News for Insurers
Top stories summarized by our editors
11/16/2018

Drugmakers are less vociferous in their opposition to the idea of international index pricing under Medicare Part B than they were when the Obama administration proposed Part B reform, says Rita Habib, a health policy adviser to Sen. Michael Bennet, D-Colo.

11/16/2018

International reference pricing is a market-based response to high drug spending in Medicare Part B, HHS Secretary Alex Azar said in a speech at the Commonwealth Fund International Symposium on Health Care.

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Alex Azar, HHS
11/16/2018

California Democrat Rep. Anna Eshoo, who is poised to chair the health subcommittee of the House Energy & Commerce Committee, said she would like to hold hearings before creating policies to address high drug prices.

11/16/2018

A clinical trial demonstrated the efficacy of AbbVie's Mavyret in eliminating most hepatitis C virus genotypes within eight weeks in previously untreated patients with compensated cirrhosis.

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HCV
11/16/2018

Medicare Advantage enrollment has increased threefold since 2005, and if it continues to grow as expected it could significantly change Medicare and put more emphasis on a marketplace of private plans, Patricia Neuman and Gretchen Jacobson of the Kaiser Family Foundation wrote in a paper published in The New England Journal of Medicine. They said policymakers in both political parties support Medicare Advantage, as plans offer extra benefits, financial protection and a convenient "one-stop shop" for all coverage.

11/16/2018

Salim Dahdah, a cardiologist from Springfield, Ohio, and operator of the Ohio Institute of Cardiac Care, and his wife, Cindy Dahdah, both entered guilty pleas to health care fraud, conspiracy to commit health care fraud and health care false statements for their involvement in a $2 million-plus Medicare and Medicaid fraud scheme. According to the indictment, the Dahdahs submitted or caused the submission of fraudulent claims to Medicare and Medicaid for unnecessary medical tests and procedures, which resulted in more than $2 million worth of improper payments from the programs.

11/16/2018

Otis Crawford, a physician and owner of Detroit-based clinic Doctors Creative Care; the clinic's office manager, Debbie Taylor; and patient recruiter Earnie Taylor, Debbie Taylor's brother, were charged with conspiracy to illegally distribute prescription drugs. Authorities said Crawford conspired with the Taylors and used his clinic, which opened in July 2016, to illegally prescribe opioids and other controlled drugs of high street value such as Xanax and Valium to patients who didn't need them.

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Department of Justice
11/16/2018

Mohammad Iqbal, the owner of a taxi company in Coram, N.Y., could face up to 15 years in prison after being charged with welfare fraud for allegedly defrauding Medicaid. Authorities said Iqbal misrepresented his annual income to the Suffolk County Department of Social Services from Dec. 1, 2009, to Sept. 30, 2017, which allowed him to fraudulently collect over $200,000 in Medicaid benefits to which he was not entitled.

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Medicaid
11/16/2018

Todd Mehrhoff, a nurse anesthetist from Waunakee, Wis., could face up to four years in prison after entering a guilty plea to obtaining fentanyl by use of misrepresentation and fraud. Mehrhoff admitted to stealing fentanyl for his personal use while working at William S. Middleton Memorial Veterans Hospital in Madison, Wis., and an investigation showed he diverted fentanyl from the hospital over 100 times between August and December 2017.

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fentanyl
11/15/2018

HHS Secretary Alex Azar said the CMS could soon permit health systems and hospitals to help with housing, nutritious food and other social determinants of health through Medicaid. "We believe we could spend less money on health care -- and, most important, help Americans live healthier lives -- if we did a better job of aligning federal health investments with our investments in non-health care needs," Azar said, noting officials at the Center for Medicare & Medicaid Innovation are exploring new strategies to better address social determinants.