News for Insurers
Top stories summarized by our editors
5/21/2018

Boys who began using marijuana before age 15 had a 68% risk of developing a drug abuse problem by age 28, compared with a 44% risk among those who started marijuana use at ages 15 or older, with every additional year of delayed marijuana use onset linked to 31% lower odds of drug abuse symptoms, according to a study in the Canadian Journal of Psychiatry. Researchers also found that earlier delinquent behavior was tied to earlier onset of marijuana use.

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HealthDay News
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marijuana
5/21/2018

Medicare coverage of some drugs can be easily shifted from Part B to Part D, potentially resulting in lower costs, depending on which drugs are chosen and how they are administered, said Pharmaceutical Care Management Association President and CEO Mark Merritt.

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Bloomberg Law
5/21/2018

The FDA and the CMS are considering requiring drugmakers to disclose list prices in direct-to-consumer advertisements, and industry watchers are questioning whether such a requirement would be legal or effective.

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FDA
5/21/2018

Drugmakers have misread the Trump administration's plan to make drugs more affordable, HHS Secretary Alex Azar says.

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The Hill
5/21/2018

Most congressional Republicans have said little about President Donald Trump's plan to reduce drug prices, and some political strategists are warning that they will miss an opportunity to connect with voters if they remain quiet.

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Axios
5/21/2018

Florida-based Hospice of the Treasure Coast, Health and Palliative Services of the Treasure Coast, and the Hospice of Martin and St. Lucie entered into a $2.5 million settlement deal to resolve allegations of defrauding Medicare and violating the False Claims Act. Court records show the organizations deliberately submitted or caused the submission of fraudulent Medicare claims from 2005 to 2011 for services rendered to patients who were not eligible to receive full or partial hospice care under Medicare rules.

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Department of Justice
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Medicare, Treasure Coast
5/21/2018

Perrin Edwards, a podiatrist from Columbia County, N.Y., was ordered to serve one year of probation and pay a fine of $5,000 after pleading guilty to health care fraud. Edwards admitted to improperly billing Medicare and private insurers for unprovided services or services he knew the insurance programs would not cover.

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Perrin Edwards, Medicare
5/21/2018

Kenneth Boyles, a member of the US Army Reserve from Clarksburg, W.Va., received a six-month prison term and was ordered to pay $244,320.07 in restitution after pleading guilty to health care fraud earlier this year. Boyles admitted that he falsely reported symptoms and improperly collected benefits worth over $224,000 from the Veterans Health Administration from 2008 to 2017.

5/21/2018

California-based physicians William Longton, Richard Shinaman and Ruben Kalra, who operate under the name Pain Medicine Consultants, collectively agreed to a $260,000 settlement deal to resolve allegations that they violated certain provisions of the Controlled Substances Act. A Drug Enforcement Administration inspection showed the doctors did not maintain sufficient records involving the receipt and distribution of controlled substances at their three California offices from Jan. 10, 2012, to Jan. 17, 2014, among other offenses.

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Department of Justice
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Pain Medicine Consultants
5/21/2018

A report found a 15% increase in the number of Minnesotans who had health coverage through small group health insurance policies last year. Health insurers said consumers have been shifting between individual and small group policies to manage costs.

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