What the 2016 Presidential Election Could Mean for ACA’s Future

31449732_lAt the federal level, the nation’s two major political parties have vastly different visions for the future of healthcare. The election will help to determine which course the nation follows for the foreseeable future. What are the likely outcomes depending on who wins the presidency?

A Republican in the White House could spell the end for the ACA

For some time now, the Republican mantra when it comes to the Affordable Care Act has been “repeal and replace.” While this phrase is oft-repeated, it is not so obvious what the GOP to actually replace the law with.  “Republicans – and Trump – are fervently united by what they oppose: ObamaCare,” John McDonough, a professor at the Harvard T.H. Chan School of Public Health, told Healthcare Dive. “They are far less certain about what they support as a replacement.”

There are certain positions Republicans generally agree upon. In an October editorial published by JAMA Internal Medicine, McDonough and his co-author Dr. David Jones from Boston University School of Public Health identified five overlapping items in Republican presidential candidate Donald Trump’s healthcare agenda and a health reform plan released by Republican House Speaker Paul Ryan.

Republican legislators widely support repeal of the ACA, interstate health insurance sales, tax deductions for health insurance premium costs, expansion of health savings accounts, and Medicaid block grants for states. However, if Republicans win control of Congress and the presidency, it is not clear which items they will prioritize.

It does seem likely Republicans will target the ACA if they win control of Congress and the presidency. However, they won’t necessarily succeed, McDonough said. Democrats will likely maintain enough influence to filibuster attempts at full repeal. Even if Republicans use the budget reconciliation process to avoid filibuster and reverse key elements of the ACA, enough Republicans might resist legislation to eliminate coverage for millions of previously uninsured Americans.

On the other hand, a Republican-controlled House has already passed a bill to repeal the ACA, but President Barack Obama vetoed the reconciliation bill in January. “Should the impediment of the presidential veto be removed, survival of the ACA in the face of a Republican-controlled Congress and White House seems unlikely,” Alexander Mainor, a fellow at the Dartmouth Institute, told Healthcare Dive.

In a March article that Mainor co-authored for The Hill, he and his colleagues encouraged Republican-leaning voters with a stake in healthcare to push for policies that preserve successful elements of the ACA. “Should a Republican be elected, careful legislation rather than repeal could preserve the architecture of the Affordable Care Act that supports value-based healthcare,” they wrote. “In this scenario, acceleration of value-based reforms would be slowed, but not lost altogether.”

Republican opposition would stymie a Democratic president’s efforts to improve the ACA

As Republicans are united in their opposition to the ACA, Democrats are united in their desire to improve the ACA. However, while there is agreement around certain policy ideas, there isn’t nearly as much around others. For instance, Democratic presidential candidate Hillary Clinton supports a public option. However, even with strong numbers in Congress, a public option is unlikely because too few Democrats support it, according to McDonough.

There are areas where Democrats widely agree, but are unlikely to make progress. For instance, most Democrats support legislation that would expand Medicaid in all 50 states. However, even if Democrats maintain control of the White House and gain a majority in the Senate, it is likely they will still have the filibuster and a Republican-controlled House of Representatives to contend with, according to Mainor.

There are some reforms, including some enhancements to the ACA, that could be enacted with bipartisan support under a Democratic president, Mainor said. These include small maintenance changes to the ACA, such as repeal of the “Cadillac Tax” and a fix for the “family glitch,” which prevents families from receiving ACA subsidies when an individual family member has access to employer-based coverage considered affordable by the law.

However, given the current political climate, the potential for bipartisan support is limited. “Any such proposal requires a willingness to negotiate from both parties that simply may not exist,” Mainor said.

The presidential candidates’ healthcare platforms do share one feature in common. Both would target rising drug costs by pushing for legislation to allow Medicare to negotiate drug prices and to remove market barriers to entry for drug manufacturers. However, there isn’t much of an appetite for either of these proposals among congressional Republicans, according to McDonough.

There seems to be more disagreement than agreement both between and within in the two parties. While there is potential for significant legislative change, both candidates would face an uphill battle when it comes to implementing their plans for healthcare. Although results the election will provide a clearer picture for where healthcare is headed, the only thing that seems truly certain is that political gridlock will make health reform difficult.

Source: http://www.healthcaredive.com/news/2016-president-election-ACA-future-healthcare/429843/

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CMS’ Slavitt Signals Tough Stance on Drug Costs

11935368_lDive Brief:

  • As the U.S. faces increasing drug costs, pharmaceutical companies and investors can either continue to fight reality or to face it, CMS acting Administrator Andy Slavitt told attendees at last week’s Biopharma Congress in Washington, DC.
  • As things stand, the cost increases are putting excessive pressure on the Medicare program, as well as state Medicaid programs, resulting in questions around how to plan for the anticipated ongoing growth while also adequately funding the rest of the programs, including efforts toward mental health.
  • Slavitt conceded the industry may indeed need to tell its “value story” better, as its advocates say, but they also need to look at the math. “If something is growing by 11%, unless it’s causing something else to decrease by 12%, it’s not going to last forever,” he argued.

 Dive Insight:

Drug cost increases have been in the spotlight in recent years as major spikes have collided with changes from the Affordable Care Act making those spikes more visible to consumers, as many are now shouldering a higher cost-sharing responsibility.

Mylan’s EpiPen proved a classic and headline-grabbing example, but despite all the attention it received, as Slavitt noted, it’s barely the tip of the iceberg. EpiPen did not even make CMS’ top 20 list for either price increases or spending overall in 2015. Of those top 20 drugs, seven with the highest increases were generic drugs, indicating increases are “pervasive,” Slavitt added.

According to CMS’ math, total prescription drug spending for 2015 was about $457 billion, or 16.7% of healthcare spending. Based on current trends, analysts expect to see average annual increases of 6.7% through 2025, with specialty drugs driving much of the change.

Slavitt held nothing back, noting that while he defended the industry following last year’s price scandal sparked by Turing, the new data are revealing too many “bad actors” to keep them from defining the industry.

The goals of innovation and affordability shouldn’t be in opposition, Slavitt argued, pointing toward success in other industries, and hinting at “plenty of policy options” depending how companies choose to respond. “CMS wants to be a partner in innovation. For those of you who look at data, find solutions, and pay for value, we want to partner with you,” he said.

Source: http://www.healthcaredive.com/news/cms-slavitt-signals-tough-new-stance-on-drug-costs/429816/

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Dental Clinic Owners Indicted for Health Care, Payroll Tax Fraud

23835693_lTammy Dickinson, United States Attorney for the Western District of Missouri, announced today that Marshfield, Mo., husband and wife have been indicted by a federal grand jury for their roles in health care fraud and payroll tax fraud schemes that totaled more than $1 million.

Pamela Van Drie, 57, and her husband, Lorin G. Van Drie, 57, both of Marshfield, were charged in a 40-count indictment returned under seal by a federal grand jury in Springfield, Mo., on Wednesday, Nov. 2, 2016. That indictment was unsealed and made public today upon the arrest and initial court appearance of Pamela Van Drie.

Pamela and Lorin Van Drie were the owners of All About Smiles, LLC, a Springfield company that provided dental services at clinics in Springfield (until it closed in November 2015), Mountain Grove, Mo., (until it closed in October 2014) and Bolivar, Mo. (until it closed in March 2014). They also owned PL Family Management Company, LLC, which managed the staff for those clinics.

$885,748 Health Care Fraud Conspiracy

Today’s indictment alleges that Pamela Van Drie participated in a conspiracy to commit health care fraud from Oct. 6, 2010, to Aug. 19, 2015. According to the indictment, this conspiracy consisted of a fraud scheme related to dentures and other dental services and a fraud scheme related to orthodontic appliances. Both fraud schemes involved fraudulent Medicaid claims and payments.

Pamela Van Drie and a dentist at the clinics arranged for All About Smiles to provide dentures and other dental services to adults who did not qualify for Medicaid reimbursement. They allegedly submitted claims to Medicaid for those dentures and other dental services, knowing that Medicaid’s requirements were not met.

The indictment alleges that Pamela Van Drie, through All About Smiles, submitted and received $720,048 on numerous claims for dentures and other dental services that lacked the required written referral from a physician.

Additionally, according to the indictment, Pamela Van Drie and a dentist at the clinics purchased Oroth-Tain orthodontic appliances (designed to straighten teeth without braces) for approximately $50 each, provided them to Medicaid pediatric beneficiaries and billed each such appliance to Medicaid as a speech aid prosthesis for approximately $695. They knew the Ortho-Tain appliances should have been billed to Medicaid as orthodontic services, the indictment says; they also knew Medicaid did not cover orthodontic services unless the Medicaid program’s requirements were met and they received precertification, which required review by a dentist/orthodontist employed by Medicaid. They allegedly billed the Ortho-Tain appliances as speech aid prostheses in order to bypass the precertification requirement.

Between Oct. 6, 2010, and Aug. 19, 2015, Pamela Van Drie submitted and received payment for approximately 241 claims submitted for speech aid prosthesis.  On each claim, All About Smiles was paid between $675 to $695, for an approximate total amount of $165,700.

$194,751 Payroll Tax Fraud Conspiracy

In addition to the health care fraud conspiracy, Pamela and Lorin Van Drie are charged with participating in a conspiracy to defraud the government by failing to pay over the IRS payroll taxes from Jan. 31, 2013, to Jan. 31, 2015. Although payroll taxes were withheld from the paychecks of employees at All About Smiles and PL Family Management Company, the indictment says, the Van Dries failed to pay over to the IRS approximately $194,751 in payroll taxes.

According to the indictment, the Van Dries diverted substantial amount of money from their businesses during this period. They allegedly caused All About Smiles and PL Family Management Company to make thousands of dollars for their personal benefit while failing to pay over to the IRS payroll taxes withheld from their employees’ paychecks.

Rather than paying the payroll taxes due and owing, the indictment alleges, the Van Dries purchased and made payments on a 2013 Tracker boat and trailer, a recreational vehicle, multiple vehicles (including a 2010 Hummer and a 2009 Mercedes), diamonds, several utility trailers, two golf carts, a motorcycle, expenses associated with two homes and family vacations in Florida, and a pulling truck called “Momma’s Money,” which Pamela Van Drie’s son used in pulling competitions throughout Missouri.

Additional Charges

In addition to the two conspiracy charges, Pamela Van Drie is charged with eight counts of health care fraud related to fraudulent claims for speech aid prosetheses, 10 counts of health care fraud related to fraudulent claims for dentures and other dental services and one count of theft of public money related to unemployment benefits that she was not entitled to receive. Lorin Van Drie is also charged with one count of theft of public money related to unemployment benefits that he was not entitled to receive and 18 counts of failure to pay over employment tax.

Today’s indictment also contains a forfeiture allegation, which would require Pamela Van Drie to forfeit to the government any property derived from the gross proceeds traceable to the alleged offenses, including at least $885,748.

Source: https://www.justice.gov/usao-wdmo/pr/former-dental-clinic-owners-indicted-1-million-health-care-payroll-tax-fraud

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Walgreens Clinical Pharmacy Manager Pleads Guilty to Fraud Scheme

DrugsPicture4On Oct. 25, 2016, Amber Reilly, 33, of Jonesborough, Tenn., pleaded guilty to one count of healthcare fraud contained in a federal information, before the Honorable J. Ronnie Greer, U.S. District Judge.  Reilly was the former Clinical Pharmacy Manager at the Walgreens Specialty Pharmacy located in the Holston Valley Hospital in Kingsport, Tenn.

Sentencing has been set for Jan. 30, 2017.  Reilly faces a potential sentence of up to 10 years in prison, a fine of up to $250,000, and supervised release of up to three years.

In a detailed plea agreement on file with the U.S District Court, Reilly admitted that between October 2014 and April 2016, she falsified prior authorizations, medical lab reports, and drug test results for at least 51 Hepatitis C patients who had prescriptions for the expensive Hepatitis C drugs of Sovaldi®, Harvoni®, Viekira Pak®, or Daklinza®.  These patients had health insurance through TennCare, which does not pay for Hepatitis C prescriptions for patients who abuse illicit substances or who have limited or no scarring of the liver.  The patient’s authentic medical lab reports and drug tests showed that they failed to meet TennCare eligibility requirements. However, Reilly admitted to replacing disqualifying information regarding levels of liver scarring and illicit substance abuse on the authentic records with qualifying information, and then submitting the altered records to TennCare.  She also admitted to fabricating allergies on the prior authorization forms of some of these patients so they could receive the most expensive Hepatitis C drug, Harvoni®.

As a result of Reilly’s conduct, TennCare paid at least $4,400,000 to purchase Sovaldi®, Harvoni®, Viekira Pak®, and Daklinza® prescriptions for these 51 patients, which they would not have paid if true and accurate prior authorizations, drug test results, and medical lab reports pertaining to these patients had been submitted.

Source: https://www.justice.gov/usao-edtn/pr/former-walgreens-clinical-pharmacy-manager-pleads-guilty-44-million-tenncare-fraud

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Whistleblowing Staffer Claims Hospital Center Dangerously Understaffed

12028461_lA senior staffer with knowledge of the Intensive Care Unit and Trauma Center at the Prince George’s Hospital Center claimed severe understaffing is endangering patients’ lives while hospital operator Dimensions Healthcare has done little to solve the problem.

“Signs and symptoms can be missed and if those are not corrected in time those patients’ level can go down and those patients can die on us,” the whistleblower said.

The staffer is making the claims as the hospital is suffering through the second evacuation of its neo-natal intensive care unit since August due to contamination by the potentially deadly pseudomonas bacteria.

But the whistleblower said problems extend far beyond the unit for critically sick infants in the hospital’s main intensive care unit and Trauma Center.

The staffer said there should be one nurse assigned to care for no more than two critically ill or injured patients. However, nurses are often charged with three patients at a time, while the supervising nurse frequently is forced to split administrative and management duties with patient care.

“I love this job. I love what I do. But it’s getting to be where it’s impacting my safety and the patients’ safety and something has got to be done about it,” the whistleblower said. “We cannot afford to keep covering this problem over and over again.  Something needs to be done about it now.”

A spokesman for Dimensions Healthcare did not have an immediate response to the whistleblower’s claims.

Source: http://www.wusa9.com/news/local/maryland/whistleblowing-staffer-claims-prince-georges-hospital-center-dangerously-understaffed/347332159

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Former American Senior Communities Executives Indicted

10353659_lUnited States Attorney Josh J. Minkler announced the indictment of four individuals for their roles in a vast fraud, kickback, and money laundering scheme involving Indiana nursing home chain American Senior Communities (ASC).  Those charged include James Burkhart, 51, of Carmel, who formerly served as ASC’s Chief Executive Officer, and Daniel Benson, 51, of Fishers, who served as Chief Operating Officer.  The four men charged are alleged to have personally pocketed millions in kickbacks and fraudulent overcharges, which they spent on vacation homes, private plane flights, golf trips, expensive jewelry, gold bullion, and casino chips.

The thirty-two count indictment charges Burkhart and Benson, along with Burkhart friend and associate Steven Ganote, 42, of North Salem, and Burkhart’s brother Joshua Burkhart, 42, of Fishers, with one count of conspiracy to commit mail, wire, and health care fraud, along with multiple other counts of mail fraud, wire fraud, and money laundering.  Additionally, the indictment charges James Burkhart, Benson, and Ganote with one count of conspiracy to violate the federal Anti-Kickback Statute.

“These men are alleged to have stolen from the most vulnerable in our society,” said Minkler.  “They took advantage of a system entrusted with the care of this state’s elderly, sick and mentally challenged allowing them to live a lifestyle of gratuitous luxury, fraught with unbridled greed.”

ASC is one of Indiana’s largest nursing home chains.  It manages the daily operations of approximately 70 senior care facilities throughout Indiana on behalf of the Health & Hospital Corporation of Marion County (Health & Hospital), a public health organization that administers hospitals, like Eskenazi Health, as well as nursing homes.  To manage the facilities, ASC purchases and refers patients to a wide variety of products and services provided by outside companies.  Nearly all of these products and services are paid for with money from Medicare and Medicaid.

According to the indictment, between 2009 and 2015, James Burkhart and his co-conspirators engaged in side deals with many of these outside vendors for their own personal benefit – unbeknownst to, and at the expense of Health & Hospital and ASC’s owners.  These side deals often involved intentionally overcharging ASC and Health & Hospital for the products and services the vendors provided and then funneling the overcharged amounts back to themselves through a web of shell companies.  For example, the indictment alleges that James Burkhart directed a landscaping vendor to artificially inflate its invoices to ASC by 45%.  After James Burkhart had ASC pay the invoices, the landscaping vendor paid the 45% overcharge back to one of James Burkhart’s shell companies, which he then split with the landscaping vendor’s shell company.  False and inflated invoices through the landscaping vendor allegedly defrauded ASC and Health & Hospital out of over $2.3 million.

In other instances, the vendors simply paid kickbacks to James Burkhart, Benson, and Ganote in exchange for doing business with ASC.  For example, the indictment alleges that the vendor who provided pharmacy services at ASC-managed facilities paid three of Ganote’s shell companies over $5.5 million in two years for purported “marketing” services.  Ganote regularly split this money among James Burkhart, Benson, and himself.

Furthermore, according to the indictment, vendors that questioned the overcharges and kickbacks were turned down.  For example, James Burkhart, Benson, and Ganote approached a company about installing new nurse call systems in all ASC facilities.  They told the company to mark up their prices by 30% and pay the overcharged amount back to a shell company.  The company declined to inflate its prices.  James Burkhart immediately terminated negotiations and moved on to a second company, which agreed to the inflated-invoice deal.  After the nurse call systems were installed, this second company was used again and again for big-ticket electrical contracting, such as generators at ASC facilities.  In total, these overcharges allegedly came to over $3.7 million.

The defendants’ scheme allegedly capitalized on much more than ASC’s need for landscaping, pharmacy, and nurse call systems.  The indictment contains allegations concerning food supplies, medical supplies, patient lifts, patient therapies, interior decorations furniture, office supplies, scent products, American flags, patient discharge packages, uniforms, and Alzheimer’s Memory Walk t-shirts.

The indictment alleges that the fraudulent proceeds and kickbacks were laundered through over 20 shell companies and bank accounts, and then divided among the four men for their personal use and benefit.  Some of the illegal proceeds, for example, were allegedly used to pay for real estate on Lake Wawasee, Indiana, and Marco Island, Florida, elaborate diamond jewelry, Rolex watches, multiple gold bars, dozens of gold coins, gambling chips at Caesars Palace Las Vegas, extensive use of a private plane, and political contributions.  In total, the indictment alleges that the defendants received over $16 million from their fraud and kickback scheme.

This case was jointly investigated by the Federal Bureau of Investigation, the Department of Health and Human Services, Office of Inspector General, the Internal Revenue Service-Criminal Investigation and the Indiana Attorney General’s Medicaid Control Fraud Unit.

“Today’s arrests are the culmination of a detailed and thorough investigation which uncovered excessive fraud,” said Special Agent in Charge W. Jay Abbott.  “Over the course of the past year, the FBI Indianapolis Office, in partnership with IRS and HHS-OIG, diligently investigated kickback schemes, inflated bills and overbilled invoices.  Together, we held these American Senior Communities executives arrested today accountable for funneling illicit profits and passing these costs along to Indiana Medicaid.  I want to commend the hard work and diligence by Special Agents Victoria Madtson and Joe Weston of the FBI, who worked in close collaboration with our Forensic Accountants Ron Winings and Chris Knight.  Their investigation illuminated the greed exhibited by these individuals who lined their own pockets at the expense of Hoosiers around the state.  The individuals arrested today violated the trust of those they were meant to serve.  These illegal actions, and the levels of greed uncovered by this investigation, are not to be tolerated. Working with our colleagues, the FBI is committed to investigate complex financial crimes in Indiana as a priority today and in the future.”

“The payment of kickbacks in exchange for the referral of patients covered by federal health care programs is illegal,” said Lamont Pugh III, Special Agent in Charge – Chicago Region, U.S. Department of Health & Human Services, Office of Inspector General. “These improper arrangements exploit our healthcare system and increase the costs for obtaining services for all program participants.  The OIG will continue to work with our federal, state and local law enforcement partners to uncover these types of schemes and hold those who execute them accountable.”

Source: https://www.justice.gov/usao-sdin/pr/former-american-senior-communities-executives-indicted

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Lifecare Settles Whistleblower Lawsuit for $145 Million

48763312_lLife Care Centers of America Inc. (Life Care) and its owner, Forrest L. Preston, have agreed to pay $145 million to resolve a government lawsuit alleging that Life Care violated the False Claims Act by knowingly causing skilled nursing facilities (SNFs) to submit false claims to Medicare and TRICARE for rehabilitation therapy services that were not reasonable, necessary or skilled, the Department of Justice announced today.  Life Care, based in Cleveland, Tennessee, owns and operates more than 220 skilled nursing facilities across the country.

“This resolution is the largest settlement with a skilled nursing facility chain in the department’s history,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.  “It is critically important that we protect the integrity of government health care programs by ensuring that services are provided based on clinical rather than financial considerations.”

This settlement resolves allegations that between Jan. 1, 2006 and Feb. 28, 2013, Life Care submitted false claims for rehabilitation therapy by engaging in a systematic effort to increase its Medicare and TRICARE billings.  Medicare reimburses skilled nursing facilities at a daily rate that reflects the skilled therapy and nursing needs of their qualifying patients.  The greater the skilled therapy and nursing needs of the patient, the higher the level of Medicare reimbursement.  The highest level of Medicare reimbursement for skilled nursing facilities is for “Ultra High” patients who require a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, speech), one of which has to be provided five days a week.

The United States alleged in its complaint that Life Care instituted corporate-wide policies and practices designed to place as many beneficiaries in the Ultra High reimbursement level irrespective of the clinical needs of the patients, resulting in the provision of unreasonable and unnecessary therapy to many beneficiaries.  Life Care also sought to keep patients longer than was necessary in order to continue billing for rehabilitation therapy, even after the treating therapists felt that therapy should be discontinued.  Life Care carefully tracked the minutes of therapy provided to each patient and number of days in therapy to ensure that as many patients as possible were at the highest level of reimbursement for the longest possible period.  The settlement also resolves allegations brought in a separate lawsuit by the United States that Forrest L. Preston, as the sole shareholder of Life Care, was unjustly enriched by Life Care’s fraudulent scheme.

“Billing federal healthcare programs for medically unnecessary rehabilitation services not only undermines the viability of those programs, it exploits our most vulnerable citizens,” said U.S. Attorney Nancy Stallard Harr for the Eastern District of Tennessee. “We are committed to working with our federal partners to protect both.”

“The resolution announced today demonstrates the commitment of the U.S. Attorney’s Office to aggressively pursue providers who utilize fraudulent practices to knowingly put their own financial self-interest over a duty to patients,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida.  “It is imperative that providers make healthcare decisions based upon a patient’s need for services rather than a self-serving desire to maximize financial profit.  Our office will continue to investigate fraud allegations, in order to ensure that providers do not compromise the integrity of our public health care programs.”

As part of this settlement, Life Care has also entered into a five-year chain-wide Corporate Integrity Agreement with the  Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires an independent review organization to annually assess the medical necessity and appropriateness of therapy services billed to Medicare.

“Therapy provided in skilled nursing facilities must be medically reasonable and necessary, and we will continue to vigorously investigate companies that subject their residents to needless and unreasonable therapy,” said HHS Inspector General Daniel R. Levinson.  “The corporate integrity agreement with Life Care is designed to ensure that it only provides therapy based on the individual needs of each resident.”

The settlement, which was based on the company’s ability to pay, resolves allegations originally brought in lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act by Tammie Taylor and Glenda Martin, former Life Care employees.  The act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.  The government may intervene and file its own complaint in such a lawsuit, as it has done in this case.  The whistleblower reward in this case will be $29 million.

Source: https://www.justice.gov/opa/pr/life-care-centers-america-inc-agrees-pay-145-million-resolve-false-claims-act-allegations

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Treating The Patient vs. The Healthcare System

10872771_lThe Physicians Foundation recently released its findings from this year’s biennial physician survey.  What surprised us the most, or should we say amazed us, were the 10,170 physicians who took the additional time to send us commentaries that filled more pages than in Gone with the Wind.  That act alone demonstrates how strongly physicians feel about what is happening today to the practice of medicine.  We will close our remarks with a sampling of theirs.

U.S. physicians continue to struggle to maintain morale levels, adapt to changing delivery and payment models, and provide patients with reasonable access to care.  According to the research titled 2016 Survey of America’s Physicians: Practice Patterns and Perspectives,” 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains consistent with the findings reported in the 2014 survey from the Foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative, with 49 percent saying they are either often or always feeling burnt out.

Conducted by Merritt Hawkins, the survey findings are based on a sizable response of over 17,000 physicians and address professional morale, practice patterns, career plans and their perspectives on recently passed government regulations.

In response to these and other challenges, 48 percent of surveyed physicians plan to cut back on hours, retire, take a non-clinical job, switch to “concierge” medicine or take other steps that will further limit patient access – an increase from those who answered similarly in the 2014 survey.  Clearly, many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles. By retiring, taking non-clinical roles or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce. This trend is to the detriment of patient access. It is imperative that all healthcare stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment.

Other interesting findings include:

  • 3 percent gave the Affordable Care Act (Obamacare) an “A” rating, while 48% gave it a “D” or “F” rating.
  • 6 percent indicated that ICD-10 has improved efficiency in their practice, while 42.5% reported that ICD-10 has detracted from efficiency. On a lighter note, neither of us has yet to find a physician who has used the code for a patient who was sucked into a jet engine.  We will keep asking!
  • 11 percent found that EHRs have improved patient interaction, while 60 percent indicated that they have detracted from patient interaction.
  • Only 8 percent of physicians agreed that the Maintenance of Certification (MOC), required by specialty boards, accurately assesses their clinical abilities.

Source: http://www.forbes.com/sites/physiciansfoundation/2016/10/25/a-balancing-act-treating-the-patient-vs-the-healthcare-system/#1a377e083dc5

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Lawmakers Getting Earful Over Rising Health Care Premiums

16684482_lThe skyrocketing cost of health care premiums is suddenly center stage in Campaign 2016.

State lawmakers are calling for a Special Session to fix what they say are catastrophic premium hikes. But now, political experts say the rate hike crisis could be a deciding factor in the election.

About 95 percent of Minnesotans — the vast majority — are not affected by the sky high rate hikes. But about 250,000 Minnesotans are facing monthly premium hikes up to 67 percent.

And candidates are getting an earful.

“I ask members:  What are you hearing about when you’re knocking on doors, talking to people?” said Senate Democratic leader Tom Bakk. “It was clear to me that we are hearing from too many Minnesotans that this is just too big a burden on them.”

And Republicans are blaming Democrats.

“They’re getting hammered by people over this, because they created it,” Senator David Hann, the GOP Minority Leader, said.

The shift coming after a politically damaging comment from Democratic Governor Mark Dayton last week:

“The affordable care act is no longer affordable,” Dayton said last week.

Political analyst Larry Jacobs says Republicans are moving quickly to capitalize, making distrust of Obamacare the central message of their campaign.

“Governor Dayton hit a hole-in-one for the other team,” said Jacobs, who teaches at the Humphrey School of Public Affairs in Minneapolis. “For a long time, Republicans have been saying that health reform doesn’t work.  Mark Dayton just provided the best evidence that they could have hoped for.”

Outside groups and Republicans are spending millions of dollars on mail flyers and radio ads.

And in the race for Congress, television commercials for Republican candidates that focus on health care.

“Health care premiums are up 50 percent,” begins one ad for Republican Congressman Erik Paulsen. Then, quoting Governor Dayton: “The affordable care act is no longer affordable.”

But Democrats say that message is flawed. The number of uninsured is at record lows after passage of the Affordable Care Act.

Consumers can’t be denied coverage for pre-existing conditions. Dependents are covered to age 26. And Governor Dayton says Republicans will take that away.

“The reality is these increases are due to the repercussions of the Affordable Care Act, and the intransigence of Republicans in Congress to make the necessary improvements,” said Dayton. “They want MNsure to fail.  They want the Affordable Care Act to fail. They want them to fail.”

Meanwhile, MNsure is strongly urging consumers who face rate hikes to check with MNsure online.  You could be eligible for tax subsidies that could dramatically reduce your monthly bill.

Minnesota is not the only state where premiums will go up sharply. The Obama administration announced Monday premiums nationwide will increase an average of 25 percent, and the number of insurers will drop.

It’s putting a lot of pressure on consumers.

Source: http://minnesota.cbslocal.com/2016/10/24/lawmakers-getting-earful-over-rising-health-care-premiums/

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AARP Sues US Agency Over Wellness Incentive Rules

20689720_lA lobbying group representing older Americans sued the Obama administration on Monday claiming regulations for programs designed to rein in employee health care costs will subject workers to invasions of their medical privacy.

Rules released in May by the U.S. Equal Employment Opportunity Commission will force workers to choose between hefty financial penalties or revealing sensitive health information to employers, AARP, formerly the American Association of Retired Persons, said in a lawsuit filed in federal court in Washington.

Wellness programs have become increasingly popular among employers in recent years. They can take many forms including companies providing incentives to workers to quit smoking, lose weight or undergo preventive health screenings. Workers who participate in the programs are often asked to divulge confidential medical information, which is typically illegal otherwise.

The EEOC rules, which take effect next year, say employers can offer workers incentives worth up to 30 percent of the cost of their cheapest individual health insurance plans, or 60 percent for couples, to participate in wellness programs without violating federal anti-discrimination laws.

But in Monday’s lawsuit, AARP said such incentives are really penalties for workers who are leery of sharing their medical information and render the programs involuntary in violation of federal law.

“Congress enacted these protections to prevent employers from discriminating and to combat stigma in the workplace against individuals with disabilities,” AARP said in the lawsuit.

The EEOC did not immediately respond to a request for comment.

AARP said it was suing on behalf of the one-third of its nearly 38 million members who are employed or looking for work.

The 2010 Affordable Care Act allowed U.S. employers to increase the incentives they offer to employees to participate in wellness programs. But in a series of 2013 lawsuits against employers including Honeywell International Inc, the EEOC claimed incentive-based wellness programs were illegal.

The commission came up with the regulations amid criticism from businesses and Republicans in Congress and after a federal judge in 2014 dismissed the lawsuit against Honeywell, saying the EEOC had not made clear how employers could offer the programs without breaBut some trade groups were still not satisfied with the rules and said they conflicted with regulations put out by other federal agencies.king the law.

Source: http://www.reuters.com/article/us-lawsuit-wellness-idUSKCN12O2ON

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