The Daily Scan

August 28, 2018

Last Updated: 8:55 AM EST

Private Sector

  • On Friday, Clover Health, a healthcare company using technology to improve medical outcomes, announced a significant national expansion by offering its Medicare Advantage health plans in Camden, Charleston, El Paso, Nashville, Philadelphia and Tucson on January 1, 2019, pending regulatory approvals. Clover also announced a strategic partnership with Taiwan-based Cathay Life Insurance, a wholly-owned subsidiary of Cathay Financial Holdings, to leverage Clover's sophisticated artificial intelligence (AI) platform to provide Cathay Life with actionable, data-driven insights.Clover released results today showing its technology has an 85 percent accuracy rate in identifying patients at risk of being admitted to the hospital in the next 28 days – an unmatched level of precision. This insight is invaluable, as it allows healthcare professionals to proactively administer the appropriate medical care to their patients and prevent hospitalizations. Reducing hospitalizations significantly improves the quality of life for the individual, while simultaneously bringing down overall costs for the healthcare ecosystem. (PRNewswire.com)

 

  • Verscend Technologies, Inc., a portfolio company of Veritas Capital and a leader in data-driven healthcare solutions, has completed its acquisition of Cotiviti Holdings, Inc., a leading provider of payment accuracy and analytics-driven solutions focused primarily on the healthcare industry. Emad Rizk, M.D., current president and chief executive officer of Verscend, will retain these titles for the combined business. The combined private company plans to operate under the Cotiviti name. “Both companies are customer-driven innovators that share a similar mission: to help our clients improve healthcare affordability, reduce waste, and identify the best path to better outcomes,” said Dr. Rizk. “With our new capabilities across payment, quality, risk, and the combination of clinical and financial data, Cotitivi will be unmatched in its ability to create differentiated value for its clients.” The acquisition of Cotiviti is the latest by Veritas Capital, which also recently acquired GE Healthcare’s ValueBased Care Division and has made previous investments in Truven Health Analytics as well as Verscend. According to chief executive officer and managing partner Ramzi Musallam, the Verscend-Cotiviti combination is a strong fit for its investment strategy. (Verscend.com)

Legislation

  • Yesterday a group of Democratic representatives sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma requesting an explanation on how the agency is implementing the recommendations of a GAO report released Friday on decreased HealthCare.gov enrollment: “We write to request an explanation of how the Department of Health and Human Services is implementing recommendations from a Government Accountability Office report finding deficiencies in the Department’s management of the 2018 Open Enrollment period. GAO found that the majority of stakeholders they interviewed attributed lower 2018 HealthCare.gov enrollment to significant consumer confusion about the status of the Affordable Care Act and the Trump Administration’s negative statements about the law. The nation’s health department, which has the self-identified objective of “improving Americans’ access to health care,” should not be working against the interests of patients and families and their goals of obtaining quality, affordable health insurance.” (HELP.Senate.gov)

Litigation

  • Seven ambulance industry defendants have agreed to pay the government a total of over $21 million to settle a False Claims Act lawsuit alleging that they knowingly submitted claims to the Medicare and Medicaid programs that violated the Anti‑Kickback Statute, the Justice Department announced yesterday.“The United States’ efforts in this case ended abusive practices in the ambulance industry,” said Acting Assistant Attorney General Chad A. Readler for the Justice Department’s Civil Division. “These settlements demonstrate our commitment to ensuring that health care decisions are made based on patient needs, not a health care provider’s financial interests.” (Justice.gov)

 

  • Last Thursday, Dr. Gilberto Sanchez of Montgomery, Alabama, was sentenced to serve 12 years and 1 month in prison for prescribing unnecessary controlled substances to his patients, committing health care fraud, and laundering money. For years, Dr. Sanchez operated a medical practice and gave patients prescriptions for controlled substances knowing that the patients did not need the medicine and would, in fact, abuse the drugs. Among the drugs Dr. Sanchez unnecessarily prescribed were dangerous opioids, including oxycodone, hydrocodone, and fentanyl. Dr. Sanchez also gave out illegitimate prescriptions for amphetamines, including Adderall, and benzodiazepines, including Xanax. To ensure that his scheme was a profitable one, Dr. Sanchez required his patients to return to his office each month and undergo physical examinations before receiving prescription refills. (Justice.gov)

 

 

 

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