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The Daily Scan

Last Updated: 1:00 PM EST


  • U.S. Attorney Maria Chapa Lopez announced Friday that the United States has settled allegations that a Tampa-based compounding pharmacy, now-defunct RS Compounding, LLC, and its owner, Renier Gobea, knowingly billed TRICARE excessive prices for compounded prescriptions. In reaching this settlement, the parties resolved allegations that, between January 1, 2012, and January 31, 2014, Gobea and RS Compounding charged TRICARE at least 2,000% more for drugs than they charged cash-paying customers, in violation of the False Claims Act. TRICARE, the health care program for uniformed service members and their families, prohibits pharmacies from charging TRICARE more than the general public. Gobea and RS Compounding charged TRICARE vastly more than they charged the public, in some cases over 10,000% more. When Gobea and RS Compounding determined that this practice violated TRICARE policy in January 2014, they made mere prospective changes and did not return the profits secured by the overcharges. In an ability-to-pay settlement, the government agreed to accept $1.2 million to resolve these allegations. (Justice.gov)

  • Montana-based Kalispell Regional Healthcare System (KRH) along with six subsidiaries and related entities have agreed to pay $24 million to resolve allegations that they violated the False Claims Act by paying physicians more than fair market value, and by conspiring to enter into arrangements that improperly induced referrals, the Department of Justice announced on Friday. Between 2010 and 2018, the KRH entities allegedly violated the Stark Law by paying excessive full-time compensation to more than 60 physician specialists – many of whom worked far less than full-time. Additionally, HealthCenter, Flathead, NH, NOSM, and AHS allegedly conspired to violate the Anti-Kickback Statute by paying excessive compensation to physicians employed by KRH, KRMC, and other KRH entities to induce referrals to HealthCenter, and by providing administrative services to HealthCenter at below fair market value to reduce expenses and increase profits distributed to physician investors at Flathead, an owner of HealthCenter, also to induce referrals to HealthCenter. (Justice.gov)


  • Today, the Centers for Medicare & Medicaid Services (CMS) announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience. The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families. The eMedicare initiative’s goal is to provide a seamless online health care experience to meet the growing expectations for this generation of Medicare beneficiaries. CMS has a cohesive, multi-year strategy of consumer data integration and web product development to modernize Medicare.gov and improve access to personal health care data. The road map for this program will enhance opportunities to go digital, offer additional self-serve options, and create a seamless multi-channel customer service experience. “Since day one, President Trump has been committed to strengthening the Medicare program—eMedicare puts his leadership into action by giving Medicare beneficiaries a simpler, more intuitive customer experience,” CMS Administrator Seema Verma said. “Our intent is not to replace traditional channels that beneficiaries trust and depend on, but to improve and enhance them with the emerging digital options to create a user-centered, seamless consumer experience.” (CMS.gov)

  • CMS recently expanded on new healthcare price transparency requirements for hospitals in a series of frequently asked questions (FAQs) published on its website. The FAQs cover which hospitals are subject to the new requirements, the definition of machine-readable, and what items and services furnished at the hospital must be included on the publicized list. In August 2018, CMS finalized the 2019 inpatient and long-term care hospital prospective payment system (IPPS/LTCH PPS) rule, which contained new requirements mandating hospitals publicize a list of their standard changes online in a machine-readable format by the new year. Hospitals would also have to update the list of prices at least annually, the rule stated. (RevCycleIntelligence.com)

Affordable Care Act

  • According to a new report from FactCheck.org, President Donald Trump has repeatedly said that Obamacare is “dead,” but recently he has been making a misleading boast about low insurance premium growth for 2019 marketplace plans. Trump claimed that “the rates are far lower than they would have been under the previous administration,” adding, “because we’re managing it very, very carefully.” The study disputes that, and experts say most administration actions in the past two years have driven premiums up. The actions the administration has taken “by and large have destabilized the market,” said Cynthia Cox, the director of the program for the study of health reform and private insurance at the Kaiser Family Foundation. (FactCheck.org)


  • The U.S. Department of Health and Human Services (HHS) and the American Society of Nephrology (ASN) have committed $2,265,000 in prize money for “KidneyX: Redesign Dialysis,” a prize competition that challenges the public to develop better treatment options for patients with kidney failure. This prize competition is the first in a planned series of Kidney Innovation Accelerator (KidneyX) prize competitions designed to develop innovative solutions that can prevent, diagnose, and/or treat kidney diseases. “With this first prize, KidneyX: Redesign Dialysis, we are looking for solutions that completely disrupt the way kidney failure is currently treated,” said Ed Simcox, HHS Chief Technology Officer, “We are asking innovators like engineers and scientists to propose and develop new technologies to redesign treatment for kidney failure. We look forward to seeing what the best and brightest envision for the future of kidney failure treatment in the first phase of Redesign Dialysis.” (HHS.gov)

  • The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) today announced a strategic partnership with Genentech, a member of the Roche Group, of South San Francisco in an effort to develop innovative medicines that combat diverse national health security threats. The company and ASPR’s Biomedical Advanced Research and Development Authority (BARDA) will jointly manage and share the cost to develop a portfolio of medicines that meet national health security requirements and have commercial uses. The partners will focus first on developing a first-in-class therapeutic for hospitalized influenza patients and a treatment for lung injuries caused by inhaling sulfur mustard gas. BARDA will contribute $43 million over five years to support a study of the investigational oral medicine baloxavir marboxil in treating severely ill patients hospitalized with seasonal or pandemic influenza viruses. (HHS.gov)

Private Sector

  • Walgreens Boots Alliance, Inc. announced on Friday that the company has reached an agreement with the Securities and Exchange Commission (SEC) to fully resolve an investigation into forward-looking financial goals and related disclosures by Walgreen Co. (Walgreens). The disclosures at issue were made prior to the merger with Alliance Boots and the establishment of Walgreens Boots Alliance on December 31, 2014. The settlement does not involve any of Walgreens Boots Alliance’s current officers or executives, nor does it allege that anyone acted intentionally or recklessly at any time. In agreeing to the settlement, Walgreens Boots Alliance neither admits nor denies the SEC’s allegations that Walgreens and its then Chief Executive Officer (CEO) and then Chief Financial Officer (CFO) acted negligently in connection with statements made in the June 2013, October 2013, December 2013 and March 2014 earnings calls, by failing to adequately disclose the increased risk to achieving certain of Walgreens previously stated fiscal 2016 financial goals. Following warnings in December 2013 and March 2014, Walgreens withdrew those fiscal 2016 goals in June 2014. Pursuant to the agreement with the SEC, Walgreens Boots Alliance consented to the SEC’s issuance of an administrative order, and the company will pay a $34.5 million penalty, which has been fully reserved for, while the Walgreens then CEO and then CFO separately resolved the matter with the SEC. (WalgreensBootsAlliance.com)

#Litigation #Medicare #AffordableCareAct #Research #PrivateSector


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