News for Insurers
Top stories summarized by our editors
8/20/2018

HHS Secretary Alex Azar said the agency has the authority to end the use of drug rebates, but pharmacy benefit managers say eliminating rebates under anti-kickback rules would require an act of Congress.

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Reuters
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HHS, Alex Azar, Congress
8/20/2018

Drugmakers are citing constitutional protections in fighting state efforts to require disclosure and justification of price increases.

8/20/2018

Technology-driven health insurance company Oscar Health is joining insurers in the Medicare Advantage market.

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Oscar Health, Oscar
8/20/2018

An agreement between Walmart and Anthem that is to take effect in January will allow seniors in Anthem's Medicare Advantage plan to use their insurance to pay for some over-the-counter medications and medical supplies purchased from the retailer. Some 250,000 people in Anthem's MA plan have the OTC benefit.

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CNBC
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Walmart
8/20/2018

Wade Barker, a bariatric surgeon and co-founder of the now-defunct Forest Park Medical Center in Dallas, could face between 60 months and 77 months in prison after agreeing to enter a guilty plea to conspiracy to pay and receive health care bribes and kickbacks in relation to an alleged $200 million health care fraud scheme involving Forest Park. Barker admitted to receiving payments in exchange for performing his surgeries at Forest Park and causing the payment of $100,000 to another doctor in July 2012 in exchange for referring patients to the hospital.

8/20/2018

Estella Natera and Felix Ramos, both employees of Texas doctor Jorge Zamora-Quezada, who is under investigation for alleged health care fraud, each entered a not-guilty plea to charges over their alleged involvement in Zamora-Quezada's case. Natera, who was charged with conspiracy to obstruct justice and commit health care fraud, and Ramos, who was charged with conspiracy to commit money laundering, were both released on bond.

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Jorge Zamora-Quezada
8/20/2018

Phillip Kuna, a former mobile therapist with the Children's Service Center in Tunkhannock, Pa., received a prison term of between four months and 23½ months plus five years of probation and was ordered to pay $19,012 in restitution for Medicaid fraud, tampering with records and theft by deception. Authorities said Kuna submitted fraudulent encounter forms for unprovided psychotherapy services supposedly rendered to several elementary school students, allowing him to collect $19,012 worth of improper payments from Medicaid's Medical Assistance program.

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Medicaid
8/20/2018

Sentencing for Anis Chalhoub, a Kentucky-based cardiologist who could face up to 10 years in prison after being convicted of medical fraud, was postponed to Oct. 30. Court records showed Chalhoub performed medically unnecessary heart procedures and then falsely billed Medicare and Medicaid for those procedures from March 2007 to July 2011.

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Anis Chalhoub, Medicare, Medicaid
8/20/2018

Highland Hospital in Oakland, Calif., is among a growing number of health care institutions that initiate opioid addiction treatment in their emergency departments, putting patients who otherwise may not seek care on the road to recovery.

8/20/2018

Compliance with a one-hour care bundle mandated by New York state for any child presenting with sepsis reduced in-hospital mortality for children with sepsis and septic shock, according to a study published in the Journal of the American Medical Association. The care bundle calls for taking blood cultures and administering broad-spectrum antibiotics and intravenous fluids within one hour, and while none of the components alone was associated with improved outcomes, completion of the entire bundle was linked to a lower death risk.