The Daily Scan

August 20, 2018

Last Updated: 9:00 AM EST

Litigation

  • Lincare, Inc., has paid $5.25 million to resolve allegations that it violated the federal False Claims Act and the Anti-Kickback Statute by offering illegal price reductions to Medicare beneficiaries, U.S. Attorney Steven D. Weinhoeft announced Thursday. Headquartered in Clearwater, Florida, Lincare is one of the nation’s largest providers of oxygen and other respiratory therapy services to patients in the home, with approximately 1,000 locations across the United States. The government alleged that, from 2011 to 2017, Lincare attempted to gain a competitive advantage in the marketplace by unlawfully waiving or reducing co-insurance, co-payments, and deductibles for beneficiaries who participated in a Medicare Advantage Plan operated through a private insurer. Lincare’s practices violated the Anti-Kickback Statute, and further caused the submission of false claims for payments to Medicare. (Justice.gov)

 

  • A grand jury indictment was unsealed on Thursday charging Patrick Wittbrodt, Dr. April Tyler and Jeffrey Fillmore of Genesee County with health care fraud and Patrick Wittbrodt with money laundering, United States Attorney Matthew Schneider announced. The Indictment charges the defendants with a conspiracy to commit health care fraud and 17 counts of health care fraud. The Indictment specifically charges that between 2014 and 2017, the defendants would attend meetings of the United Auto Workers (“UAW”) union. At those meetings, the defendants touted unnecessary prescription pain cream, scar cream, pain patches and vitamins to UAW members. The prescriptions were unnecessary because Dr. April Tyler did not establish a valid doctor-patient relationship with any of the UAW members and/or did not determine medical necessity for the prescriptions she wrote for the UAW members. Many of the compounded pain and scar creams were billed to the insurance company at over $15,000 per prescription. (Justice.gov)

Legislation

  • Senators Elizabeth Warren (D-MA) and Tina Smith (D-MN) sent a letter to HHS Secretary Alex Azar on Friday questioning comments made in his June 2018 Senate testimony regarding pharmacy benefit managers: "Earlier this year, when President Trump unveiled his drug pricing proposals, he promised the public that they would see rapid reductions in drug prices. He said, "We're going to have some of the big drug companies in in two weeks and they're going to announce - because of what we did - they're going to announce voluntary massive drops in prices ... there will be a major drop in the cost of prescription drugs." 1 But President Trump has not been able to keep his promise. There have been no drug price drops of significance. Instead, drug companies have - at best - announced token actions that are nothing more than public relations stunts." (Warren.Senate.gov)

Medicaid

  • Late last week, the Centers for Medicare and Medicaid Services (CMS) announced significant improvements in managing the Medicaid program in partnership with states. An official press release explained: "Identified early as a priority for both the Trump Administration and the National Association of Medicaid Director’s (NAMD), CMS has implemented changes resulting in faster processing of state requests to make program or benefit changes to their Medicaid program through the state plan amendment (SPA) and section 1915 waiver review process. “With faster processing times and earlier communication, states now have much greater ability to manage their programs in an effective and predictable manner,” said CMS Administrator Seema Verma. “We want to ease bureaucratic requirements for both states and our own staff so that we can focus those resources on improving health outcomes rather than pushing paperwork.”" (CMS.gov)

 

  • According to a Governing.com article, the Trump administration is reportedly preparing to propose a rule that would deter legal immigrants from using government service: "The rule, according to leaked drafts of it, would make it harder for legal immigrants to become citizens or get green cards if they have ever used a wide range of public welfare, including Medicaid, food stamps, the Children’s Health Insurance Program (CHIP) and subsidies to buy health insurance. There are already scattered reports of immigrants, afraid of jeopardizing their shot at permanent residency, choosing not to use health benefits for which they -- or their children -- qualify. If a significant number of legal immigrants forgo health insurance, that could have negative ripple effects on so-called Obamacare premiums and on the health-care system as a whole." (Governing.com)

 

 

 

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