Category: Investigations

“File this under ‘how ironic.’
Drug makers are asking for more transparency from the government agency that is requiring them to be more transparent about how much they pay doctors.
The Pharmaceutical Research and Manufacturers of America, or PhRMA, is calling on the Centers for Medicare and Medicaid Services to further explain why the agency has removed one-third of the payment information from an online database that is due to be made public by Sept. 30.
Earlier this month, CMS said it would withhold about one-third of the payment data from the so-called “Open Payments” system. The agency also said it would return the records to drug makers because they were “intermingled,” including the erroneous linking of payment information for some doctors to still other doctors with similar names. CMS cited incorrect state medical-license numbers as one reason for the mix-up, among others.
CMS had collected partial-year 2013 payment data from the companies and began allowing doctors to go online for a preview this summer, before the database goes public by Sept. 30, in order to dispute any inaccuracies. But CMS closed the preview function for about 11 days to investigate the data intermingling and re-opened the site nearly two weeks ago. The missing one-third will be put back in the database at a later date, likely next year.”

“Middle Tennessee State University (MTSU) is restricting student work because of compliance issues associated with the Affordable Care Act (ACA), commonly known as Obamacare.
In an email last week, MTSU President Sidney McPhee explained that “due to our interpretation of the reporting requirements of ACA,” graduate assistants, adjunct faculty members, and resident assistants are barred from working on-campus jobs that exceed 29 hours of work per week.
“[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus.” Tweet This
Now, they cannot take on multiple campus jobs.
“[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus,” the email stated.
McPhee noted that violations of the law “could add up as high as $6 million” in penalties.”

“Revenue at not-for-profit hospitals grew at an all-time low of 3.9% last year with sluggish gains in both inpatient and outpatient activity, according to a report on 2013 medians from Moody’s Investors Service.
In comparison, hospital revenue increased 5.1% in 2012 and historically has grown about 7% per year.
Moody’s pegged the increased popularity of high-deductible health plans for leading people to postpone care or seek out lower cost retail clinics. “Patients have more skin in the game,” said Jennifer Ewing, an analyst at Moody’s.
The volume decline also is coming amid a number of Medicare reimbursement cuts, including the ones known as sequestration triggered by the 2012 Budget Control Act and reductions in disproportionate-share hospital payments under the Patient Protection and Affordable Care Act. In addition, Medicare’s two-midnight rule has made it harder for hospitals to bill short stays as inpatient care, and commercial payers have offered lower payment rate increases.”

“Devin Payne had gone years without health insurance – having little need and not much money to pay for it.
Then Payne, who had a wife and four children, realized she could no longer live as a man.
In her early 40s, she changed her name, began wearing long skirts and grew out her sandy blond hair. And she started taking female hormones, which caused her breasts to develop and the muscle mass on her 6-foot one-inch frame to shrink.
The next step was gender reassignment surgery. For that, Payne, who is now 44, said she needed health coverage. “It is not a simple, easy, magical surgery,” said Payne, a photographer who lives in Palm Springs. “Trying to do this without insurance is a big risk. Things can go wrong … not having the money to pay for it would be awful.”
Payne learned in the fall that she might qualify for subsidies through the state’s new insurance marketplace, Covered California, because her income fell under the limit of $46,000 a year. She eagerly signed up in March for a Blue Shield plan for about $230 a month, and began making preparations for the surgery that would change her life.”

“As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.
The move is prompted by concerns that offering free or discounted care to low-income, uninsured patients might dissuade them from getting government-subsidized coverage. It also reflects hospitals’ strong financial interest in having more patients covered by insurance as the federal government makes big cuts in funding for uncompensated care.
If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.
Most hospitals are still wrestling with that question, but a few have changed their programs, Cunningham says.”

“From Halbig to Sovaldi, this summer was a busy one for health policy and politics. We’ve made it easy to catch up, collecting all of the top stories you clicked on over the past few months. Together, they tell a story about the state of healthcare in the U.S., and offer clues as to where things may be headed when Congress returns in the fall.
Among them: The political battle over Obmacare has become more complicated for Republicans since the government cleaned up the Healthcare.gov mess, and with midterm elections around the corner, the focus will be on how much either party continues to attack or ignore the law. There are policy, legal and business matters to be settled as well – the employer mandate is under attack from the left and the right, the courts have been a wildcard for the health law to this point and could continue to be so, and employers and employees are finding themselves wading through the on-the-ground impacts of the law. That doesn’t even get to our top three storylines of the summer, so be sure to click through to find out what tops the list.”

“Health insurance companies in California may not refuse to cover the cost of abortions, state insurance officials have ruled in a reversal of policy stemming from the decision by two Catholic universities to drop elective abortions from their employee health plans.
Although the federal Affordable Care Act does not compel employers to provide workers with health insurance that includes abortion coverage, the director of California’s Department of Managed Health Care said in a letter to seven insurance companies on Friday that the state Constitution and a 1975 state law prohibits them from selling group plans that exclude the procedure. The law in question requires such plans to encompass all “medically necessary” care.
“Abortion is a basic health care service,” department director Michelle Rouillard wrote in the letter. “All health plans must treat maternity services and legal abortion neutrally.”
Jesuit-run Santa Clara University and Loyola Marymount University notified employees last fall that they planned to stop paying for elective abortions, but said faculty and staff members could pay for supplemental coverage that would be provided through a third party. The two schools said their insurers, Anthem Blue Cross and Kaiser Permanente, had cleared the move with the state.”

“The state of Oregon filed a lawsuit Friday against Oracle America Inc. and several of its executives over the technology company’s role in creating the troubled website for the state’s online health insurance exchange.
The lawsuit, filed in Marion County Circuit Court in Salem, alleges that Oracle officials lied, breached contracts and engaged in “a pattern of racketeering activity.”
Oracle was the largest technology contractor working on Oregon’s health insurance enrollment website, known as Cover Oregon. The public website was never launched, forcing the state to hire hundreds of workers to process paper applications by hand. The website’s failure became a political problem to Democratic Gov. John Kitzhaber, who is running for re-election.
A related project to modernize functions for social services also was scrapped. The state paid Oracle $240 million for both projects.”

“CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes.
What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.
But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.
The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.”

“Verizon is making a bet that telemedicine — a term for virtually administered medical care — could provide a big business opportunity.
The company recently announced it was providing private network services to the University of Virginia and Stanford University for a study on a so-called “artificial pancreas” — a series of devices that could monitor glucose levels in Type 1 diabetics and automatically release insulin into the body.
For the past few years, Verizon has been supporting universities as they perform clinical trials on telemedicine, providing them with the required network services. Verizon declined to share the financial terms of these agreements, though it said it was providing a private wireless network and data center services, among other services.
The artificial pancreas uses a tiny glucose monitor, inserted under the skin, which relays glucose levels to a smartphone. There an application can communicate with an insulin pump to release insulin into the body as needed. (Diabetics often manage this process manually by periodically measuring glucose levels and injecting themselves with glucose, according to the study.)”