News for Insurers
Top stories summarized by our editors
1/27/2020

Gilead Sciences is refuting an HHS complaint that the drugmaker violated government-owned patents related to the HIV drug Truvada. The drugmaker said the four patents referred to in the HHS complaint are invalid and don't "reflect any 'innovative regimens' developed by the CDC."

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Regulatory Focus
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Truvada
1/27/2020

Former New York Mayor Mike Bloomberg's health care strategy aligns him with other moderate Democrats running for the party's nomination for president. Bloomberg supports building on the Affordable Care Act, mainly by expanding subsidies for buying private insurance and capping out-of-pocket payments, and creating a public option.

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Kaiser Health News
1/27/2020

The Healthy Wyoming coalition plans to lobby state legislators in favor of expanding Medicaid. Wyoming Medical Society President Dr. David Wheeler said expanding Medicaid would provide coverage to thousands of state residents, and research and experiences shows having health insurance improves public health.

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Wyoming Medical Society
1/27/2020

Chang-Wen Chen, a family physician from Knoxville, Tenn., and his practice agreed to pay $285,000 to settle accusations that they violated the False Claims Act and defrauded federal health care programs. Authorities said Chen submitted inflated claims to Tricare, TennCare and Medicare for services provided by nurse practitioners using physician rates from 2013 to 2019.

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Department of Justice
1/27/2020

Leon Margolin, a doctor from Columbus, Ohio, and his pain clinic Comprehensive Pain Management Institute agreed to a $650,000 settlement to resolve accusations that they violated the False Claims Act by improperly billing Medicare. Authorities said Margolin and his clinic submitted fraudulent claims to Medicare for medically unnecessary or unprovided alcohol/substance abuse assessments and interventions and nerve conduction studies.

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Department of Justice
1/27/2020

Michael Harris, a doctor from Gulf Breeze, Fla, is set to be sentenced in April after pleading guilty to using another person's identification to acquire controlled substances by fraud and acquiring controlled substances by fraud. Documents showed Harris forged another doctor's signature or used presigned prescriptions without the doctor's approval and used fraudulent prescriptions to obtain oxycodone, methadone, alprazolam and morphine sulfate from various pharmacies around Santa Rosa County from Nov. 4, 2015 to Aug. 11, 2016.

1/27/2020

Channa Sontag, a licensed professional counselor and owner of Children's Behavioral Therapy in Waterbury, Conn., agreed to pay $39,471 to resolve accusations that she violated the False Claims Act and defrauded Medicaid. Authorities said Sontag submitted inflated claims to Medicaid for purported psychotherapy services from 2014 to 2017.

1/27/2020

Senior Living Properties, including certain doctors who provide care to patients at its 37 skilled nursing and long-term-care facilities in Texas and Oklahoma, agreed to join Genesis Healthcare's accountable care organization. The deal won't require any upfront investment from Senior Living, but the company will share in any bonuses paid through the model while possibly seeing benefits like improved care coordination and reduced hospitalizations.

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Skilled Nursing News
1/24/2020

The World Health Organization said Thursday that it's too early to designate the emerging coronavirus spreading in Wuhan, China, as a public health emergency of international concern due to the small number of cases outside the country and the Chinese government's efforts to stop the virus from spreading. "Make no mistake. This is an emergency in China, but it has not yet become a global health emergency," said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus.

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CNN, The Hill
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World Health Organization
1/24/2020

The CMS said it plans to combine and standardize the eight existing Compare sites into a single tool called "Medicare Care Compare" this spring. In a blog post, CMS Administrator Seema Verma said the move will permit "users to access the same information through a single point of entry and simplified navigation to find the information that is currently divided in places like Nursing Home Compare and Hospital Compare."