The Daily Scan

August 2, 2018

Last Updated: 8:50 AM EST 

Litigation

  • The U.S. Attorney for the Eastern District of North Carolina announced that federal court awarded a nearly $3 million judgement against Compassionate Home Care Services, Inc. This comes after the company was only entering the judgement on July 30th 2018, the owners Carol Anders and Ryan Santiago were convicted for their participation in a fraud on the North Carolina Medicaid program in violation of the federal and North Carolina False Claims Acts. The evidence at trial showed that between 2008 and 2013, Compassionate Home Care Services, Inc. billed the North Carolina Medicaid program $585,082.73 in fraudulent claims, including not only claims for services provided in violation of Medicaid policies, but also claims for services that were never provided at all. (Justice.gov

  • A Somerset, New Jersey, man was sentenced to 20 months in prison for defrauding the Veterans Affairs program by billion for services he never performed. A physician specializing in cardiology and electrophysiology, Apostolos Voudouris, pleaded guilty to health care fraud in Newark federal court earlier this week. Voudouris admitted that on more than 350 occasions between 2011 and 2015, he submitted documentation to the VA claiming to have performed procedures he never performed. As a result, Voudouris fraudulently received $238,230 from the VA. (Justice.gov)

  • A federal grand jury has added over 100 counts, including health care fraud to the indictment against a former Pittsburgh-area physician. The physician, Andrzej K. Zielke is already accused of illegally prescribing and distributing opioid painkillers. The arrest was made in October on 13 counts of unlawfully distributing oxycodone and other controlled drugs. Earlier this week, there were additions to his charges including, 4 counts of health care fraud for allegedly submitting false claims to insurers. (Law360.com

Regulation 

  • Yesterday, the California Insurance Commissioner Dave Jones issued his findings on the negative effects of the proposed merger of CVS Health and Aetna, Inc. These negative effects are anti-competitive impacts on American consumers and health care and health insurance markets. Jones formally recommends that the United States Department of Justice sue to block the proposed merger. Jones commented, "The proposed merger of CVS and Aetna will significantly reduce competition in the PBM and Medicare Part D markets, affecting millions of health care consumers throughout the country, a merger of this size and type, according to experts on health insurer and health care mergers, will likely lead to increased prices and decreased quality. Further, partial divestiture or other remedies traditionally used by the Department of Justice will not adequately protect consumers or address the adverse consequences of a merger of CVS and Aetna. Traditional methods to avoid market concentration will not address potential impacts on service quality, the power to charge excessive rates, or the creation of barriers to block a potential market participant with the resources to enter into new markets." (Insurance.ca.gov)

  • Tomorrow, the U.S. Food and Drug Administration will be hosting a public advisory committee meeting to review data from the most recent assessment of the Risk Evaluation and Mitigation Strategy (REMS) with elements to assure safe use for transmucosal immediate-release fentanyl products. As agencies such as the FDA help combat the crisis of opioid addiction facing the nation, TIRF products are medically important but also pose serious risks. The FDA is seeking the advice of outside experts on the effectiveness of the REMS and whether changes to the REMS might be necessary. The FDA commented, "As part of our ongoing commitment to the safe use of these products, the FDA will seek the committee’s feedback on any possible modifications to the TIRF REMS goals and requirements, as well as input on the adequacy of the evaluations conducted in the REMS assessments to determine whether the TIRF REMS goals are being met." (FDA.gov

International 

  • Yesterday, the government of the Democratic Republic of the Congo announced that preliminary laboratory results indicate a cluster of cases of Ebola virus in North Kivu province. “Ebola is a constant threat in the DRC,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “What adds to our confidence in the country’s ability to respond is the transparency they have displayed once again. Working closely with the Ministry of Health and partners, we will fight this one as we did the last.” The World Health Organization will work with neighboring countries and areas to ensure health authorities are alerted and prepared to respond. They hope to have a head start on this cluster of Ebola. (WHO.int)

 

 

 

 

 

 

 

 

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