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The Daily Scan

Last Updated: 8:45 AM EST


  • JAMA Internal Medicine published a research letter yesterday titled "Analysis of Work Requirement Exemptions and Medicaid Spending." The study was conducted because no previous studies had quantified the potential influence of work requirements on Medicaid spending. Researchers concluded: "Results of our analysis indicate that savings to Medicaid would be minimal if exemptions were precisely applied. However, savings might be much larger (as Kentucky’s governor has suggested) if work requirements caused a “spillover effect” (i.e., loss of coverage by exempt Medicaid enrollees unable to comply with documentation requirements). If spillover loss of coverage is the primary mechanism by which work requirements decrease Medicaid enrollment and spending, these savings would likely come at substantial cost in terms of human health." (JAMANetwork.com)


  • The Government Accountability Office (GAO) released a new Medicare Advantage report on Monday titled "Benefits and Challenges of Payment Adjustments Based on Beneficiaries' Ability to Perform Daily Tasks." According to the report highlights, accurate risk adjustment avoids the creation of a financial advantage or disadvantage for plans solely on the basis of the health status of enrolled beneficiaries. The 21st Century Cures Act contains a provision for GAO to report on issues related to incorporating functional status into MA risk adjustment. Among other reporting objectives, this report examines the accuracy of the current CMS risk adjustment model for beneficiaries with functional limitations and the potential benefits of accounting for functional status in MA risk adjustment; and the potential challenges of accounting for functional status in risk adjustment. (GAO.gov)


  • The AHA, Association of American Medical Colleges, America’s Essential Hospitals, 340B Health and three hospital systems asked a federal court yesterday to order the Department of Health and Human Services to make effective within 30 days a final rule requiring drug companies to disclose the ceiling price for 340B outpatient drugs. Required by Congress in 2010, HHS has delayed the rule’s effective date five times. To ensure accuracy and compliance with the 340B drug savings program, the rule also describes how ceiling prices must be calculated and would allow the federal government to levy civil monetary penalties against drug companies that intentionally overcharge 340B providers. (AHA.org: Announcement, Complaint)

  • A Detroit-area podiatrist was sentenced to 28 months in prison yesterday for his participation in a $1 million scheme involving podiatry services that were billed to Medicare but were never rendered. As part of his guilty plea, Lawrence Young, D.P.M. admitted that from approximately January 2010 through April 2017, he engaged in a scheme to defraud the Medicare program by causing the submission of false and fraudulent claims to Medicare for the application of an “Unna Boot,” which is a type of medicated dressing typically applied after surgery to control swelling of the leg or foot. Young admitted regularly submitting these claims for reimbursement even though he knew that his patients routinely received nothing more than a non-medicated dressing. The scheme involved the submission of more $1 million in fraudulent claims to Medicare, he admitted. (Justice.gov)


  • Yesterday the Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) awarded $21 million to 46 community health centers to support their participation in the National Institutes of Health’s (NIH) All of Us Research Program. All of Us is a national effort to gather data from one million or more U.S. residents to accelerate research and improve health by taking individuals’ differences in lifestyle, environment, biology and other factors into account. HRSA’s investment supports community health centers’ capabilities to enroll and retain participant partners in All of Us, which seeks to advance precision medicine. (HHS.gov)

Private Sector

  • A pharma executive has defended his decision to raise the price of an antibiotic mixture to more than $2,000 a bottle, arguing there was a “moral requirement to sell the product at the highest price”. Last month, Nostrum Laboratories, a small Missouri-based drugmaker, more than quadrupled the price of a bottle of nitrofurantoin from $474.75 to $2,392, according to Elsevier’s Gold Standard drug database. Nitrofurantoin is an antibiotic used to treat bladder infections that was first marketed in 1953, which appears on the World Health Organization’s list of essential medicines. It comes in a tablet form as well as a liquid version that Nostrum makes. In an interview, Nirmal Mulye, Nostrum chief executive, said he had priced the product according to market dynamics, adding: “I think it is a moral requirement to make money when you can...to sell the product for the highest price." (FT.com)

#Medicaid #Medicare #Litigation #Research #PrivateSector


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