The Daily Scan

August 22, 2018

Last Updated: 8:50 AM EST

Litigation

  • Geoffrey S. Berman, the United States Attorney for the Southern District of New York, announced that physician Ewald J. Antoine was sentenced today by U.S. District Judge Lorna G. Schofield to one year and one day in prison for his participation in a $30 million scheme to defraud Medicare and the New York State Medicaid Program.  Antoine falsely posed as the owner of two medical clinics, which were actually owned by a corrupt businessman, and falsely claimed that he had examined and treated hundreds of patients whom he had not in fact seen. Antoine pled guilty on January 11, 2018, to health care fraud and conspiracy to commit health care fraud, mail fraud, and wire fraud. (Justice.gov)

 

  • A Sugar Land, Texas man has admitted to conspiring to commit health care fraud through Medicare ambulance claims, announced U.S. Attorney Ryan K. Patrick. Anthony Chukwudi Nwosah is the owner of Tonieann EMS and Rosenberg EMS. Earlier this week, he admitted he conspired to submit more than $3 million in false and fraudulent claims to Medicare for ambulance transport services that were not provided and not medically necessary. Nwosah received approximately $1,094,260 as payment for those claims. Nwosah admitted he submitted the ambulance claims for Medicare beneficiaries transported by vans, not ambulances, to routine psychotherapy appointments and for at least one other beneficiary who did not require ambulance transportation. Nwosah also admitted he instructed a licensed emergency medical technician (EMT) to create fake ambulance transport records which included fake vital signs, patient narratives and transport mileage. Additionally, he admitted that more than 2,000 fake ambulance transport records contained the name of another EMT who never worked for him. (Justice.gov)

 

  • Governor Tom Wolf said today’s Pennsylvania Supreme Court Decision to allow his 2015 homecare executive order to proceed is a victory for seniors and people with disabilities in Pennsylvania.

    “Today’s Pennsylvania Supreme Court decision is a victory for seniors, people with disabilities, and homecare workers,” Governor Wolf said. “The court’s decision affirms a key part of my plan to provide choices for seniors, improve home and community-based care and attract more qualified homecare attendants. Governor Wolf signed the executive order in January 2015 as a first step in rebalancing the state’s homecare system. The order ensures that homecare workers have a voice in shaping the future of the industry and seniors have choices about where to receive care. The executive order does not grant collective bargaining rights to workers, does not force them to join a union, does not make them state employees, and does not give them a right to enter into a contract with the state. Since the order was signed, the departments of Aging and Human Services have been successfully implementing programs to expand services for older Pennsylvanians, reduce long-term care costs and ensure seniors have choices about where to age, as well as launching an online homecare directory. (Governor.PA.gov)

Regulation

  • The Government Accountability Office (GAO) publicly released a new testimony yesterday titled "CMS Has Taken Steps to Address Program Risks but Further Actions Needed to Strengthen Program Integrity." Medicaid allows significant flexibility for states to design and implement program innovations based on their unique needs. The resulting diversity of the program and its size make the program particularly challenging to oversee at the federal level. For example, in fiscal year 2017 estimated improper payments were $36.7 billion. Further, the Medicaid program accounted for about 26 percent of the fiscal year 2017 government-wide improper payment estimate. This testimony focuses on the (1) major risks to the integrity of the Medicaid program, and examples of actions CMS has taken to address these risks; and (2) other actions needed to strengthen oversight of the program. This testimony draws on GAO’s reports issued between November 2012 and July 2018 on the Medicaid program, and information on a program integrity strategy CMS announced in June 2018. (GAO.gov)

 

  • To address shortages of EpiPen, Pfizer is coordinating with FDA to extend the expiration dates of specific lots of EpiPen® 0.3 mg Auto-Injectors and its authorized generic version after review of stability data. Patients should have confidence in using the products from these particular lots as Pfizer works to stabilize supply, which is anticipated in the fourth-quarter of 2018. This announcement is based on a careful review of product stability data provided by Pfizer. We believe the extension of the expiration date will temporarily address patients’ access to and use of EpiPen® 0.3 mg Auto-Injectors, and the authorized generic, particularly during back-to-school season as demand increases. (Pfizer.com)

Research

  • JAMA published a new original investigation yesterday titled "Medicare Spending on Brand-name Combination Medications vs Their Generic Constituents." In this retrospective analysis of Medicare Part D expenditures, it was found that the difference between the amount Medicare reported spending in 2016 on 29 brand-name combination products and the estimated spending for their generic constituents for the same number of doses would have been $925 million, which includes $235 million if generic products had been prescribed at the same doses, $219 million using generic substitution at different doses, and $471 million from substitution of similar generic medications in the same therapeutic class. This means that generic substitution and therapeutic interchange may offer important opportunities to achieve substantial savings. (JAMANetwork.com)

 

 

 

 

 

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