The Daily Scan

August 15, 2018

Last Updated: 8:50 AM EST 

Regulation

  • The Office of Inspector General of Health and Human Services has viewed Maryland’s Medicaid data. The objective was to determine whether Maryland adequately secured its Medicaid Management Information System (MMIS) and data and whether it claimed certain Medicaid administrative costs in accordance with Federal requirements. After reviewing all policies and procedures among other factors, the OIG has concurred that Maryland did not adequately secure its Medicaid data and information systems in accordance with Federal requirements and guidance. The OIG wrote, “although Maryland had adopted a security program for its MMIS, numerous significant system vulnerabilities existed. These vulnerabilities remained because Maryland did not implement sufficient controls over its MMIS data and information systems. Although we did not identify evidence that anyone had exploited these vulnerabilities, exploitation could have resulted in unauthorized access to and disclosure of Medicaid data, as well as the disruption of critical Medicaid operations. These vulnerabilities were collectively and, in some cases, individually significant and could have compromised the integrity of Maryland’s Medicaid program.” (OIG.HHS.gov)

  • President Donald Trump signed H.R. 2345 into law, the "National Suicide Hotline Improvements Act of 2018." As the press release stated, "this requires the Federal Communications Commission, in coordination with the Departments of Health and Human Services and Veterans Affairs, to study the feasibility of designating a three digit dialing code for a national suicide prevention and mental health crisis hotline system." (WhiteHouse.gov

Litigation

  • Merced former CEO and licensed nurse has plead guilty to healthcare fraud and conspiracy to receive kickbacks. Sandra Haar, CEO and founder of Horisons Unlimited, a nonprofit public benefit corporation that provided health and dental services in Merced and surrounding communities will be sentenced  by U.S. District Judge Lawrence J. O’Neill on January 28, 2019. According to the plea agreement, Haar also received thousands of dollars in kickbacks in cash from an account executive at a laboratory in exchange for using it for Horisons patients’ laboratory testing. Haar orchestrated a scheme to bill Medicare and Medi-Cal for services she knew were not reimbursable, and she profited by over $3.7 million from her fraud. (Justice.gov)

  • In a federal lawsuit filed yesterday, Arkansans are challenging approval of Arkansas’s request to condition the receipt of health coverage on an onerous work requirement. It has been stated that the approval would lead to thousands to low-income individuals and families losing access to vital health care. Legal Aid of Arkansas Attorney Kevin De Liban commented, “the Arkansas waiver plan has it all backwards. Cutting people’s health care and making them jump through administrative hoops will make it harder for our clients to work and make a better life, not easier, almost 60% of people covered by Medicaid expansion in the state already work, and nearly all the rest either have a disability or look after family. These work requirements and the online-only reporting system threaten everyone’s care” (HealthLaw.org

  • Attorney General Underwood and Governor Cuomo announced a suit against Purdue Pharma for widespread fraud and deception in marketing of opioid products. The lawsuit has alleged that Purdue misrepresented its opioid products as less subject to abuse and addiction than other opioid products. The representations made by Purdue Pharma has been alleged to be an effort to increase sales of its opioid products and directly affected prescribing, public opinion, and consumption of those products. Attorney General Underwood commented, “our investigation found a pattern of deception and reckless disregard for New Yorkers’ health and wellbeing – as Purdue lined its own pockets by deliberately exploiting our communities and fueling an opioid epidemic that’s destroyed families across the state.” (AG.NY.gov

Private Sector 

  • CVS Health is working to reconstruct its contracts to implement the Ohio Department of Medicaid's new "pass-through" pricing model requirement. CVS Health is actively working with its Ohio Managed Medicaid clients to complete this effective requirement by January 1, 2019. CVS Health commented, "PBMs have saved Ohio taxpayers $145 million annually through the services they provide to the state's Medicaid managed care plans. CVS Health will continue to help its Ohio Medicaid clients manage their drug costs and improve their members' health outcomes in 2019 and beyond." (CVSHealth.com

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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