News for Insurers
Top stories summarized by our editors
10/19/2018

The FDA declined to approve a request from Novartis to expand the indication on canakinumab to prevent heart attack recurrence in certain people with cardiovascular disease.

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Reuters
10/19/2018

Pharmacy benefit managers have driven drug prices down by negotiating bulk discounts, the Wall Street Journal Editorial Board writes.

10/19/2018

A study showed seniors found the CMS' Medicare Plan Finder website was cluttered and lacked clarity, and information on out-of-pocket costs was difficult to find and understand, Joel White of the Clear Choices Campaign and Howard Bedlin of the National Council on Aging told AHIP's National Conference on Medicare. While the CMS recently updated the site, Bedlin said there are still problems, such as the inability for consumers to search for all supplemental benefits.

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FierceHealthcare
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Medicare, Medicare, AHIP
10/19/2018

John Verstraete, a physician with medical offices in Kansas City, Mo., received a one-year prison term after pleading guilty to charges of health care fraud and distribution of controlled substances outside the scope of legitimate medical practice. Verstraete admitted to illegally prescribing and reselling human growth hormone, and to selling about 25,000 units of illegally imported anabolic steroids to patients who didn't need them.

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Growth hormone
10/19/2018

Hafiz Tahir and Tasneem Tahir, owners of home health agencies in the Detroit area, received prison terms of 10 years and six years, respectively, and were ordered to pay more than $14 million in restitution jointly and severally with their co-defendants after pleading guilty to conspiracy to commit health care fraud, conspiracy to pay and receive health care kickbacks, and wire fraud for their involvement in a multimillion-dollar Medicare fraud scheme. The Tahirs admitted to paying illegal kickbacks in exchange for patient referrals and submitting fraudulent claims to Medicare for unprovided home health services from 2009 to 2017.

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WDIV-TV (Detroit)
10/19/2018

Felmor Agatep, a doctor from Jacksonville, Fla., could face a maximum 10-year prison term after pleading guilty to theft of government property for his involvement in a $4.4 million Tricare fraud scheme. Court documents showed Agatep wrote 268 fraudulent prescriptions for expensive and medically unnecessary compounded scar and pain creams in exchange for cash payments from late 2014 to early 2015, which resulted in about $4.4 million worth of improper payments from Tricare.

10/19/2018

Juliet Jacob, co-operator of Transitional Development And Training and It Takes A Promise, which offer social and psychotherapy services in Bridgeport, Conn., agreed to pay $2,711,173 in restitution and could face up to 10 years in prison after entering a guilty plea to health care fraud for her role in a $2.5 million Medicaid fraud scheme. Court records showed Jacob and her business partner used their businesses to submit fraudulent claims to Medicaid for unprovided psychotherapy services, which resulted in about $2.5 million worth of improper payments from Medicaid.

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Department of Justice
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Medicaid
10/18/2018

Danish women with a history of preeclampsia had a 53% higher dementia risk and were more than three times as likely to develop vascular dementia, compared with those who didn't have preeclampsia, researchers reported in The BMJ. The findings, based on an analysis of registry data involving more than 1.1 million women who gave birth from 1978 to 2015, also showed that preeclampsia was more strongly associated with vascular dementia in late-onset than early-onset disease and had a modest link to Alzheimer's disease and other/unspecified dementia.

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Alzheimer's disease
10/18/2018

A survey from Capital One found that many employees with access to an employer-sponsored retirement plan don't participate because they believe they don't make enough to contribute. However, educating individuals about tax benefits and fees could help encourage participation, says Stuart Robertson of Capital One Advisors.

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PlanAdviser online
10/18/2018

President Donald Trump is asking his Cabinet to develop a plan to cut 5% from the budget of each agency. The order follows a Treasury Department report showing a 17% increase in the annual federal budget deficit, which Senate Majority Leader Mitch McConnell, R-Ky., blamed on unwillingness to contain spending in programs such as Medicare, Medicaid and Social Security.