News for Insurers
Top stories summarized by our editors
10/18/2018

Providers at the AHIP conference outlined concerns about state proposals to allow people who do not qualify for Medicaid to buy into the program. Issues with buy-in programs included the potential for shifting costs to the commercial insurance market and the impact on state budgets and Medicaid physician networks.

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Medicaid, AHIP
10/18/2018

The Equal Employment Opportunity Commission has pushed back its update on wellness program regulations from January 2019 until next June, according to its regulatory agenda released this week. Rules on wellness incentives will be vacated in January under a federal court order in a case brought by AARP.

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Bloomberg Law
10/18/2018

Basil Ubanwa, owner and manager of Northwest Ambulance Service in Crown Point, Ind., was charged with health care fraud and conspiracy to commit health care fraud for allegedly orchestrating a scheme to defraud Medicare and Medicaid. According to the indictment, Ubanwa conspired with others to submit fraudulent claims to Medicare and Medicaid for medically unnecessary and unprovided medical transportation services to kidney dialysis patients from 2011 to 2018.

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Medicare, Medicaid
10/18/2018

Patience Okoroji, a Texas nurse and part-time owner of Timely Home Health Services, was sentenced to a 10-year prison term for her involvement in an $11.3 million Medicare fraud scheme, while co-defendant Kelly Robinett, former co-owner and supervising doctor at Boomer House Calls, received three years and six months. Their co-defendants -- nurses Joy Ogwuegbu and Kingsley Nwanguma and physician Angel Claudio -- also received prison sentences for their roles in the scheme, which involved the submission of fraudulent Medicare claims through Timely Home and Boomer House between 2007 and 2015.

10/18/2018

Stanley Callas and Scott Eskanos, co-owners of Crown Point Pharmacy and Sky Ridge Pharmacy in Colorado, entered a guilty plea to illegal distribution of controlled substances. Callas admitted to illegally dispensing morphine, lorazepam and meperidine to a patient without a legitimate medical purpose and outside the usual course of professional practice on Sept. 13, 2012, while Eskanos admitted to illegally dispensing 840 oxycodone pills to an individual who used a fraudulent prescription on Sept. 12, 2012.

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oxycodone, lorazepam, Morphine
10/18/2018

Venkat Aachi, a doctor from Saratoga, Calif., was charged with health care fraud and illegally distributing an opioid for allegedly prescribing hydrocodone outside the scope of professional practice and with no legitimate medical purpose. Authorities accused Aachi of illegally distributing hydrocodone six times from November 2017 to March 2018 and submitting a false claim to a private insurer to seek payment for health care benefits.

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hydrocodone
10/17/2018

CMS Administrator Seema Verma said the "Medicare for all" idea being pushed by some Democrats would decimate doctor networks and create a permanent physician shortage because the program doesn't cover full health care provider costs. "Under 'Medicare for all,' you either take private insurance away from those 170 million Americans, or greatly restrict access to it, meaning there is no relief valve for physicians facing up to 40% payment cuts," Verma told attendees at AHIP's Medicare conference in Washington.

10/17/2018

Pfizer's once-daily talazoparib was approved by the FDA as a treatment for patients who have advanced breast cancer associated with BRCA mutations.

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Reuters
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Pfizer, FDA, BRCA
10/17/2018

Researchers found that global life expectancy will rise an average of 4.4 years and health will improve by 2040, but deaths from non-communicable diseases such as diabetes, lung cancer and chronic kidney disease will increase, as will deteriorating health from obesity. The findings in The Lancet, based on 250 causes of death in 195 countries between 1990 and 2016, showed that life expectancy in the US will increase by only 1.1 years to about 80 years in 2040, compared with a 5.6-year increase in China and a 2.5-year increase in the UK.

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diabetes
10/17/2018

A Food Research and Action Center report showed participation by low-income children in after-school supper programs in Kentucky increased by 16% from 2016 to 2017. Elizabeth Fiehler of the Kentucky Department of Education said after-school meals create a continuation of the meals students have during the school day.

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Public News Service