Opioid-drug makers were able to inject an element of doubt into plaintiffs' claims in early lawsuits, but the argument that patients were to blame for abuse and addiction might not hold up against current lawsuits brought by state attorneys general, says Rebecca Haffajee, a lawyer and professor of public health at the University of Michigan.
Congressional aides and lobbyists say biologic-drug makers are pushing for provisions in an appropriations package that would bar higher Medicare payments for biosimilars than for branded biologics at hospitals participating in the 340B discount program.
With bond yields low, financial advisers should consider using fixed indexed annuities, said Roger G. Ibbotson, emeritus professor of finance at the Yale School of Management. Indexed annuities are likely to outperform bonds in the future, Ibbotson said, and they give advisers some flexibility to tailor them to clients' needs.
The Medicare Payment Advisory Commission suggested ending Medicare's Merit-based Incentive Payment System because it could hamper physicians' transition to advanced alternative payment models and the program's design flaws will likely not improve quality of care, according to the panel's March report to Congress. "If history is any guide, once the apparatus for MIPS is established and up and running, the process will have its own momentum, and it will become even more difficult to substantially change or improve the program," the report states.
Successfully implementing value-based insurance design in health care policy and payment models requires the right infrastructure and culture as well as cooperation, experts say. Health care providers said they need streamlined, harmonized quality measures and better ways to communicate clinical nuance to patients and payers.
Seth Rehfuss, a resident of Somerset, N.J., was indicted on conspiracy to commit health care fraud and other charges over his alleged role in a more than $1 million scheme to defraud Medicare. Rehfuss is accused of receiving commissions worth over $100,000 in exchange for persuading senior citizens from low-income housing complexes to undergo medically unnecessary genetic testing between July 2014 and December 2015, which resulted in Medicare paying over $1 million to clinic laboratories, court records show.
Maryland-based health care providers Saint Agnes Healthcare, Horizon Vascular Specialists, Riverside Medical Associates, Maryland Specialty Group and physician Itsuro Uchino separately reached settlement deals with the US Attorney's Office in Baltimore to resolve accusations that they submitted fraudulent claims to Medicare for leg blood flow tests. The settlement amounts range from nearly $70,000 to around $520,000, prosecutors say.
Manhattan, N.Y.- based doctors Gordon Freedman, Todd Schlifstein, Jeffrey Goldstein, Alexandru Burducea, and Dialecti Voudouris all entered not-guilty pleas to charges of conspiracy and violation of anti-kickback laws over their alleged involvement in a pharmaceutical kickback scheme. Authorities say the doctors received bogus speaker fees, expensive dinners and other inducements from Insys Therapeutics' sales staff in exchange for prescribing Subsys, a fentanyl-based painkiller.
Omar Almusa, a doctor from University of Pittsburgh Medical Center in Pittsburgh, was recently indicted on 86 drug violations and one count each of health care fraud and conspiracy to commit health care fraud. The indictment says Almusa conspired with others to write and submit unnecessary Vicodin prescriptions.
President Donald Trump reportedly plans to announce a new plan to address the country's opioid abuse epidemic, and the proposal is expected to include a mix of prevention and treatment measures and stricter law enforcement penalties, including possible capital punishment for drug traffickers. A draft version of the plan, which could be released in final form as soon as Monday, also calls on lawmakers to make it easier for Medicaid beneficiaries experiencing addiction to get inpatient care.