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Industry News

Apr 13, 2018

Almost a third of telemedicine claims sampled by HHS' Office of Inspector General did not meet Medicare requirements, resulting in an estimated $3.7 million in unnecessary spending by the CMS.

The OIG reviewed 191,118 claims from 2014 and 2015 for distant-site telehealth services that resulted in payments of about $13.8 million. Of a representative sample of 100 claims, the OIG found that 31 claims did not meet Medicare requirements. Most of those 31 did not qualify because the...

Apr 13, 2018

A recently unsealed False Claims Act lawsuit against CVS Health claims the company, through its pharmacy benefits manager, illegally billed Medicare for higher prices than it was actually paying pharmacies.

Sarah Behnke, a senior actuary with Aetna, filed the lawsuit in 2014 alleging that CVS Caremark was getting better prices on drugs with its pharmacies, but was not passing those savings to Medicare Part D. The lawsuit was unsealed after the federal government declined to intervene...

Apr 13, 2018


The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

Happy Friday! Welcome back to The Friday Breeze, where I (KHN’s newsletter editor) wade through hundreds of health articles from the week so you don’t have to.

Health certainly was not at the top of mind for this week’s news cycle (what with the House...

Apr 13, 2018

An online pharmacy that bills itself as Canada's largest is expected to be fined $34 million Friday for importing counterfeit cancer drugs and other unapproved pharmaceuticals into the United States, a sentence that one advocacy group called too light for such a heinous crime.

Canada Drugs has filled millions of prescriptions by offering itself as a safe alternative for patients to save money on expensive drugs, and its founder, Kristian Thorkelson, has been hailed as an industry...

Apr 13, 2018

A federal judge with an audacious plan to settle hundreds of lawsuits filed by local governments against the drug industry over the destruction wrought by prescription opioid painkillers has altered his course.

Cleveland-based Judge Dan Polster issued an order Wednesday scheduling three Ohio trials for 2019 — a shift from his earlier plan to try to work out settlements without also preparing for trials.

In his order, the judge says the parties have made "good progress" and...

Apr 13, 2018

The Trump administration is hustling Congress to move VA Choice healthcare reforms before the end of May despite the absence of a department secretary. Key negotiators believe a deal to expand community care for veterans is around the corner.

In a Thursday roundtable meeting at the White House, President Donald Trump specifically called out Sen. Jerry Moran (R-Kan.) in front of the group of lawmakers to discuss VA Choice and emphasized that he wants to get the reforms done, according...

Apr 12, 2018

As a geriatric physician, I've witnessed firsthand the challenges that arise when older patients and their families must juggle multiple chronic conditions.

Patients are overwhelmed by medical appointments, medications, tests and procedures, and often discouraged by conflicting recommendations from their clinicians. Care can be fragmented, burdensome and even harmful. It is estimated 1 in 5 Medicare beneficiaries experience "guideline-driven harm," as their clinicians prescribe...

Apr 12, 2018
(Updated at 6:50 pm ET)

Banner Health will pay $18 million to settle a federal False Claims Act case accusing the not-for-profit health system of admitting Medicare patients who could have been treated as outpatients, the U.S. Justice Department announced Thursday.

The Justice Department accused Phoenix-based Banner of knowingly overcharging Medicare patients and billing Medicare for short-stay, inpatient procedures that should have been billed on a less costly outpatient basis. The...

Apr 12, 2018
A panel of Pennsylvania judges ruled in favor of UnitedHealth Group, deciding that state officials wrongly met with Centene Corp. executives as they deliberated which insurance companies would receive some of the state's $12 billion in Medicaid contracts.

The Pennsylvania Commonwealth Court's ruling reverses the Department of Human Services' decision last June to throw out UnitedHealthcare of Pennsylvania's challenges to its selection process for Medicaid contracts. UnitedHealthcare...

Apr 12, 2018

For the first time, the Food and Drug Administration has approved marketing a medical device that uses artificial intelligence. On Wednesday, IDx, an Iowa-based company, received approval to market its retinopathy-detecting software, IDx-DR. This is the first screening device the FDA has authorized that doesn't need a clinician's interpretation to look for a particular condition.

The device's software uses artificial intelligence to analyze images of the eye, judging whether or not...

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