News for Insurers
Top stories summarized by our editors
8/17/2018

Gilead Sciences CEO John Milligan, Chairman John Martin and Chief Medical Officer Andrew Cheng announced plans to leave the company amid lagging sales of Yescarta, a CAR-T therapy for lymphoma, which Gilead acquired when it bought Kite Pharma for $11.9 billion.

8/17/2018

Businesses don't need to simply endure negative reviews online. There are ways to respond to unhappy customers on social media and deal with other damaging online content, writes Sameer Somal, co-founder and chief financial officer of Blue Ocean Global Technology.

Full Story:
Social Media Examiner
More Summaries:
Sameer Somal
8/17/2018

Sandra Bailey, a former employee of durable medical equipment firm Jaspan Medical Systems in Tennessee, was given a 10-year prison term and ordered to pay more than $1.4 million in restitution, and her husband, Calvin Bailey, also a former Jaspan employee, was sentenced to 45 months in prison and was ordered to pay restitution of more than $1.3 million after being convicted of charges for their involvement in a health care fraud scheme. Authorities said that while working for Jaspan from November 2009 to September 2011, the couple falsified medical records to make it look like patients were eligible to receive medical equipment for free, which resulted in over $4 million worth of improper payments from the government.

8/17/2018

Lincare, a Florida-based medical equipment provider with approximately 1,000 locations in the US, agreed to pay $5.25 million to settle a whistleblower lawsuit accusing the company of defrauding Medicare and violating the False Claims Act and the Anti-Kickback Statute. Authorities accused Lincare of illegally waiving or lowering copayments, coinsurance and deductibles for recipients of a Medicare Advantage plan from 2011 to 2017, which resulted in the submission of fraudulent claims to Medicare.

More Summaries:
Medicare, Lincare
8/17/2018

April Tyler, a doctor from Genesee County, Mich., was charged with health care fraud and conspiracy to commit health fraud for her alleged involvement in a scheme to defraud Medicare and private insurers. Tyler was accused of prescribing medically unnecessary and expensive prescription creams, pain patches and vitamins to members of the United Auto Workers union from 2014 to 2017, which caused the submission of about $9.5 million worth of fraudulent claims to private insurers and resulted in more than $800,000 worth of improper payments from Medicare, the indictment said.

Full Story:
Department of Justice
More Summaries:
Medicare, United Auto Workers
8/17/2018

Louis Impell of Pittsburgh could face up to five years in prison after being charged with theft of government funds over allegations he fraudulently collected benefits from the Social Security Administration. According to the indictment, Impell did not disclose his income, which allowed him to collect and convert approximately $72,186.78 worth of Supplemental Security Income benefits he was not entitled to from August 2009 to June 2018.

Full Story:
Department of Justice
8/16/2018

Preliminary CDC data showed US drug overdose mortality hit record levels last year, increasing to more than 72,000 deaths, driven mainly by the continued increase in fatalities involving fentanyl and other synthetic opioids. Overdose deaths from synthetic opioids rose by more than 9,000 from the prior year, reaching almost 30,000 deaths in 2017, while fatalities from heroin, prescription opioids and methadone have dropped.

More Summaries:
drug overdose, CDC, fentanyl, heroin, methadone
8/16/2018

Two EHR-integrated, web-based tools that use Substitutable Medical Applications and Reusable Technologies on the Fast Healthcare Interoperability Resources standard are being launched by Geisinger Health System and Merck. The Family Caregiver app is designed to support communication between health care providers and caregivers, while the MedTrue app is meant to improve medication adherence and reconciliation by integrating medication data with clinical workflows.

Full Story:
EHR Intelligence
8/16/2018

Nevada said it will start operating its own Affordable Care Act exchange beginning in 2020, a move marketplace Executive Director Heather Korbulic said will save the state more than $18 million over the life of the contract. Nevada Health Link has partnered with GetInsured, which operates exchanges for seven other states.

More Summaries:
ACA, Heather Korbulic
8/16/2018

Oral arguments in a case filed in a Texas court by 20 states questioning the constitutionality of the Affordable Care Act will be held on Sept. 10, two months before the midterm elections and about six weeks before open enrollment begins on Nov. 1. Rather than defending the law, Justice Department attorneys also said the ACA is not constitutional and asked the court to strike down the law's protections for people with pre-existing conditions.

More Summaries:
ACA, Justice Department