The Daily Scan

June 5, 2018

Last Updated: 1:15 PM EST

Litigation

  • Justice Michaela Murphy of the Maine Superior Court ordered Ricker Hamilton, the Commissioner of the Maine Department of Health and Human Services, to submit a state plan amendment to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services ensuring MaineCare eligibility for people under 65 years of age who qualify for medical assistance. Medicaid expansion was approved by Maine voters in the November 2017 election, but Republic Governor Paul LePage was fighting the expansion. (Courts.Maine.gov)

 

  • U.S. Attorney for the Western District of North Carolina R. Andrew Murray announced Friday that Dr. Michael Alson Smith, a former Mt. Holly, N.C. family practice physician, pleaded guilty in federal court to drug distribution, health care fraud, and aggravated identity theft charges, in connection with the illegal distribution of controlled substances to female patients in exchange for sex acts. Dr. Smith submitted fraudulent claims to, and received payment from, North Carolina Medicaid and Medicare, for non-existent medical services for the office visits in which he performed and received sex acts from female patients. Also, as a result of his illegal prescriptions, Dr. Smith caused some of these patients to submit claims to Medicaid and Medicare when they filled the prescriptions at area pharmacies.(Justice.gov)

 

  • U.S. Attorney Dayle Elieson for the District of Nevada announced Friday that three Southern Nevada residents, including two nurse practitioners, have been arrested and charged in a 29-count indictment for unlawful distribution of prescription opioids and Medicare/Medicaid fraud. Two of the individuals used a prescription pad belonging to an unnamed physician to distribute Hydrocodone and Oxycodone to patients without a legitimate medical purpose in exchange for cash. They further prescribed Lidocaine, Modafinil, and Diclofenac Sodium to patients without a legitimate medical purpose, many of which were billed to Medicare/Medicaid by a pharmacy that filled the prescriptions. All three individuals were paid cash kickbacks for their patient referrals to the unnamed pharmacy. (Justice.gov)

Legislation

  • Affordable Care Act insurers in New York and Washington states are proposing double digit rate hikes for 2019. The proposed increases have been attributed to Congress’s repeal of the individual mandate while Washington is blaming the Trump administration’s changes to the ACA. As the department of financial services reviews all of the submissions, they will ensure any changes are in accordance with both New York and Washington Law. (TheHill.com)

Regulation

  • CMS today released a new rule updating the Medicare Required Prior Authorization List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that require prior authorization as a condition of payment. This document announces the addition of 31 Healthcare Common Procedure Coding System (HCPCS) codes to the Required Prior Authorization List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that require prior authorization as a condition of payment. Prior authorization for these codes will be implemented nationwide effective September 1, 2018. (FederalRegister.gov)

 

  • The Health Resources and Service Administration (HRSA) of the Department of Health and Human Services (HHS) announced today that the effective date of the 340B Drug Pricing Program final rule, which will set forth the calculation of the ceiling price and application of civil monetary penalties, has been pushed back to July 1, 2019. (FederalRegister.gov)

Medicare

  • The HHS Office of Inspector General released a new study on "Increases in Reimbursement for Brand-Name Drugs in Part D". The findings show that although there were fewer prescriptions for brand-name drugs in 2015 than in 2011, increases in Part D unit costs for brand-name drugs led to greater overall Medicare Part D spending and higher beneficiary out-of-pocket costs for these drugs. (OIG.HHS.gov)

Medicaid

  • In a blog post this morning, CMS Administrator Seema Verma announced "A New Era of Accountability and Transparency in Medicaid" with the release of the first ever Medicaid and Children's Health Insurance Program (CHIP) Scorecard. CMS developed the scorecard to increase public transparency and accountability about the programs’ administration and outcomes. The Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: State Health System Performance, State Administrative Accountability, and Federal Administrative Accountability. (Medicaid.gov: Blog, Scorecard, Fact Sheet)

 

 

 

 

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