News for Insurers
Top stories summarized by our editors
4/24/2019

A study published in Health Affairs found by 2029 more than one-half of middle-income seniors ages 75 and older could be unable to pay for assisted living care or medical expenses. Researchers suggested Medicare benefits could be expanded to include more support services or the program could add a new benefit covering long-term care.

Full Story:
Kaiser Health News
4/24/2019

The American Cancer Society this week launched a $4.5 million initiative to support Medicaid expansion in states that are debating it. The Medicaid Covers US project, which will focus on Alabama, Georgia, Kansas and North Carolina, will talk about how Medicaid expansion helps beneficiaries and communities.

Full Story:
Politico
4/24/2019

James Dye, a dentist from Missouri, was ordered to serve five years of probation and pay $167,000 in restitution for his involvement in a Medicaid fraud scheme. Authorities said Dye conspired with dental clinic owner Pamela Van Drie to submit over $165,000 worth of fraudulent claims to Medicaid from 2010 to 2015 by falsely claiming they provided patients with speech aid prosthetics worth almost $700 instead of $50 devices.

More Summaries:
James Dye
4/24/2019

M. Wagdi Attia, a former psychotherapist who owned a medical practice in Gaithersburg, Md., agreed to an $82,000 settlement to resolve accusations that he defrauded federal health care programs for almost five years. Attia, who reached a separate $400,000 settlement deal with the federal government last year, was accused of submitting fraudulent claims to Medicare and Medicaid for psychotherapy services that did not meet specific requirements from Jan. 1, 2013, to May 31, 2017, authorities said.

Full Story:
Patch
4/24/2019

Johnny Ng, a nurse practitioner from Oklahoma, agreed to a $60,000 settlement to resolve civil penalty claims stemming from accusations that he violated the Comprehensive Drug Abuse Prevention and Control Act of 1970. Authorities accused Ng of issuing prescriptions for Schedule III and IV controlled substances on Nov. 1 and Nov. 2 while his DEA certification of registration was expired.

Full Story:
Department of Justice
4/24/2019

Vanessa Vargas, a personal care attendant from Reading, Pa., was charged with Medicaid fraud, theft by deception and submitting false claims on allegations she defrauded Medicaid. Authorities said Vargas double-billed Medicaid from May 8, 2017, to Sept. 1, 2017, for home health care services she provided to a woman with whom she was living, which resulted in approximately $15,500 worth of improper payments from the program.

Full Story:
Home Care Daily
More Summaries:
Medicaid
4/24/2019

The Medical Society of Delaware and the Pennsylvania Medical Society are encouraging members to participate in health insurers' value-based care programs. The groups are also working with a data-mining firm to track patient data to reduce duplicative care without blocking access to needed care.

Full Story:
Delaware Public Media
4/24/2019

Fifteen organizations submitted a total of 19 applications to the Oregon Health Authority to coordinate physical, behavioral and oral health care for Medicaid beneficiaries from Jan. 1, 2020, through the end of 2024. Contract awardees will be announced in July.

4/23/2019

CDC officials have confirmed 626 measles cases across 22 states this year, including 71 reported during the week ending April 19, and the total is on track to exceed the 667 cases recorded in 2014, the highest since the disease was thought to have been eliminated in the US in 2000. The increasing prevalence of measles has prompted the FDA to issue a reminder regarding the safety and efficacy of measles, mumps and rubella vaccination.

More Summaries:
CDC, rubella, FDA
4/23/2019

A survey of patients with ST-segment elevation myocardial infarction who were admitted to a coronary ICU found eating a late dinner and skipping breakfast was tied to an up to fivefold higher risk of another MI or death. Researchers said inflammatory response, oxidative stress and endothelial function may be factors in the link between eating behaviors and cardiovascular outcomes.