News for Insurers
Top stories summarized by our editors
2/21/2018

Mergers and acquisitions in the generic-drug sector would be expected amid payer pressure on prices and FDA action to boost competition, but Federal Trade Commission is no longer accepting the divestiture of experimental complex drugs under development as a condition of approval.

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Federal Trade Commission, FDA
2/21/2018

Former Celgene CEO Bob Hugin is running for the Republican nomination to fill the US Senate seat now held by New Jersey Democrat Robert Menendez, and drug prices are likely to be a point of contention.

2/21/2018

Genetic testing goes together with precision medicine, but genetic test results are often difficult to interpret, and many corresponding treatments are experimental or have not been clinically validated, creating a barrier to coverage. Some payers have set up outcome-based reimbursement contracts for genetic testing and treatments, and a House bill would allow state Medicaid programs to apply for coverage waivers to expand access.

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Health IT Analytics
2/21/2018

A collaboration among public health agencies and organizations, EHR vendors and the health care sector, called Digital Bridge, has developed an approach to electronic case reporting to help improve outbreak response and public health monitoring of infectious diseases. The collaboration aims to reduce costs for information sharing, encourage partnerships for improving data for public health and clinical partnerships, and streamline interoperability between EHR systems and public health agencies' IT systems.

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Healthcare IT News
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Digital Bridge
2/21/2018

The IRS has been notifying businesses that they're on the hook for fines -- sometimes amounting to millions of dollars -- for failing to meet the Affordable Care Act's employer mandate going back as far as 2015. Companies are preparing to fight the fines, with one potential line of attack alleging that, since the government never sent the required notifications, companies aren't liable for the penalties.

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Politico
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IRS, ACA
2/21/2018

Tuesday, the Trump administration unveiled a proposal to change the rules regarding what kinds of short-term health insurance companies can offer. Here's a quick rundown of things to keep in mind about the proposed changes, from the fact that they are just a draft at this point to their predicted impact.

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Trump
2/21/2018

Trump has proposed a paid parental leave plan in his budget for next year, but the idea hasn't found much support on the right without a clear funding source. A new proposal would allow parents to take leave and pay for it by taking their Social Security benefits early and delaying their retirement to pay it back.

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The Hill
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Trump
2/21/2018

Nicholas Tedesco of Linwood, N.J. faces up to 10 years in prison and was ordered to pay at least $2,069,847 in restitution and forfeit $782,766 in criminal proceeds after pleading guilty to conspiracy to commit health care fraud in a $50 million prescription drug fraud scheme. Tedesco admitted to recruiting patients to fraudulently obtain drugs from an out-of-state pharmacy from January 2015 to April 2016, and to submitting over $2 million worth of fraudulent claims to New Jersey's health benefits programs and other insurance firms for unnecessary compounded drugs, court records show.

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Nicholas Tedesco
2/21/2018

Owners, managers and doctors associated with Hope Clinic, which has offices in Virginia and West Virginia, were charged in a 69-count indictment on allegations of conspiring in running a pill mill. Most of the defendants, including clinic owner James Blume and manager Mark Radcliffe, were charged with conspiracy to distribute controlled substances such as oxycodone outside of legitimate medical use between 2010 and 2015, the indictment says.

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ABC News
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Hope Clinic, oxycodone
2/21/2018

Felicia Prysock, a resident of Wellford, S.C., received a prison term of two years and one day and was ordered to pay $1,132 in restitution after being convicted of aggravated identity theft and obtaining a controlled substance by fraud. Prysock was accused of forging the names of physicians and her children to fraudulently obtain 10 different prescriptions for schedule II opioids, which were paid by Medicaid, from July 2016 to April 2017.

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Medicaid, fraud