News for Insurers
Top stories summarized by our editors
10/22/2018

HHS asked a federal court to delay a lawsuit brought by hospital groups over delays in implementing new rules for the 340B drug discount program. HHS said it intends to issue proposed rules Nov. 1 moving the effective date for 340B ceiling prices and penalties to Jan. 1.

10/22/2018

More companies are offering or are expected to offer programs that help employees pay off their student loan debt. Employee retention is one reason for employer interest, as a survey by the advocacy group American Student Assistance found 86% of employees said they would work for a company for at least five years if a student loan debt benefit was offered.

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Detroit Free Press
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American Student Assistance
10/22/2018

Devon Golding, a physician from St. Louis County, Mo., is scheduled to be sentenced in January after being convicted of health care fraud and conspiracy to commit health care fraud for his involvement in an illegal kickback scheme. Authorities said Golding received illegal kickbacks in exchange for referring blood and urine samples to Allegiance Medical Services for testing, which allowed the medical laboratory to submit fraudulent claims to Medicare and Medicaid.

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KMOV-TV (St. Louis)
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Devon Golding, Medicare, Medicaid
10/22/2018

A whistleblower lawsuit has been filed against anesthesiology group TeamHealth by anesthesiologist John Mamalakis on allegations that the group violated the False Claims Act and defrauded Medicare and state insurance programs in 16 states and the District of Columbia. Mamalakis accused TeamHealth and its doctors of submitting millions of dollars' worth of fraudulent claims to Medicare, Medicaid and Tricare for nonexistent or nonreimbursable anesthesiology services performed at Ascension All Saints Hospital in Racine, Wis., and other TeamHealth-affiliated hospitals and clinics from at least 2011 to 2014.

10/22/2018

The federal government filed a lawsuit to intervene in a false claims and Medicare fraud case against Aarti Pandya, an ophthalmologist from Conyers, Ga., and her practice, Aarti D. Pandya, M.D. The lawsuit accuses Pandya of submitting fraudulent claims to Medicare for upcoded, medically unnecessary and, in some cases, unprovided office visits, surgical procedures and diagnostic tests from Jan. 1, 2011, to Dec. 31, 2016.

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Department of Justice
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federal government
10/22/2018

Patricia Williams of Binghamton, N.Y., could face up to 10 years in prison after being convicted of theft of government property and fraud for defrauding the Social Security Administration. Evidence showed Williams failed to inform the SSA about her husband's death in 1990, allowing her to continue collecting his benefits until 2013, and then she also applied for Supplemental Security Income benefits from 2008 to 2015, which resulted in at least $63,500 worth of improper payments from Social Security.

10/22/2018

The percentage of health care payments in the US tied to value instead of volume rose from 23% in 2015 to 34% last year, according to a Health Care Payment Learning and Action Network report. Nearly 50% of Medicare Advantage payments in 2017 were linked to value, compared with 38% in Medicare fee-for-service plans, 28% in commercial plans and 25% in Medicaid, according to the report.

10/22/2018

Including urologists in accountable care organizations might reduce overtreatment of men newly diagnosed with prostate cancer, according to a study published in Cancer. Urologist input was not significantly associated with less treatment or lower spending in the first year after diagnosis, but it was associated with a lower potential for overtreatment in men who had a high risk of noncancer mortality, the researchers found.

10/22/2018

More than 130 House members asked CMS Administrator Seema Verma to reconsider applying site-neutral payment rules to more hospitals' off-campus outpatient departments next year, saying the expansion could slow hospitals' transition to value-based care models. Expanding the site-neutral payment policy is likely to result in lower revenue, hindering hospitals' ability to invest in new services and technology, the representatives said.

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RevCycle Intelligence
10/19/2018

A study in The BMJ found that individuals who consumed the highest levels of seafood-derived docosapentaenoic acid had a 24% reduced risk of aging unhealthily, compared with those with the least consumption. Based on 2,622 adults from the Cardiovascular Health Study with an average age of 74, those in the top three DPA-consuming quintiles reduced their risk of experiencing unhealthy aging by up to 21%.

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Medical News Today