The Daily Scan

October 29, 2018

Last Updated: 1:00 PM EST

 

Litigation

  • United States Attorney William M. McSwain announced today that pharmaceutical companies Abbott Laboratories and AbbVie Inc. (“Abbott”) will pay $25 million to resolve allegations that it employed kickbacks and unlawful methods of marketing and promotion to induce physicians to prescribe the drug TriCor®. The settlement resolves allegations that, between 2006 and 2008, Abbott knowingly paid kickbacks to physicians in order to induce TriCor® prescriptions. Abbott, through its sales representatives, allegedly provided physicians with improper gift baskets, gift cards, and other items to induce prescriptions of TriCor®. Abbott also engaged health care providers for consulting services and speaking engagements, where one purpose of the remuneration for the programs was to induce or reward physicians for TriCor® prescriptions. In addition to the kickback allegations, the settlement also resolves allegations that Abbott engaged in unlawful methods of off-label marketing and promotion relating to the sale of TriCor® for unapproved indications. (Justice.gov)  

Medicaid

  • Federal advisers will ask the Trump administration to hold off on approving controversial Medicaid work requirements, an advisory panel decided October 25. The new rules tie Medicaid eligibility to maintaining a job, pursuing education, or volunteering. Members of the Medicaid and CHIP Payment and Access Commission also want Arkansas, the first state to roll out the sweeping eligibility overhaul, to slow down implementation while they build in more safeguards for beneficiaries. Implementation of sweeping Medicaid overhauls is always difficult but less so with more time and more data, Commissioner Christopher Gorton said. Gorton is the former president of public plans at Tufts Health Plan.“Let’s do it right,” he said. “Let’s hit the pause button, not forever or in response to what we’re seeing in Arkansas, simply because we’re not ready to dance here.”The panel, which advises Congress and health-care officials, plans to detail its concerns in a letter to Health and Human Services Secretary Secretary Alex Azar. (BNA.com)

Medicare

  • On Friday, CMS issued a proposed rule that updates Medicare Advantage (MA or Part C) and the Medicare prescription drug benefit program (Part D) by promoting flexibility and innovation so that MA and Part D sponsors are empowered with the tools to improve quality of care and provide more plan choices for MA and Part D enrollees. CMS took significant action to increase MA plan choices for plan year 2019 and aims to continue to expand opportunities to enrollees so they have access to MA plans that meet their unique health needs. In continuing the efforts to increase plan flexibility and plan choices for beneficiaries, CMS is proposing to provide additional flexibilities in the MA program that will allow more options and new benefits for beneficiaries. In addition to creating opportunities for increasing plan flexibility and plan choices, CMS is making critical updates with respect to program integrity and taking steps to help the agency recover improper payments made to Medicare Advantage organizations. If finalized, the proposed changes would result in an estimated $4.5 billion savings to the Medicare Trust Funds over ten years, largely arising from recovery of overpayments to MA plans. (CMS.gov, FederalRegister.gov)

 

 

 

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