News for Insurers
Top stories summarized by our editors
1/19/2018

President Donald Trump plans to shift two grant programs administered by the Office of National Drug Control Policy, the High Intensity Drug Trafficking Areas grant and the Drug Free Communities Act, to other agencies, cutting the office's budget by $340 million.

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Politico
1/19/2018

The National Governors Association made more than two dozen recommendations in asking the federal government for help in fighting the opioid epidemic. The plea comes less than three months after the President Donald Trump declared the epidemic a public health emergency and it praises the president for taking first steps, including a promise to help states pay for treatment through Medicaid, but calls for more assistance.

1/19/2018

Detroit, Mich.-based physician Gerald Daneshvar received a 24-month prison term after being convicted of conspiracy to commit health care fraud over his role in a $1.7 million Medicare fraud case. Trial evidence showed Daneshvar submitted fraudulent claims to Medicare for home visits provided to ineligible patients, conspired with others to submit inflated claims, and referred patients for unnecessary home health services while working for Lake MI Mobile Doctors, a home-visiting physician firm, from August 2012 to August 2013.

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WDIV-TV (Detroit)
1/19/2018

Tea Kaganovich and Ramazi Mitaishivili, owners of several New York-based diagnostic testing firms including Sophisticated Imaging and East Coast Diagnostics, both entered not-guilty pleas to grand larceny and money laundering charges related to allegations that they submitted more than $1 million worth of fraudulent claims to Medicaid, a prosecutor said. The couple were previously charged over their alleged roles in a $44 million scheme to defraud Medicare and other insurers.

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New York Post
1/19/2018

Jose Leyson, a New Jersey-based physician and medical clinic owner, is facing up to 30 years in prison after entering a guilty plea to illegal distribution of oxycodone and conspiracy to commit health care fraud. Court records show Leyson illegally sold oxycodone prescriptions to an undercover informant four times between November 2013 and January 2014 and conspired with others to submit fraudulent Medicaid and Medicare claims for allergy tests he prescribed without performing patient examinations, which resulted in at least $30,000 worth of improper payments from April 2010 to January 2013.

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Department of Justice
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oxycodone, Medicaid, Medicare
1/19/2018

Roger Bowling, a resident of Hutchinson, Kan., received a 36-month probation sentence with an underlying five-year prison term and was ordered to repay the state's Medicaid program over $11,000 after pleading guilty last year to making a false claim to the Medicaid program. Bowling concealed the assets of a dependent adult from June 2013 to April 2014, which allowed him to enroll that person in the Medicaid program to pay for nursing home expenses while he spent the assets on himself, an investigation found.

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Medicaid
1/18/2018

The Senate Finance Committee voted 15-12 to advance Alex Azar's nomination as HHS secretary. The former Eli Lilly and Co. executive now faces a vote in the full Senate, where confirmation is expected.

1/18/2018

Youths who smoked cigarettes in early adolescence or those who used marijuana in early and late adolescence were more likely to have psychotic experiences such as delusions, hallucinations and thought interferences at age 18, compared with those who didn't use either substance, researchers reported in JAMA Psychiatry. The findings showed that only the association between marijuana use and subsequent psychosis remained strong after adjusting for other factors, while evidence linking early psychotic experiences to increased cigarette or marijuana use was limited.

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marijuana, psychosis
1/18/2018

The CMS has proposed a new policy to fight the opioid abuse epidemic by preventing at-risk Medicare beneficiaries from obtaining prescription drugs from multiple physicians or pharmacies. Locking certain beneficiaries in to a single prescriber for Medicare Part D benefits will improve care coordination while maintaining access to necessary painkillers and make it easier to track billing patterns, CMS official Kimberly Brandt said at a House subcommittee hearing Wednesday.

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opioid abuse, painkillers
1/18/2018

Physical therapist Heather Henry says evidence does not support the idea that people who have muscle soreness after a workout, which can be caused by microscopic tears in muscle fibers, get stronger than those without pain. Henry says a better way to evaluate a workout is through physical measures, such as heart rate, speed and endurance, over time.

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HealthDay News
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heart rate