News for Insurers
Top stories summarized by our editors
11/15/2018

Republicans want to push through some key health care bills during the lame-duck session of Congress, covering issues such as drugmaker contributions to the Medicare Part D "doughnut hole," the CREATES Act and the medical device tax. The measures could be included in the must-pass government funding bill but there is not much interest among Democrats in cooperating, and lobbyists say they are not optimistic about anything getting done.

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Congress
11/15/2018

Yvette Diaz-Juarez, former owner of Raindrops Daycare in Brooklyn, N.Y., could face up to 15 years in prison after being charged with grand larceny, welfare fraud and repeated failure to file personal income and earnings taxes in a Medicaid fraud case. Authorities accused Diaz-Juarez of underreporting her household income to the Nassau County Department of Social Services from June 2009 to December 2015, which allowed her to collect $72,046.29 worth of Medicaid benefits to which she was not entitled.

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Patch
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Medicaid
11/15/2018

Jacklyn Price, former owner of Detroit-based clinics Patient Choice Internal Medicine and Metro Mobile Physicians, received a 13-year prison term and was ordered to pay $6.3 million in restitution together with her co-defendants after pleading guilty to health care fraud and conspiracy to commit health care fraud for her involvement in an $8.6 million Medicare fraud scheme. Court records showed Price gave patients medically unnecessary prescriptions for oxycodone and other controlled substances in exchange for using their Medicare beneficiary numbers and submitted fraudulent claims to Medicare for medically unnecessary and unprovided clinic services.

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The Detroit News
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Medicare, oxycodone
11/15/2018

Robert Gallagher of Northfield, N.H., is scheduled to be sentenced in February after entering a guilty plea to making false statements to obtain Social Security disability insurance benefits. Prosecutors said Gallagher lied to the Social Security Administration about being unemployed and having a medical disability, which allowed him to fraudulently collect disability benefits from October 2013 to March 2017.

11/15/2018

Zhizhong Zheng, the owner of a car rental business in Upper Tumon, Guam, was ordered to serve two years of probation and could face deportation after pleading guilty to unauthorized use or possession of food stamp benefits. Authorities said Zheng gave cash to Supplemental Nutrition Assistance Program recipients in exchange for using their food stamp benefits from February 2013 to July 2014.

11/15/2018

Researchers found that Eko's artificial intelligence algorithm, which uses machine learning to analyze heart sound recordings from noninvasive sensors, more accurately detected pediatric heart murmurs, outperforming four of five cardiologists. The findings, presented at the American Heart Association's annual meeting, showed that the tool could help noncardiology clinicians, such as family practice and internal medicine physicians, in heart murmur screening.

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American Heart Association, Eko, AI
11/14/2018

The US Preventive Services Task Force published final guidelines in the Journal of the American Medical Association calling for health care providers to screen all adults, including pregnant women, for unhealthy alcohol use and offer brief behavioral counseling interventions to patients who screen positive. The task force found insufficient evidence to make a similar recommendation for teens under age 18 and called for additional research.

11/14/2018

Bold ideas are often picked apart until there's nothing unique left, unless leaders adopt a curious mindset that gives every proposal a chance, writes Jennifer V. Miller. "Even if the idea doesn't come to fruition, your team will see that you support their innovations and are willing to give them the needed incubation time for an idea's promise to show itself," she writes.

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SmartBrief/Leadership
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Jennifer V. Miller
11/14/2018

The percentage of US counties reporting cancer as the top cause of mortality rose from 21% in 2003 to 41% in 2015, while the percentage that listed heart disease as the leading cause dropped from 79% to 59% during the same period, according to a study in the Annals of Internal Medicine. Mortality for both diseases dropped during the study period, but cancer mortality fell more slowly.

11/14/2018

The CMS sent a letter to state Medicaid directors Tuesday urging states to apply for new waivers enabling expanded coverage of inpatient care at institutions of mental disease. The waiver will apply to all Medicaid beneficiaries, not just those in managed care, and will allow for 30 days of care for severe mental illness.

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CMS, Medicaid