The Daily Scan

September 20, 2018

Last Updated: 1:00 PM EST

 

Medicaid

  • As the Maine Medicaid expansion debate continues, Maine Speaker of the House Sara Gideon (D) sent a letter Tuesday addressed to Seema Verma, Administrator for the Centers for Medicare and Medicaid Services, urging the administration to approve it. In the letter, Gideon comments that the legislature has evaluated and appropriated the actual cost of expansion, Maine has ample funds for expansion, and Governor LePage has failed to submit a formal plan for funding. Ending the letter, Gideon wrote: “The Legislature has fulfilled its obligation and passed an appropriation to fund the cost of expansion at a level that meets the governor’s demands, even though other independent analysis suggests that the true cost is much less than the governor claims. The governor’s decision to veto this legislation does not change the fact that the expansion of MaineCare is mandated by Maine law.” (SpeakerGideon.com)

Medicare

  • On Monday, CMS released the "Recovery Auditing in Medicare Fee-For-Service for Fiscal Year 2016 Report to Congress". Of note, the report found that in fiscal year (FY) 2016, Medicare FFS RACs collectively identified and corrected 380,229 claims with improper payments that resulted in $473.92 million in improper payments being corrected. The total corrections identified include $404.46 million in overpayments collected and $69.46 million in underpayments repaid to providers (see Table 1). This represents a 7.5% increase from program corrections in FY 2015, which were $440.69 million. In FY 2016, the Medicare FFS Recovery Audit Program returned a net of $214.09 million to the Medicare Trust Funds. This represents a 50% increase from returned dollars in FY 2015, which were $141.87 million. (CMS.gov)

Litigation

  • Yesterday the Federal Circuit Court affirmed the Court of Federal Claims' dismissal on the matter of CliniComp International, Inc. v. United States for lack of standing. CliniComp was the incumbent provider of EHR systems to the VA. It filed a bid protest in 2017 with the Claims Court, asserting (among other things) that the VA’s sole-source decision lacked a rational basis and violated the Competition in Contracting Act. CliniComp also moved for a preliminary and permanent injunction preventing the VA from awarding a sole-source contract to Cerner. Cerner intervened. CliniComp then moved for judgment on the administrative record, and the government and Cerner responded with motions to dismiss and cross-motions for judgment on the administrative record. The Claims Court granted the motions to dismiss, finding that CliniComp lacked standing to protest the VA’s sole-source decision. (CAFC.USCourts.gov)

 

  • A federal jury found a physician and two clinic owners and operators guilty on Tuesday for their roles in a $17 million Medicare fraud scheme. According to evidence presented at trial, from approximately December 2011 to August 2015, John P. Ramirez, M.D., Ann Nwoko Shepherd, and Yvette Nwoko, all of Houston, Texas, conspired and schemed to defraud Medicare out of payments for medical services. Shepherd owned and operated Southwest Total Medical Inc., a purported medical clinic doing business as Amex Medical Clinic in Houston. Shepherd sold medical orders and other documents signed by Ramirez to home-health agencies in and around Houston. Ramirez falsely certified in these medical orders information about the patient’s medical condition and need for medical services. Co-conspirators at home-health agencies then used the false and fraudulent paperwork signed by Ramirez and sold by Shepherd to bill and receive payment from Medicare for medical services that were not medically necessary or not provided. Later in the conspiracy and scheme, Nwoko acted as the manager of Amex Medical Clinic where she too sold false and fraudulent paperwork used by co-conspirators to bill and receive payment from Medicare for similarly unnecessary medical services, the evidence showed. Shepherd also caused Amex Medical Clinic to bill Medicare for purported physician services that were actually provided by an unlicensed practitioner, if at all, the evidence showed. (Justice.gov)

 

  • The U.S. District Court has entered a civil judgment of $1,374,058, in favor of the United States and against Calloway Laboratories, Inc., a clinical laboratory based in Woburn, Massachusetts, holding Calloway liable for submitting false claims to federal healthcare programs, including Medicare and TRICARE. This civil judgment, announced yesterday by the U.S. Attorney’s Office, is part of a settlement agreement resolving False Claims Act allegations that, during the period May 2014 to November 2014, Calloway submitted false claims for payment for urine drug testing referred by physicians to whom Calloway provided free testing supplies.  As part of the settlement agreement, Calloway acknowledged that it provided free testing supplies to physicians for the purpose of inducing or rewarding referrals of urine drug testing to Calloway. Calloway then submitted claims to Medicare and TRICARE seeking payment for the testing referred by these physicians. (Justice.gov)

Research

  • Yesterday Health and Human Services Deputy Secretary Eric Hargan announced the creation of the Deputy Secretary’s Innovation and Investment Summit (DSIIS). The DSIIS will be a yearlong collaboration between healthcare innovation and investment professionals and HHS personnel who will meet quarterly to discuss the innovation and investment landscape within the healthcare sector, emerging opportunities, and the government’s role in facilitating more investment and accelerated innovation. This announcement follows a June 2018 “Request for Information” posted by HHS in the Federal Register requesting public feedback and input on this issue. The DSIIS will produce high-level dialogues between HHS and private sector innovators to accelerate new investment and research in healthcare that will advance the mission of HHS to enhance and protect the health and well-being of all Americans. (HHS.gov)

 

  • Today, the U.S. Surgeon General released a new report titled "Facing Addiction in America: The Surgeon General’s Spotlight on Opioids." The report calls for a cultural shift in the way Americans talk about the opioid crisis and recommends actions that can prevent and treat opioid misuse and promote recovery. The Surgeon General today also released a digital postcard, highlighting tangible actions that all Americans can take to raise awareness, prevent opioid misuse and reduce overdose deaths. “Addiction is a brain disease that touches families across America – even my own,” said U.S. Surgeon General Jerome M. Adams. “We need to work together to put an end to stigma.”According to preliminary data from the Centers for Disease Control and Prevention, overdose deaths in 2017 increased by almost 10% – claiming the lives of more than 70,000 Americans. Nearly 48,000 of those were opioid overdose deaths, with the sharpest increase occurring among deaths related to illicitly made fentanyl and fentanyl analogs (synthetic opioids). (HHS.gov)

 

 

 

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