News for Insurers
Top stories summarized by our editors
8/15/2018

The AIDS Healthcare Foundation filed a petition asking the Supreme Court to review Gilead Sciences' five-year market exclusivity rights on tenofovir alafenamide fumarate

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FiercePharma
8/15/2018

Among the ideas in a National Governors Association report to manage drug spending are recommendations to push federal officials to acquire patents, to allow states to manage Medicaid formularies, to seek subscription payment deals with drugmakers and to set spending caps.

8/15/2018

Express Scripts is negotiating with BioMarin Pharmaceutical, Spark Therapeutics and bluebird bio on an exclusive distribution deal for new gene therapies for hemophilia when they become available in 2019 and 2020, Chief Medical Officer Dr. Steve Miller said.

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Reuters
8/15/2018

Democrats who have been on the defensive about health care for years are now actively campaigning on the merits of the Affordable Care Act. Lawmakers are meeting with voters, holding roundtables and taking out advertising, while their Republican counterparts are focused on tax cuts and jobs.

8/15/2018

Steven Gibson, a pharmacist and owner of Gibson's Discount Drugs in Red Bud, Ill., could face up to 10 years in prison after pleading guilty to fraud charges over his submission of claims to Medicaid, Medicare and private insurers for prescription drugs that were not authorized by a health care provider. Gibson, who is scheduled for sentencing Nov. 27, admitted that he used the names of his family members and pharmacy customers in the claims, which resulted in over $630,000 worth of improper payments.

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Medicaid, Medicare
8/15/2018

Ebube Otuonye, a pharmacist and owner of Neighborhood Pharmacy in Wichita, Kan., was indicted on health care fraud and drug charges on allegations he illegally dispensed almost 100,000 prescription drugs including oxycodone, methadone, hydromorphone and alprazolam. Otuonye also submitted fraudulent claims to Medicare and Medicaid for the prescriptions, according to the indictment.

8/15/2018

James Moorehead, a registered nurse from Mason City, Iowa, pleaded guilty to acquiring a controlled substance by misrepresentation, fraud, deception or subterfuge for stealing controlled substances, particularly hydrocodone-containing pills, for himself while working for Hampton, Iowa-based Franklin General Hospital from 2016 to 2017. Moorehead, who could face up to 11 years in prison, admitted to giving patients Tylenol instead of their prescribed medications and falsifying medical records to hide his actions.

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James Moorehead
8/15/2018

Saudia Shuler of Philadelphia was charged with two counts of Social Security fraud on allegations she fraudulently collected benefits from the Social Security Administration. Authorities said Shuler claimed she was disabled and unable to work when she applied for benefits and deliberately concealed her income as a restaurant owner, which allowed her to fraudulently collect $36,785.67 worth of benefits.

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KYW-TV (Philadelphia)
8/15/2018

A report from cybersecurity firm McAfee showed that flaws in medical devices could allow hackers to change a patient's vital signs, including blood pressure, heartbeat and oxygen level, which "could lead to extended hospitalization, additional testing and side effects from medications prescribed to control heart rhythm and/or prevent clots," said Dr. Shaun Nordeck, who spoke with researchers for the report. Researchers were able to modify a patient's heartbeat data displayed on a central monitoring station by using an electrocardiogram simulator to intercept how the bedside monitor communicates with the central station.

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McAfee
8/15/2018

Advanced primary care models such as patient-centered medical homes and accountable care organizations make a natural, mutually beneficial pairing that results in better health care quality and improved shared savings, according to research from the Patient-Centered Primary Care Collaborative and the Robert Graham Center. The analysis of 333 ACOs found those with PCMH physicians had better shared savings, health promotion scores, health status scores, preventive care scores and chronic disease management scores than ACOs with no PCMH physicians.

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HealthLeaders Media