The Daily Scan

July 26, 2018

Last Updated: 8:55 AM EST

Litigation

  • Waveney Blackman, the owner of a company that provided durable medical equipment pleaded guilty to a federal charge of health care fraud for carrying out a scheme in which she fraudulently obtained more than $9.4 million in District of Columbia Medicaid payments. Blackman was the sole owner and CEO of WaveCare Health Services, LLC, a company which provided durable medical equipment including wound care and incontinence supplies, to Medicaid beneficiaries and others. Blackman used this money to buy real estate and a luxury car. (Justice.gov)

 

  • On July 19, a Federal Grand Jury in the District of Puerto Rico returned an indictment charging Dr. Miguel Rivera-Sanabria with 18 counts of health care fraud, three counts of aggravated identity theft, three counts of false statement relating to health care matters, and eight counts for attempted distribution of controlled substances. The defendant was arrested yesterday. According to the indictment, from on or about August 2013, and continuing through on or about August 2017, Dr. Miguel Rivera-Sanabria enriched himself by submitting false and fraudulent claims to Medicare through claims submissions to Medicare Advantage plans for medical services that were never performed. Rivera-Sanabria fraudulently billed Medicare $252,055, and he caused Medicare to pay $225,250 based on these false and fraudulent claims. (Justice.gov)

Medicare & Medicaid

  • In a speech yesterday at the Commonwealth Club in San Francisco, Centers for Medicare and Medicaid Services Administrator Seema Verma commented on Medicare for All: "Medicare for All would become Medicare for None. By choosing a socialized system, you are giving the government complete control over the decisions pertaining to your care, or whether you receive care at all. It would be the furthest thing from patient-centric care." (CMS.gov)

 

  • Yesterday, the Centers for Medicare & Medicaid Services (CMS) took steps to strengthen the Medicare program with proposed changes to ensure that seniors can access the care they need at the site of care that they choose. The proposed policies in the CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule would help lay the foundation for a patient-driven healthcare system. To increase the sustainability of the Medicare program and improve quality of care for seniors, CMS is moving toward site neutral payments for clinic visits (which are essentially check-ups with a clinician). Clinic visits are the most common service billed under the OPPS. Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. (CMS.gov)

Legislation

 

  • The House of Representatives voted Wednesday on bills to delay an Affordable Care Act tax and allow consumers broader use of health savings accounts. In a 242-176 vote, House Republicans joined one dozen Democrats to support a bill that would postpone the health insurance tax through 2021. The tax, which already had been delayed through 2019, is intended to help fund the health law's insurance expansion. Another health-related tax bill allowing consumers to use health savings accounts to purchase over-the-counter medications and other health-related products received bipartisan support in a 277-142 vote. (USAToday.com)

 

  • Yesterday, the Senate Health Committee unanimously passed legislation authored by U.S. Senators Susan Collins (R-ME), Claire McCaskill (D-MO), Debbie Stabenow (D-MI), John Barrasso (R-WY), and Bill Cassidy (R-LA) to remove barriers that prevent patients from paying the lowest possible prices for their prescription drugs. The Patient Right to Know Drug Prices Act would prohibit the use of “gag clauses” by health insurers and pharmacy benefit managers, a practice that conceals lower prescription drug prices from patients at the pharmacy, causing consumers to overpay. (Collins.Senate.gov)

 

  • Reps. Doggett, Welch, and Cummings unveiled new legislation with more than 60 original cosponsors to address the prescription drug affordability crisis: The Medicare Negotiation and Competitive Licensing Act. The approach would harness the government’s purchasing power and relies on market-driven competition to restrain monopoly pricing. Rep. Lloyd Doggett (D-Texas) commented: “It’s time to put patients over price-gouging. Negotiation, bidding, competition—a truly American way to get Americans affordable drug prices, to stop putting America last. Our replacement would authorize Medicare to negotiate reasonable prices much as the Veterans Administration already does. This bill calls the President’s bluff on his drug pricing promises. It would give him the very bidding authority to save billions that he promised and back that authority up with the power of good ol’ American competition through competitive licensing. Patients cannot wait.” (Welch.House.gov)

 

 

 

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