Robin Cronin, a dental office manager from Worcester, Mass., entered a guilty plea to one count of health care fraud and one count of conspiracy to commit health care fraud. Authorities said Cronin conspired with two dentists to submit fraudulent claims to MassHealth for dental services that were not reimbursable because the services were provided by a dentist who had previously been terminated from the health care program.
State Medicaid programs should cover Biogen and Eisai's Alzheimer's disease drug Aduhelm as an outpatient drug, said John Coster, director of pharmacy at CMS' Center for Medicaid and CHIP Services. Speaking at AHIP's National Conference on Medicare, Medicaid & Dual Eligibles, Coster said Biogen is part of Medicaid's drug rebate program, though states can create criteria for treatment eligibility.
Former FDA Commissioner Scott Gottlieb said the COVID-19 surge driven by the Delta variant could be the last major wave of coronavirus infections, but the pandemic is far from over, despite a recent decline in new COVID-19 cases and hospitalizations. Data from Johns Hopkins University indicate the country's seven-day average for new COVID-19 cases dropped to 130,790 as of Wednesday, down from 172,001 on Sept. 14, while the number of COVID-19 patients being cared for in US hospitals fell to about 86,920 on Thursday.
Patients' risk of hospitalization or all-cause mortality decreased 87% with a three-day course of intravenous remdesivir, according to data released by Gilead. Remdesivir is approved for use in hospitalized patients, but outpatient treatment for high-risk individuals like those included in the study is investigational.
Data from 1,613 pregnant women vaccinated against COVID-19 in their second or third trimester showed the vaccine was not associated with a higher risk of birth defects or miscarriage, says CDC Medical Officer Christine Olson. Another researcher, Dr. Elyse Kharbanda of the HealthPartners Institute, found no link between COVID-19 vaccines and stillbirths in a study that tracked pregnant, vaccinated women in the CDC's Vaccine Safety Datalink database.
Six drugmakers -- Sanofi, AstraZeneca, Novartis, Eli Lilly, Novo Nordisk and United Therapeutics -- received letters from HHS' Health Resources and Services Administration warning that they may face up to $5,000 in fines for refusing to provide 340B discounts to hospitals. The HRSA referred the drugmakers to the HHS Office of Inspector General, which will decide whether the firms should be fined for deliberately overcharging 340B hospitals.
The American Hospital Association predicts a $54 billion loss in net income for the country's hospitals this year, but that figure could be higher as the effects of the Delta and Mu COVID-19 variants are uncertain. Hospitals are treating sicker patients due to care delays because of the pandemic, and expenses for labor, drugs and supplies are higher, according to the report.
Jonah Miller of Shoreline, Wash., was sentenced to more than 8 years in prison after pleading guilty to one count of conspiring to commit health care fraud for a scheme that defrauded Tricare of about $19.4 million. Authorities said Miller recruited Tricare beneficiaries to order expensive compounded drugs that were medically unnecessary from a Florida-based pharmacy, among other offenses.
Jason Nardachone, a public school teacher in Essex County, N.J., entered a guilty plea to one count of conspiracy to commit health care fraud. Court documents showed Nardachone engaged in a scheme to defraud the N.J. School Employees' Health Benefits Program by obtaining compounded medications that were medically unnecessary for himself and three other teachers, as well as paid the other teachers in exchange for their agreement to receive the unnecessary compounded medications.
David Ciancimino, a doctor from Connecticut, was arrested and charged with distribution of controlled substances outside the scope of professional practice and not for legitimate medical purpose, health care fraud and making false statements relating to health care matters. Court documents showed Ciancimino provided Xanax and Adderall prescriptions with little to no medical examination in exchange for cash to numerous patients, many of whom used Medicaid to pay for the prescriptions.
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