lyster Army Health Clinic at Fort Rucker in Alabama, agreed to enter a guilty plea to one count of obtaining controlled substances by fraud or deception as part of plea deal. Cox was accused of entering fraudulent prescriptions for hydrocodone, Percocet and other controlled substances into the clinic's computer system and filling them for herself on multiple occasions from December 2015 to March 2016, court records show.

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Holly Jean Cox
8/15/2017

Jamie Thomason, a resident of Rossville, Ga., is facing charges of TennCare fraud and theft of services worth over $10,000 on allegations of falsely collecting TennCare benefits by claiming to be a resident of Hamilton County, Tenn., according to officials.

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Jamie Thomason
8/15/2017

Annuities can be used to make sure that people who need assistance from Medicaid to pay for long-term care plan their finances and make sure they comply with Medicaid asset limits, according to a report from Stephen Moses, president of the Seattle-based Center for Long-Term Care Reform. One Medicaid planning strategy involves buying a Medicaid-compliant annuity in the name of a spouse who doesn't require long-term care in order to reduce the assets allocated to the spouse who will require nursing home care, according to the report.

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Medicaid, Stephen Moses
8/15/2017

The Congressional Budget Office plans to release a report later today on the impact that discontinuing cost-sharing reduction payments to insurers will have on the federal budget, health care costs, coverage and market stability, and this report will inform the Senate Health Committee's hearings on short-term insurance market stabilization in early September. Committee Chairman Lamar Alexander, R-Tenn., has expressed support for continuing the payments, though the Trump administration has not confirmed whether these payments will be made in August.

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The Hill
8/15/2017

White House officials have been in discussions with 15 to 20 moderate and conservative House Democrats in the effort to reform the tax code, saying they would prefer a bipartisan approach. Marc Short, White House director of legislative affairs, adds that the White House plans to initiate conversations with Senate Democrats soon. Democrats have signaled that they are open to a bipartisan process, although this approach is counter to the approach described by Senate Majority Leader Mitch McConnell, R-Ky., who said Republicans plan to use the simple-majority budget reconciliation process.

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Politico