News for Insurers
Top stories summarized by our editors
7/16/2019

Health insurance providers are ramping up efforts and taking on more risk to address social determinants of health, and AHIP is leading the effort with Project Link, which aims to promote the sharing of approaches used by health care stakeholders to address social barriers to well-being and good health. One example is CareMore Health's Togetherness program, which identifies patients who may be lonely using health records, then works to connect them to their communities and meet health care needs with the help of care managers.

More Summaries:
CareMore Health, AHIP
7/16/2019

Former Vice President and Democratic presidential hopeful Joe Biden released a $750 billion health care plan, which he says would shore up the Affordable Care Act and allow Americans to maintain coverage by private health insurance or purchase coverage through a public option like Medicare. Biden's plan also includes proposals to cut prescription drug prices by allowing Medicare to negotiate prices with drugmakers, restricting prices for new drugs with no competition and permitting consumers to purchase drugs from abroad.

Full Story:
Reuters, The Hill
More Summaries:
Joe Biden, Medicare, ACA
7/16/2019

Medicare is exploring coverage of acupuncture as an alternative to potentially addictive painkillers for chronic low back pain. The CMS said for now it will cover the treatment only for seniors who are enrolled in approved clinical studies.

Full Story:
The Associated Press
More Summaries:
Medicare, painkillers
7/16/2019

A study published in the Journal of Thoracic Oncology found use of low-dose computed tomography instead of chest X-rays for lung cancer screening helped lower lung cancer mortality in current and former smokers. The study, an extended analysis of patients included in the National Lung Screening Trial, confirmed the 2011 study's initial findings that the risk of lung cancer death was lower in high-risk patients screened with LDCT, with and extended median follow-up of 12.3 years.

Full Story:
HealthDay News
7/16/2019

The FDA has approved Zydus Cadila's misoprostol tablets for prevention of gastric ulcers in people taking painkillers. The product, a generic version of Pfizer's Cytotec, is designed especially for patients at increased risk of ulcers or with a previous history of ulcers.

Full Story:
Drug Store News
7/16/2019

A plan announced by presidential hopeful Sen. Kamala Harris, D-Calif., would allow HHS to set a "fair price" for any drug available for a lower price in an economically similar country, or when a manufacturer raises a price by more than the rate of inflation. Harris' plan would also impose a 100% tax on all profits manufacturers gain from selling products above the fair price and pass that money onto consumers.

Full Story:
CNN
More Summaries:
Sen. Kamala Harris, HHS
7/16/2019

WellCare of Kentucky, part of WellCare Health Plans, launched a new online program to help members find jobs, further their education and gain access to various social services. The WellCare Works program, which can be accessed through WellCare's member portal, will use "unique digital platforms" to offer members assistance with resume development and interview preparation as they search for jobs, and it also features a registry of more than 485,000 social support resources, including assistance with transportation, housing, food, utilities and child care.

More Summaries:
WellCare, WellCare Health Plans
7/16/2019

Dinesh Goyal, former owner of Tristate Medical Laboratory in Owensboro, Ky., entered a guilty plea to conspiracy to commit an offense against the United States in a $1.3 million-plus health insurance fraud case. Authorities say Goyal, in exchange for a share of fraudulent reimbursements, allowed another lab to bill health insurance programs for urine drug tests using Tristate's billing information, which resulted in over $1.3 million worth of improper payments from several private insurers, among other offenses.

Full Story:
Department of Justice
7/16/2019

Millcreek Community Hospital in Erie, Pa., agreed to a settlement worth almost $2.5 million to resolve accusations that it violated the False Claims Act and defrauded Medicare and Medicaid. Authorities accused the hospital of submitting fraudulent claims to Medicare and Medicaid for medically unnecessary inpatient rehabilitation services from July 2013 to December 2017.

7/16/2019

John and Roberta Pangallo, owners and operators of Pangallo's House of Care Counseling Center in Reno, Nev., each received a one-year suspended prison term and were ordered to jointly pay restitution of $30,000 after being convicted of Medicaid fraud. An investigation showed the couple submitted Medicaid claims for behavioral health services with false or missing documentation from March 2016 to January 2017, which resulted in improper payments from the program.