News for Insurers
Top stories summarized by our editors
12/11/2018

CDC officials reported 158 confirmed cases of acute flaccid myelitis in 36 states this year, most involving children, with an additional 153 cases being investigated. The CDC said the new total marks the highest number of cases since the agency started tracking AFM in August 2014, and although the cause is unclear, most of the patients "had a mild respiratory illness or fever consistent with a viral infection before they developed AFM."

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CNN
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CDC, myelitis
12/11/2018

Researchers examined data from a population-based cohort study of 1,758 Japanese adults with a mean age of 61 and found those who had 10 hours or more of sedentary time daily on average had a higher prevalence of diabetes and higher odds of developing diabetes, compared with those who had six hours or less of sedentary time per day. The findings in the Journal of Diabetes Investigation also revealed higher levels of insulin resistance among those with more sedentary time.

12/11/2018

Health insurers are taking steps to improve health outcomes and reduce costs by addressing social determinants of health, with interventions such as paying for meal deliveries, buying air filters for families with asthmatic children and even building affordable housing. Advocates say the federal government could bolster these efforts by increasing flexibility around how Medicaid and Medicare funding can be spent and by eliminating the divisions among social services and health care organizations that make it difficult to tackle social problems in a coordinated way.

12/11/2018

A bill that would formally authorize provider-coordinated health homes for children with complex conditions could be passed by House lawmakers this week. Under the Advancing Care for Exceptional Kids Act, states that establish the model would receive a 15-percentage-point increase in Medicaid matching funds for two quarters.

12/11/2018

House Democrats are likely to advance legislation meant to bolster the Affordable Care Act and reduce health care and prescription drug costs, but the party has not coalesced around specific policies, and some may hesitate to hand the president a win.

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The Hill
12/11/2018

Sen. Tammy Baldwin, D-Wis., asked Pfizer CEO Ian Read for a full list of the company's drugs that are scheduled for price increases, the cost of ingredients, how much the company spends on marketing and advertising, and total revenue and net profits from the drugs.

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Pfizer, Sen. Tammy Baldwin, Ian Read
12/11/2018

Stephen Chalker, a pharmacist from South Florida, received a prison term of six years and six months for his involvement in an almost $5 million health care fraud scheme. Court records showed Chalker submitted fraudulent claims to Medicare, Medicaid and Tricare for medically unnecessary or unprovided compounded medications and other prescription drugs while working at Pop's Pharmacy in Deerfield Beach, Fla., which resulted in almost $5 million worth of improper payments from the programs.

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FDAnews
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Medicare
12/11/2018

Young Yi of Sterling, Va., and former owner of 1st Class Sleep Diagnostic Center and 1st Class Medical, received a seven-year prison term for her involvement in a $10 million-plus scheme to defraud federal health care programs, private insurers and the IRS. Court records showed Yi used her businesses to submit fraudulent claims to Medicare, Tricare and private insurers for medically unnecessary sleep studies, among other offenses.

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The Virginia Mercury
12/11/2018

Luis Vargas, an unlicensed dentist from Roselle, N.J., could face up to 25 years in prison after being convicted of health care fraud and other charges for his role in a health insurance fraud scheme. Authorities accused Vargas of posing as a dentist and conspiring with others to pay kickbacks to patients and submit fraudulent claims to health insurance firms for unprovided dental services or services performed by Vargas from around 2012 through at least November 2017 in the Southern District of New York and other areas, resulting in more than $2 million worth of improper payments from insurers.

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Department of Justice
12/11/2018

M. Wagdi Attia, a doctor who practiced in Gaithersburg, Md., until April 1, agreed to a $400,000 settlement to resolve accusations that he defrauded federal health care programs. Authorities said Attia submitted fraudulent claims to Medicare and Medicaid for psychotherapy services that did not meet certain requirements of both programs from Jan. 1, 2013, to May 31, 2017, among other offenses.

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Department of Justice
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Medicare, Medicaid