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The Daily Scan

Last Updated: 11:00 AM EST


  • Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced yesterday the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in the arrests. In addition, HHS announced yesterday that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse. (Justice.gov)

  • A Denver jury awarded a monumental $383.5 million dollar jury verdict against GranuFlo dialysis provider, DaVita Inc. yesterday, according to national law firm Hagens Berman in conjunction with the North Carolina-based Paynter Law Firm. The firms represented the families of three patients who suffered cardiac arrests and died after receiving dialysis treatments at DaVita clinics. DaVita treated the patients with GranuFlo, a product DaVita knew could cause toxic pH imbalances and alkalosis in its patients. The jury verdicts were returned June 27, 2018, in the U.S. District Court for the District of Colorado. Each of the three parties was awarded $125 million in punitive damages from the jury, with compensatory damages ranging from $1.5 million to $5 million. (HBSSLaw.com)

  • A grand jury returned an indictment on Tuesday charging Dr. Lesly Pompy of Monroe, Michigan with unlawful distribution of prescription drugs and health care fraud. The 37-count Indictment charges that between 2012 and 2016, Dr. Pompy unlawfully distributed more than 4,221,892 dosage units of Schedule II controlled substances and over 6,196,642 total dosage units of all controlled substances outside the course of professional medical practice. During that time frame, he also submitted claims to Medicare, Medicaid and Blue Cross Blue Shield totaling approximately $16,856,683. The majority of these fraudulent claims were seeking reimbursement for the costs of office visits and other services that were not medically necessary and that Dr. Pompy never rendered. (Justice.gov)


  • The Centers for Medicare & Medicaid Services (CMS) has approved Pennsylvania’s request for an amendment to the “Pennsylvania Medicaid Coverage for Former Foster Care Youth from a Different State” section 1115 demonstration (Project Number: 11-W-00308/3), which is now referred to as the “Pennsylvania Medicaid Coverage for Former Foster Care Youth from a Different State and Substance Use Disorder (SUD) Demonstration.” This approval is effective beginning July 1, 2018 through September 30, 2022. This approval authorizes Pennsylvania to receive federal financial participation (FFP) for the continuum of services to treat addictions to opioids and other substances, including services provided to Medicaid enrollees with SUD who are short-term residents in residential and inpatient treatment facilities that meet the definition of an Institution for Mental Diseases (IMD) and who receive services via managed care. (Medicaid.gov)

Private Sector

  • Amazon and PillPack announced yesterday that they have entered into a definitive merger agreement under which Amazon will acquire PillPack. PillPack is a pharmacy designed to provide the best possible customer experience in the U.S. for people who take multiple daily prescriptions. PillPack delivers medications in pre-sorted dose packaging, coordinates refills and renewals, and makes sure shipments are sent on time. “PillPack’s visionary team has a combination of deep pharmacy experience and a focus on technology,” says Jeff Wilke, Amazon CEO Worldwide Consumer. “PillPack is meaningfully improving its customers’ lives, and we want to help them continue making it easy for people to save time, simplify their lives, and feel healthier." Completion of this transaction is subject to regulatory approvals and other customary closing conditions. The parties expect to close the transaction during the second half of 2018. (BusinessWire.com)

  • Atlantic Health System, an integrated health care delivery system, and MedExpress, a neighborhood health care provider, announced yesterday that are collaborating to coordinate care between MedExpress’ 11 neighborhood medical centers in northern New Jersey and Atlantic Health System’s extensive clinically integrated network of physicians, hospitals and other care sites. The jointly owned centers will enable MedExpress’ urgent care patients to seek care at an Atlantic Health System facility if additional or more advanced care is needed. In turn, MedExpress locations can serve as an extension of the services available within Atlantic Health System, as MedExpress neighborhood medical centers offer a broad scope of walk-in urgent care, employer health services, and basic wellness and prevention services. (MedExpress.com)

#Litigation #Medicaid #PrivateSector


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