News for Insurers
Top stories summarized by our editors
9/21/2018

George Beecher, an otolaryngologist from New Providence, N.J., could face a maximum 10-year prison term after pleading guilty to conspiracy and distribution of a controlled dangerous substance. An investigation found Beecher wrote tens of thousands of medically unnecessary oxycodone prescriptions for people he didn't meet, examine or treat, which supplied an oxycodone distribution ring with the drug.

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oxycodone
9/21/2018

Dentists seeking to increase their income are learning how to file claims with health plans for services that may be covered as medical care. Florida dentist Chris Farrugia tells colleagues to seek coverage for services such as full head, neck and mouth exams on new patients, but AHIP spokeswoman Kristine Grow said procedures not related to an emergency or trauma may not be medically necessary and may not be covered.

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California Healthline
9/21/2018

Shane Faithful, owner of Gulfton Community Health Center in Houston, and one of the clinic's doctors, Gazelle Craig, both were sentenced to 35-year prison terms after being convicted of unlawfully distributing and dispensing controlled substances and conspiracy to unlawfully distribute controlled substances for their involvement in a pill-mill operation. Authorities said Craig prescribed over 33,000 prescriptions of hydrocodone and carisoprodol from March 2015 to July 2017, and they charged $300 per opioid prescription.

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hydrocodone, carisoprodol
9/21/2018

A study in the Annals of Family Medicine on social determinants of health showed 97% to 99% of 1,130 patients screened had a SDOH need documented in an EHR, but just 19% were given an EHR-documented SDOH referral. Researchers also found that relatively few patients -- 15% in one clinic and 21% in another -- wanted assistance with their SDOH needs.

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AAFP News
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SDOH
9/21/2018

JC Scott, who will be stepping in as president and CEO of the Pharmaceutical Care Management Association, "is an exceptional choice with a tremendous record of accomplishments, both in the regulatory sphere as well as legislatively," said PCMA Board Chairman Tim Wentworth in a statement. "He has the policy depth and acumen in federal and state advocacy that will serve our association and industry well, and set us on new paths of success moving forward," Wentworth said.

9/21/2018

Etienne Allonce, owner of the medical equipment firm Medical Solutions Management, entered a not-guilty plea to health care fraud and conspiracy in a Long Island, N.Y., court for his alleged involvement in a Medicaid and Medicare fraud scheme. Allonce, who fled the country and hid in Haiti for several years after being accused of fraud in 2007, allegedly conspired with his wife, Helen Michel, in submitting $10 million worth of fraudulent claims to Medicaid and Medicare for unprovided medical services, prosecutors said.

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New York Post
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Medicaid, Medicare
9/21/2018

Rita Luthra, a former gynecologist from Longmeadow, Mass., was ordered to serve one year of probation after being convicted of violating privacy laws and lying to federal agents in relation to a kickback scheme investigation involving the now-defunct drugmaker Warner Chilcott. Authorities accused Luthra of accepting $23,500 in kickbacks through speaker fees in exchange for prescribing Warner's osteoporosis drugs and allowing a pharmaceutical firm representative to access her patient records to more efficiently complete preauthorization insurance forms.

9/21/2018

Pharmaceutical Research and Manufacturers of America is lobbying Congress to add language to legislation intended to curb opioids misuse that would reverse rules requiring drugmakers to offer larger discounts to Medicare Part D subscribers in the coverage gap.

9/21/2018

The Pharmaceutical Care Management Association says a law in North Dakota "will increase drug costs and risk patient safety." The organization is challenging the law.

9/21/2018

Joe Grogan, director of health programs at the White House's Office of Management and Budget, said he wants changes to Medicare Part D that go beyond the administration's proposals.

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OMB, White House