News for Insurers
Top stories summarized by our editors
5/25/2018

Pfizer entered into a $23.85 million settlement deal to resolve accusations that it violated the False Claims Act by improperly using a foundation as a conduit to cover copayments of patients taking three of the firm's prescription kidney cancer and heart drugs. Authorities said the scheme, which ran between 2012 and 2016, allowed Pfizer to increase its revenue and raise drug prices.

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Reuters
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Pfizer
5/25/2018

The Senate Judiciary Committee backed five bills intended to address opioid misuse that include provisions to increase participation in drug take-back programs, strengthen Drug Enforcement Administration authority to set quotas and reduce demand for illicit narcotics.

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AHA News Now
5/25/2018

A Thomsons Online Benefits survey of 2,200 employees worldwide found almost 60% want to improve their mental and physical well-being and 75% are focused on achieving a work/life balance. The survey found employees who felt their employer-provided benefits positively affected their lives were more than 40% more likely to say they were loyal to their company.

5/25/2018

Intermountain Healthcare, Ascension, SSM Health, Trinity Health and the Department of Veterans Affairs are collaborating on producing oral medications and sterile injectable drugs on their own or by contracting with manufacturers to create a more reliable supply of generic drugs. A survey by Reaction Data found that 90% of 605 hospitals and clinics said they would buy drugs from the partners, and 80% of nearly 750 health care providers, payers and drugmakers polled expressed optimism that the partnership would succeed.

5/25/2018

Republicans and advocacy groups led by former US Sen. Rick Santorum plan to release a proposal aimed at repealing the Affordable Care Act before the midterm elections in November. The coalition of conservative groups has spent eight months crafting a proposal that would give states more control over health care, but Republicans are mixed on whether it is advantageous to bring up the issue again.

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Sen. Rick Santorum, ACA
5/25/2018

David Williams, a fitness trainer from Fort Worth, Texas, and owner of Kinesiology Specialists, could face up to 40 years in prison after being convicted of four counts of health care fraud. Trial evidence showed Williams, who provided fitness and exercise training services, falsely certified himself as a health care provider and improperly billed private insurers for medical services, allowing him to collect more than $3.9 million worth of improper payments from November 2012 to August 2017.

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Department of Justice
5/25/2018

Maurice Sharpe, co-founder and manager of Torrington, Conn.-based social services agency Family First Community Support Services, was ordered to serve five years of probation and pay $211,131 in restitution after pleading guilty to health care fraud for his role in a Medicaid fraud scheme. Sharpe admitted to fraudulently billing Medicaid for unprovided psychotherapy services or services rendered by unlicensed individuals using the Medicaid provider number of a licensed social worker, which resulted in about $1.6 million worth of improper payments from Medicaid.

5/25/2018

Mauran Ambulance Service co-owner Toros Yeranosian and the company's manager, Aharon Krkasharyan, both California residents who were convicted of conspiracy to commit health care fraud last year over their involvement in a $1 million-plus Medicare fraud scheme, were recently suspended from participating in California's workers' compensation program. The California Division of Workers' Compensation also suspended Los Angeles-based doctor Ronald Grusd from participating in the program after being convicted last year for his role in a $20 million-plus kickback and fraud scheme.

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Insurance Journal
5/24/2018

Kaiser Permanente is investing $200 million in the next two to three years in affordable housing and the fight against homelessness in eight states and Washington, D.C., as part of its efforts to improve health by addressing social issues. "As a family physician, I've provided medical care to the homeless, and have seen first-hand the impact that living without a home can have on someone's health," said Kaiser's Chief Community Health Officer Dr. Bechara Choucair.

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CityLab
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Kaiser Permanente
5/24/2018

The Senate Committee on Health, Education, Labor and Pensions on Wednesday voted to advance a bill that would reauthorize the Pandemic and All-Hazards Preparedness Act, a law originally passed in 2006 that aimed to improve how federal, state and local governments respond to disease outbreaks, natural disasters and attacks. The new version includes provisions to advance development of influenza vaccines and medications and to boost research on antibiotic resistance.