The Daily Scan

August 16, 2018

Last Updated: 8:45 AM EST

Litigation

  • Steven P. Gibson, pharmacist and owner of Gibson’s Discount Drugs in Red Bud, Illinois, pled guilty in federal court on Tuesday to charges that he engaged in a scheme to defraud health care benefit programs by submitting false claims for fraudulent prescription medications to Medicare, Medicaid, and private insurance companies that were not authorized by a physician, nurse practitioner, or a physician’s assistant as required. During his plea hearing, Gibson admitted that he submitted false and fraudulent claims in the names of family members and pharmacy customers for prescription medication. Gibson often selected expensive prescription medications that he knew would be paid for by insurance companies (including Medicare and Medicaid). In total, Gibson received payments of over $630,000 from Medicare, Medicaid, and private insurance companies. (Justice.gov)

Medicaid

  • In an August 14 letter to Ohio's five Medicaid managed care plans, Ohio Medicaid Director Barbara Sears ordered them to terminate contracts with two pharmacy benefit managers using "spread pricing" models and to negotiate new contracts with "pass through" pricing models.

Regulation

  • The Department of Health & Human Services Office of Inspector General has released updates to their Work Plan. Recently added active items include:

    • Review of States' Oversight of Opioids

    • Potential Abuse and Neglect of Children Receiving Medicaid Benefits

    • CMS Oversight of Nursing Facility Staffing Levels

    • Hospitals' Compliance with Medicare's Transfer Policy With the Resumption of Home Health Services and the Use of Condition Codes

    • Review of Federal Programs Administered by American Indian and Alaska Native Tribes

    • Physicians Billing for Critical Care Evaluation and Management Services

    • Blood Lead Screening Tests, Followup Services, and Treatment for Medicaid-Enrolled Children

    • ACF Child Care Development Fund: Program Integrity

    • Penetration Test of the Affordable Care Act Website and Associated System

    • Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data

    • Medicare Market Shares of Mail Order Diabetic Test Strips from April-June 2018

 

  • Yesterday, the U.S. Department of Health and Human Services (HHS) announced $125 million in Quality Improvement grant awards to 1,352 community health centers across all U.S. states, territories and the District of Columbia. Funded by the Health Resources and Services Administration (HRSA), health centers will use these funds to continue to improve quality, efficiency, and the effectiveness of healthcare delivery in the communities they serve. This announcement comes during National Health Center Week, the annual celebration that highlights the critical role community health centers play in providing high-quality, affordable, primary healthcare. (HHS.gov)

Private Sector

  • Express Scripts is in talks with biotechnology companies Biomarin Pharmaceutical Inc (BMRN.O), Spark Therapeutics Inc. and Bluebird Bio Inc. to have its specialty pharmaceutical business exclusively distribute their new hemophilia therapies when they are expected to become available in 2019 and 2020, Chief Medical Officer Steve Miller told Reuters in an interview. Biomarin, Spark and Bluebird confirmed to Reuters that they were speaking to a payers - a group generally defined as pharmacy benefit managers, health plans and government agencies - about pricing models for future therapies. tyAnalysts project those drugs could top $1 million to $1.5 million in price. (Reuters.com)

 

  • Best Buy announced yesterday that they have agreed to acquire GreatCall Inc. in an $800 million deal that expands their reach in the large and growing health space. GreatCall is a leading provider of connected health and personal emergency response services to the aging population, with more than 900,000 subscribers. It sells easy-to-use mobile phones and connected devices that provide a way for seniors to reach a medical professional at the touch of the button. That design allows aging consumers to live independently longer, while also providing peace of mind to their loved ones. According to a corporate press release: "Those offerings align with Best Buy’s mission to enrich people’s lives through technology and build on our existin­­­g efforts in the health space. As part of our Best Buy 2020: Building the New Blue strategy, we have specifically focused on addressing the growing needs of the aging population with the help of technology products and services." (BestBuy.com)

 

 

 

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