The Daily Scan

July 19, 2018

Last Updated: 8:40 AM EST 

Litigation

  • Southern SNF Management, Inc., Rehab Services in Motion d/b/a Dynamic Rehab and nine affiliated skilled nursing facilities in Florida and Alabama have agreed to resolve allegations that they violated the False Claims Act by submitting or causing the submission of false claims to Medicare for medically unnecessary rehabilitation therapy services, the Department of Justice announced yesterday. The facilities will pay the United States a total of $10 million to resolve these allegations. Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division commented, “Today’s settlement demonstrates our continuing commitment to ensure that Medicare providers do not place their own financial gain over patients’ clinical needs, such conduct is especially unacceptable when it seeks to take advantage of older Americans, who are some of the most vulnerable members of our community.” (Justice.gov)

 

  • The city of New York has agreed to pay $20.8 million to settle federal discrimination charges made by registered nurses and midwives who were subjected to discrimination because they are women. The U.S. Attorney’s office for the Eastern District of New York filed the proposed settlement along with a complaint in federal district court. The city failed to recognize that the work of predominately- female registered nurses and midwives was “physically taxing,” while deeming other predominately- male occupations “physically taxing.” As stated, in result the City employees in the predominantly-male “physically taxing” jobs were allowed to retire with full pensions as early as age 50, while registered nurses and midwives, who are predominantly female, had to wait until age 55 or 57 to retire with full pensions. (Justice.gov)

Private Sector 

  • “[We] made the decision prior to some of the recent events that we were going to withdraw any further price increases and make a commitment internally that we’re not going to take any further price increases for the remainder of 2018.” -Vasant Narasimhan, Novartis CEO during yesterday’s Q2 2018 Earnings Call (SeekingAlpha.com)

 

  • The health insurer Anthem Inc. was sued by doctors in Georgia for declining to pay for some emergency-room care. The American College of Emergency Physicians and the Medical Association of Georgia filed suit in U.S. District Court in Atlanta against Anthem's Blue Cross and Blue Shield of Georgia unit over the denied payments. The groups commented in the filing: "Providers and patients alike are operating in fear of denial of payment by defendants when patients seek emergency department care." Anthem says the policy was designed to cut down on patients going to an emergency room in situations that don't require it. Lawmakers wrote "by denying patient claims based on the patient's final diagnosis and ignoring the patient's symptoms present at the time of the emergency, we believe that Anthem likely violated federal law." (Bloomberg.com)

 

  • In a unanimous decision, the Pennsylvania Supreme Court said yesterday that in-network access to UPMC for Highmark Security Blue HMO and Freedom Blue PPO subscribers will end on June 30, 2019. The ruling reverses a lower court decision that had granted continued access to UPMC through all of 2019. (Press Release: Post-Gazette.com, Court Opinion: PACourts.US)

 

Research

  • After examining the characteristics of 340B-participating hospitals and how they compared with hospitals that did not participate in the program, the GAO released a report with additional material surrounding these characteristics. The 340B Drug Pricing Program enables certain categories of hospitals to obtain discounts on covered outpatient drugs. The GAO found that among all hospitals in its analysis for 2016, 340B hospitals were generally smaller in terms of the number of inpatient beds, and a somewhat higher percentage of these hospitals were teaching hospitals compared with non-340B hospitals. However, in nearly all characteristics included in GAO's analysis, the differences between 340B and non-340B hospitals varied by hospital type. The GAO conducted this study to examine the characteristics of hospitals that participate in the program and changes in characteristics after Medicaid expansions. (GAO.gov)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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