News for Insurers
Top stories summarized by our editors
11/22/2017

The FDA approved GlaxoSmithKline's Juluca, a once-daily tablet that combines dolutegravir and rilpivirine, for HIV patients who have followed a stable regimen for at least six months.

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Reuters
11/22/2017

A federal jury ruled that Johnson & Johnson must pay $247 million to settle claims that it failed to warn doctors and patients about possible defects with its Pinnacle artificial hips. J&J plans to appeal the ruling.

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Johnson & Johnson
11/22/2017

Auxilium, a unit of Endo International, is not liable for a heart attack suffered by a man who was taking the company's testosterone replacement drug Testim, a federal jury ruled last week. Endo is facing more than 1,200 other lawsuits involving Testim.

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Reuters
11/22/2017

The Oregon Health Authority will continue to cover care for some 80,000 children and 1,700 pregnant women through April despite Congress' failure to renew Children's Health Insurance Program funding. Gov. Kate Brown had asked OHA officials to work with coordinated care organizations to extend coverage.

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KTVZ-TV (Bend, Ore.)
11/22/2017

Samuel Konell of Boca Raton, Fla., entered a guilty plea to conspiracy to defraud the US government and to receive health care kickbacks over his involvement in a $63 million Medicare fraud scheme. Konell received $9.5 million to $25 million from Greater Miami Behavioral Healthcare Center between January 2006 and June 2012 in exchange for referring Medicare beneficiaries to the clinic for unnecessary treatments, according to prosecutors.

11/22/2017

George Compton, a psychologist practicing in Coldwater, Mich, received a 28-month prison term and was ordered to pay restitution after pleading guilty to health care fraud. Compton collected more than $800,000 in fraudulent reimbursements from private insurers for counseling sessions he never rendered between January 2013 and June 2016, according to authorities.

11/22/2017

A Medscape survey found that 55% of more than 4,000 physicians surveyed across 25 specialties said they were the subject of a malpractice lawsuit at least once in their career, with surgeons and obstetrian/gynecologists -- both at 85% -- the most likely to be sued. The most common reasons for a suit were diagnosis failures and treatment complications.

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HealthLeaders Media
11/22/2017

Charissie Davis, a resident of Decatur, Ga., received an 18-month prison term and was ordered to pay $50,244 in restitution after pleading guilty to improperly billing a Medicaid waiver program. Davis submitted fraudulent timesheets to the Home Services Program between February 2011 and March 2014 for services she claimed were provided to her by her son.

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Medicaid
11/22/2017

Paul Biddle, a doctor from Orchard Park, N.Y., was arrested and charged with identity theft and obtaining controlled substances by fraud on allegations that he used his patients' identities to illegally obtain opioids for himself. Biddle allegedly wrote 888 opioid painkiller prescriptions for 23 patients, two of whom were deceased, from November 2013 to October 2017 using a pharmacy in Tampa, Fla., but kept the drugs for his own use, according to court records.

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identity theft
11/22/2017

Enrollment numbers in Affordable Care Act marketplaces are about 300,000 higher than at this time last year, but the Trump administration's cuts to the advertising budget and shortening of the enrollment period may still result in fewer people signing up overall, experts say. Data indicates that in prior years there have been two spikes in enrollment -- the first made up of older and sicker people and the second made up of younger and healthier people who respond to outreach. The second spike may not occur this year.