The Daily Scan

September 18, 2018

Last Updated: 1:00 PM EST

Legislation

  • U.S. Senate Majority Leader Mitch McConnell (R-KY) delivered the following remarks yesterday on the Senate floor regarding the landmark opioids legislation before the Senate: “Today, the Senate will take two important actions to help vulnerable Americans. First, we will pass the Patient Right to Know Drug Prices Act, spearheaded by Senator Collins. This legislation would ban so-called ‘pharmacy gag clauses,’ which prohibit pharmacists from sharing drug pricing information that could save consumers money. In circumstances when the out-of-pocket retail cost of a medication is actually cheaper than the price through insurance, it will allow customers access to the information they need to choose the more affordable route. After that, we’ll vote on major, landmark legislation to address the opioid crisis that continues to weigh on our nation...The effects of this emergency compound themselves. The crisis can eat away at family ties, at community institutions, at economic opportunities -- precisely the things that are necessary to lift Americans out of addiction and into recovery." The "Right to Know" Act passed 98-2 and the opioid bill package passed 99-1. (McConnell.Senate.gov)

 

  • Yesterday morning prior to the Senate vote, President Trump tweeted about his support of the "Right to Know" Act: "Americans deserve to know the lowest drug price at their pharmacy, but “gag clauses” prevent your pharmacist from telling you! I support legislation that will remove gag clauses and urge the Senate to act. #AmericanPatientsFirst" (Twitter.com)

Medicare & Medicaid

  • The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to revise the applicable conditions of participation (CoPs) for providers and conditions for coverage (CfCs) as a continuation of our efforts to reduce regulatory burden in accordance with the January 30, 2017 Executive Order “Reducing Regulation and Controlling Regulatory Costs” (Executive Order 13771). In a continued effort to balance patient safety and quality of care while limiting unnecessary procedural burdens on providers, and in accordance with the aforementioned Executive Order, CMS conducted a comprehensive review of the Medicare conditions of participation for all provider types. (CMS.gov)

Private Sector

  • Cigna Corporation and Express Scripts Holding Company announced yesterday that the Antitrust Division of the United States Department of Justice has cleared their pending merger, terminating the applicable waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976. “We are pleased that the Department of Justice has cleared our transaction and that we are another step closer to completing our merger and delivering greater affordability, choice and predictability to our customers and clients as a combined company,” said David Cordani, President and Chief Executive Officer of Cigna. “The value that we deliver together will help put our society on a far more sustainable path – one that helps health care professionals close gaps in care and supports our customers along their health journey.“ To date, Cigna and Express Scripts have obtained clearances from departments of insurance in 16 states. The companies are working constructively with regulators in the remaining jurisdictions to obtain clearance for the merger. Cigna and Express Scripts continue to anticipate that the deal will close by year-end 2018, subject to the satisfaction of all closing conditions. (Cigna.com)

Litigation

  • Dr. Tod Hagins of Wintersville, Ohio was sentenced yesterday to 57 months incarceration for writing fraudulent prescriptions to be sold on the streets from his Weirton, West Virginia practice. Hagins pled guilty to one count of “Conspiracy to Distribute Controlled Substances Outside the Bounds of Professional Medical Practice,” one count of “Healthcare Fraud,” and one count of “Money Laundering” in April 2018. Hagins operated a general medical practice, as well as the Weirton Suboxone Clinic. Hagins admitted to prescribing oxycodone to several individuals without a legitimate medical purpose to be sold on the streets for a share in the profits. Hagins also admitted to writing the prescriptions for oxycodone in a manner that would allow the individual filling said prescriptions to be paid for by West Virginia Medicaid. As a part of the conspiracy, Hagins deposited $4,000 into a business equity line of credit to be used in the scheme, with the intention of concealing the criminal activity. (Justice.gov)

 

  • Kristen Khanna of Windham, New Hampshire pled guilty in federal court yesterday to healthcare fraud and prescription fraud charges. According to court documents and statements made in court, Khanna is a nurse practitioner licensed to practice in the State of New Hampshire who operated Total Pain Care and Wellness, P.A. in Salem, New Hampshire. Khanna was the only licensed provider at Total Pain Care, but had an employee who was not a medical provider. The government’s investigation, which included patient interviews, a review of prescribing data and other investigative techniques, revealed that Khanna was often not present at Total Pain Care and allowed office visits to be conducted by the employee. On numerous occasions, Khanna would then bill Medicare for those office visits as if she had conducted them herself, causing Medicare to reimburse Total Pain Care for the services purportedly rendered. Medicare would not have paid for these sham office visits if it had known that the employee, and not Khanna, was providing the service. Khanna also admitted that she would often leave the employee with a pad of pre-signed, but otherwise blank, prescription forms for the employee to fill out and issue to patients in what the two often referred to as “drive-by” visits. Patients would then take those prescriptions and fill them at local pharmacies, causing Medicare to pay for the prescriptions through the Part D prescription drug program. The government determined that more than 200 prescriptions for controlled substances were filled by more than a dozen Medicare patients in this manner in 2015. (Justice.gov)

 

 

 

 

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