The Daily Scan

September 26, 2018

Last Updated: 1:00 PM EST

 

Litigation

  • Health Management Associates, LLC (HMA), formerly a U.S. hospital chain headquartered in Naples, Florida, will pay over $260 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States. The government alleged that HMA knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services, paid remuneration to physicians in return for patient referrals, and submitted inflated claims for emergency department facility fees. According to admissions made in the resolution documents, HMA instituted a formal and aggressive plan to improperly increase overall emergency department inpatient admissions at all HMA hospitals. As part of the plan, HMA set mandatory company-wide admission rate benchmarks for patients presenting to HMA hospital emergency departments – a range of 15 to 20% for all patients presenting to the emergency department, depending on the HMA hospital, and 50% for patients 65 and older (i.e. Medicare beneficiaries) - solely to increase HMA revenue. HMA executives and HMA hospital administrators executed the scheme by pressuring, coercing and inducing physicians and medical directors to meet the mandatory admission rate benchmarks and admit patients who did not need impatient admission through a variety of means, including by threatening to fire physicians and medical directors if they did not increase the number of patients admitted. (Justice.gov)

Legislation 

  • The Senate and House of Representatives reached consensus last night on what Senate Majority Leader Mitch McConnell (R-Ky.) calls “landmark” opioids legislation that is the product of bipartisan bills that passed the House of Representatives by a vote of 396-14 and the Senate by a vote of 99-1. The House and then the Senate will need to pass this consensus legislation before it can go to the President for his signature. “This legislation represents the work of 8 committees in the House and 5 committees in the Senate who have worked together to reach consensus about how to help address the opioid crisis which is affecting virtually every American community,” said Senate health committee Chairman Lamar Alexander (R-Tenn.). “The consensus legislation includes the STOP Act to help stop the shipment of synthetic opioids, extends support for Medicaid patients seeking treatment from 15 to 30 days, covering all substance use disorders, and permanently allows more medical professionals to treat people in recovery to prevent relapse and overdoses. The bill also allows the FDA to require prescription opioids to be packaged in set amounts like a 3 or 7 day supply in blister packs, and will help spur the development of a non-addictive painkiller. There is bipartisan urgency for both of our chambers to pass this consensus legislation so the President can sign it as soon as possible.” (HELP.Senate.gov)

 

  • In an interview with The Salt Lake Tribune, Senate hopeful Mitt Romney praised the state of Utah’s partial approach to Medicaid expansion, which uses work requirements and a lower income threshold to limit enrollment and, by extension, costs. "If the federal government’s share of health care costs were to change, he said, full-expansion states would be on the hook to make up the difference.“Medicaid expansion is a very complex issue,” he said. “It requires extensive research and analysis and I think is generally done best by elected representatives of the people.” As a senator, Romney said he would work hard to persuade the federal Department of Health and Human Services to approve Utah’s Medicaid waiver. “What the state has arrived at is a better way,” he said. (SLTrib.com)

Research

  • A test that may reduce, from days to hours, the time needed to diagnose patients with bacterial infections and determine how well an antibiotic will work against specific infections will receive advanced development support from the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR). The Biomedical Advanced Research and Development Authority (BARDA), part of ASPR, will sponsor the advanced development of the new testing technology under an 18-month, approximately $9.3 million contract with SeLux Diagnostic, Inc of Charlestown, Massachusetts. SeLux is developing a phenotypic test; it identifies bacteria based on observable physical or biochemical characteristics of the bacteria. Based on the characteristics, the test identifies the class of bacteria and which antibiotics are best for treating that particular bacterial infection. Faster information to select the best antibiotic can speed a patient’s recovery, which means fewer days spent in a hospital and better outcomes for patients. (HHS.gov)

 

 

 

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