News for Insurers
Top stories summarized by our editors
9/22/2017

The Midwest Business Group on Health says employers should work closely with their pharmacy benefit managers, which typically reduce drug-benefit costs by 30%, according to the Pharmaceutical Care Management Association. "In an era of high drug prices and expensive specialty medicines, employers, unions, and government health programs rely on pharmacy benefit managers to restrain costs by, among other things, negotiating aggressive price concessions from drug companies," PCMA stated, also citing a recent survey of business owners showing a 95% satisfaction rate with the company they've hired to manage their prescription drug benefits.

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AIS Health
9/22/2017

The fate of state Medicaid waiver requests depends on whether Republican efforts to repeal parts of the Affordable Care Act succeed.

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Medicaid, ACA
9/22/2017

Drugmakers never began 20% of the post-approval safety studies required in 2009 and 2010, and 9% of those studies were delayed, researchers reported in The New England Journal of Medicine. Drugmakers and the FDA said the study's conclusions are inaccurate.

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Reuters
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FDA
9/22/2017

Lisa Crinel, owner of home health services firm Abide Corporations in New Orleans, La., was sentenced to a prison term of six years and eight months and was ordered to pay restitution of more than $16 million after admitting her involvement in a $30 million Medicare fraud scheme. Crinel and her co-defendants were accused of conspiring to submit false claims to Medicare for unprovided services, among other offenses, for eight years starting in 2008.

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Lisa Crinel, Abide Corporations
9/22/2017

James Sayadzal, former CEO of Aggeus Healthcare in Chicago, received a prison sentence of 366 days and was ordered to pay $1.77 million in restitution to Medicare after admitting to a conspiracy charge. Sayadzal conspired with Aggeus owner Yev Gray and other employees in submitting false claims to Medicare for unnecessary or unprovided podiatry services supposedly rendered to nursing home and long-term care facility residents.

9/22/2017

Glenn Petty, a podiatrist and former operator of Dr. Petty's Foot Clinic in Texarkana, Texas, was ordered to serve five years of probation and pay $157,660 in restitution after entering a guilty plea to a single count of health care fraud. Petty, who now operates Legacy Foot and Ankle in Frisco, Texas, admitted to improperly billing Medicare for providing therapeutic exercises to a patient when he merely gave the patient a sheet of exercise instructions, authorities say.

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Glenn Petty
9/22/2017

Mack Cole, a retired Army master sergeant from San Antonio, Texas, received a 27-month prison term followed by three years of supervised release and was ordered to pay back $434,000 to the federal government after he was found guilty of health care fraud and making false statements related to a health care benefit program. Cole faked the severity of a back injury and claimed he could not walk to get over $400,000 worth of benefits from the Department of Veteran Affairs, according to prosecutors.

9/22/2017

Last week the Senate Finance Committee developed a deal to reauthorize funding for five years for the Children's Health Insurance Program, which expires on Sept. 30, but approval has been put on hold as the Senate focuses its attention on the GOP efforts to repeal and replace the Affordable Care Act. The committee will work on advancing these programs "as quickly as possible," according to Sen. Orrin Hatch, R-Utah, the committee chairman, but states may begin shutting down their programs without the guarantee of federal funding.

9/21/2017

The fertility rate among women in Flint, Mich., dropped by 12%, while fetal death rates rose by 58% after the city switched to a water supply with elevated lead levels in April 2014, according to a working paper by health economists David Slusky of Kansas University and Daniel Grossman of West Virginia University. The findings also show that Flint infants were born half a week earlier, weighed about 150 grams less and gained 5 grams per week less, compared with those born in other parts of Michigan.

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Flint
9/21/2017

A spokesman for Senate Majority Leader Mitch McConnell, R-Ky., said the senator plans to bring the Graham-Cassidy health care bill to a vote next week, but it remains unclear whether the party has enough votes to advance the bill. The legislation, which is seen as the GOP's last attempt to repeal portions of the Affordable Care Act under reconciliation rules before the Sept. 30 deadline, is predicted to cut funding to states by $215 billion through 2026, and 34 states are expected to be affected by the reductions, according to an Avalere Health analysis.

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Reuters, The Hill