News for Insurers
Top stories summarized by our editors
4/25/2017

Biogen announced that spinal muscular atrophy drug Spinraza, which carries a list price of $750,000 for the first year of treatment, improved motor function in 2- to 12-year-old children.

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Endpoints News
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Biogen, spinal muscular atrophy
4/25/2017

Fransesia Davis of Lake Worth, Fla., Michael Bonds of Delray Beach, Fla., and Stefan Gatt of Deerfield Beach, Fla., were sentenced Monday to serve seven years, four years and 18 months in prison, respectively, after pleading guilty to conspiracy to commit health care fraud. All three admitted their roles in a fraud scheme that falsely billed insurers for unnecessary treatment and testing for residents of sober homes owned by Kenneth Chatman, who operated the scheme.

4/25/2017

Crittenton Hospital Medical Center in Rochester Hills, Mich., has agreed to a $791,047 settlement to resolve allegations of health care fraud related to convicted oncologist Farid Fata. The hospital was accused of submitting fraudulent claims for unnecessary laboratory tests for Fata's patients.

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The Detroit News
4/25/2017

Kevin Davies and Melvin Davies, owners and operators of KMD Healthcare Services in Houston, were sentenced to serve over four years in federal prison after admitting to charges including conspiracy to commit health care fraud. Officials say the brothers pleaded guilty to fraudulently billing Medicare, Medicaid and Tricare for approximately $6 million worth of unprovided ambulance services and bribing a local physician for a certificate of medical necessity for the transportation services.

4/25/2017

Brienne Fitzsimmons of Hackettstown, N.J., was sentenced to serve three years of probation after pleading guilty to third-degree attempt to obtain a controlled dangerous substance by fraud. Fitzsimmons admitted that she called in and attempted to pick up a fraudulent prescription at a local pharmacy, authorities say.

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Brienne Fitzsimmons
4/24/2017

Eight medical groups in Indiana and Kentucky will join Humana's Total Joint Replacement Episode-Based Model for Medicare Advantage members. Health care providers participating in Humana's value-based care program in 2015 had higher Healthcare Effectiveness Data and Information Set than those in standard Medicare Advantage programs, and their patients had fewer emergency department visits, according to the insurer.

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Humana
4/24/2017

HHS has indicated support for state initiatives linking Medicaid benefits to work requirements, but almost 60% of beneficiaries are already employed at least part-time. Many of those who are unemployed report that illness, school or the need to care for a family member prevents them from working, according to the Kaiser Family Foundation.

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HHS, Kaiser Family Foundation
4/24/2017

According to a recent CDC report, campylobacter was the most common cause of food poisoning in 2016, passing salmonella, which held the number one position for two decades. Campylobacter is commonly found in unpasteurized dairy products but may also occur in chicken, water and produce.

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campylobacter, salmonella, CDC
4/24/2017

Study data suggest 50,400 American deaths from colorectal cancer, along with 25,600 German deaths, were prevented because patients had undergone a colonoscopy in the previous 10 years, researchers reported in Gastrointestinal Endoscopy. The study, which included patients ages 55 to 79, found that if all US adults eligible for colonoscopy had undergone the screening, about 36% of CRC deaths in the US could have been prevented.

4/24/2017

Students who had lunch before recess ate more vegetables but those who had recess first wasted less food, according to research presented at the American Society for Nutrition's annual meeting. Researchers said students who had longer lunch and recess periods and ate lunch before recess were more active, while children with less time for both periods were more active if they had recess first.

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HealthDay News