The Daily Scan

September 7, 2018

Last Updated: 8:55 AM EST

Medicaid

  • More than 4,500 low-income Arkansans lost their health insurance on September 1 because they did not report 80 hours of work online for three consecutive months, according to state data. Approximately 4,574 residents did not report work or volunteer activities for June, July, and August to maintain Medicaid insurance as of Monday, said Arkansas Department of Human Services spokesperson Amy Webb in an email to ThinkProgress. She added that the state provided individuals with a five-day grace period, giving them until Wednesday at 9 p.m. local time to report work activities. Additionally, the state is giving beneficiaries until October to apply for a “good cause exemption” if they faced a computer problem when attempting to report their hours. For those who ultimately fail to meet the requirement, individuals are locked out of health coverage until January 1. It is unclear whether they have been notified that their coverage has been terminated. The official state report will be released next Thursday. (ThinkProgress.org)

Medicare

  • Modern Healthcare reported yesterday that the Medicare Provider Reimbursement Review Board quietly issued 90 pages of updated rules last week that, if not followed to the letter, could scrap appeals worth millions of dollars. The new rules were issued without notice and took effect when they were issued last week. The PRRB has jurisdiction over Medicare Part A, and most of its appeals come from hospitals. One of the biggest changes in the new rules is that parties filing appeals must now send their cover letter, called the preliminary position paper, and exhibits, to the board at the outset of an appeal. Previously, those materials were only shared between the hospital and the Medicare Administrative Contractor, the third-party contractors the CMS uses to audit and issue reimbursement notices. (ModernHealthcare.com

Litigation

  • Two individuals associated with a mental health company pleaded guilty on Wednesday to health care fraud related to the submission of false claims to Medicaid and tax evasion. According to documents and information provided to the court, Catinia Farrington owned Durham County Mental Health and Behavioral Health Services, LLC (“DCMBHS”) in Durham, NC. Farrington submitted false claims to Medicaid for mental health services that were not performed. From 2011 through 2015, Farrington submitted thousands of false claims to Medicaid that resulted in Medicaid paying approximately $4 million to DCMBHS. Also during the relevant period, Haydn Thomas worked as the practice manager for an oral surgeon and provided Farrington with name and Medicaid number of a dental patient, causing the filing of a false medical claim. Farrington and Thomas diverted millions of dollars from DCMBHS for their own personal use and evaded income taxes by, among other things, transferring money to various business bank accounts and paying personal expenses from the business bank accounts. (Justice.gov)

Legislation

  • The Senate will vote next week on a package of bills aimed at curbing the nation's opioid epidemic, Majority Leader Mitch McConnell (R-Ky.) announced Thursday. The sweeping opioid package focuses on treatment and prevention as well as curbing the flow of illicit substances into the US. (TheHill.com)

Private Sector

  • Blood testing company Theranos, whose founder and former CEO Elizabeth Holmes is facing fraud charges, has announced that it will shut down. In a letter to shareholders published earlier this week in The Wall Street Journal, CEO and General Counsel David Taylor wrote: "We are now out of time. Despite our careful cash management, we are in default under the Fortress credit facility. Fortress has the legal right to foreclose upon, and to sell or take ownership of, all of the Company’s assets, including the Company’s intellectual property (which is owned by a “special purpose subsidiary” of the Company). In addition to Fortress, we owe at least $60 million to our unsecured creditors." (WSJ.com)

Research

  • The JAMA Network released a new report this week on an original investigation into "Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015." The investigation explored how patterns of care for low-acuity patients with acute conditions have changed over time among a commercially insured population. An analysis of data from a large commercial health plan from 2008 to 2015 showed that emergency department visits per enrollee for the treatment of low-acuity conditions decreased by 36%, whereas utilization of non–emergency department acute care venues increased by 140%. There was also a net increase in overall utilization of acute care venues for the treatment of low-acuity conditions and in associated spending, proving that there were substantial shifts at which venue Americans received acute care for low-acuity conditions. (JAMANetwork.com)

 

 

 

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