The civil False Claims Act is the principal weapon in the government's arsenal to combat healthcare fraud. The Senate and the House are considering bills that would further expand the scope of liability under the Act and eliminate two of the key defenses to meritless lawsuits filed by qui tam plaintiffs.
To improve the quality, safety, efficiency and effectiveness of the healthcare system, the U.S. Agency for Healthcare Research and Quality (AHRQ) is tasked with a mission to gather research and disseminate valuable findings to those who can translate information into practice. Carolyn Clancy, MD, an internist with decades of experience in fact finding and analysis, directs the agency.
In enacting legislation to delay a reduction to Medicare physician fees, Capitol Hill Democrats demonstrated their intent to undermine the role of private insurers in providing care to seniors. Although all sides agreed to avoid a big cut in Medicare payments to doctors, Republicans fought efforts to fund the fees by reducing payments to Medicare Advantage plans.
The US orphan drug program has demonstrated that economic incentives and regulatory flexibility can spur development of treatments for small patient populations. Since enactment of the Orphan Drug Act (ODA) in 1983, FDA has approved >300 medicines for approximately 12 million patients around the world. However, there are approximately 6,000 to 8,000 rare diseases, so “we still have a very long way to go,” commented Janet Woodcock, director of the Center for Drug Evaluation and Research (CDER), at a May conference commemorating ODA’s 25th anniversary, which was sponsored by the Drug Information Association (DIA).
Hospital-acquired pneumonia (HAP) is a frequently occurring complication of endotracheal intubation and hospitalization that is associated with a significant increase in morbidity, mortality, and cost of care.
Tolvaptan is an oral selective vasopressin V2 receptor antagonist that works to produce aquaresis (water diuresis without electrolyte excretion) by blocking the effects of AVP. This effect makes tolvaptan a viable treatment option for patients with acute decompensated heart failure (ADHF) and hyponatremia.
Generic drugs approved by FDA (through July 2008) including fluoxetine capsules and calcipotriene topical solution.
Recent FDA action (through July 2008) related to tigecycline, bazedoxifene, balsalazide tablet, tacrolimus, fospropofol injection, bivalirudin, 13-valent pneumococcal conjugate vaccine, pirfenidone, LX1032, palifosfamide, SB1518, oral tetrathiomolybdate, and terguride.
New indication: Atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor, was approved on May 7, 2008, for the maintenance treatment of ADHD in children and adolescents.
NME: Alvimopan (Entereg), a peripherally acting mu-opioid receptor antagonist, was approved on May 20, 2008, to accelerate the time to upper and lower GI recovery after partial large or small bowel resection surgery with primary anastomosis.
According to the results of an extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK), long-term reduction of blood pressure to a lower goal than the standard demonstrates no significant effect on the progression of chronic kidney disease (CKD) in nondiabetic hypertensive patients, except in patients with baseline urinary protein/creatinine ratio >0.22, said Jackson Wright, MD, professor of medicine and director of the hypertension program at Case Western Reserve University, Cleveland. These results were presented at the 23rd Annual Scientific Meeting of the American Society of Hypertension, New Orleans, May 14–17, 2008.
Drugs in development for the treatment of adult and juvenile rheumatoid arthritis
It's no secret that health insurance claim errors resulting in hundreds of millions of dollars in overpayments are common for large health plans. However, when the health plan is providing administrative services only (ASO) for self-funded plans, the incentive to recover overpayments decreases for a number of reasons.
Washington, D.C. - Several Congressional leaders, the Bush administration and major players in the e-health community are promoting electronic prescribing systems as an achievable step toward broader health information interconnectivity. Legislation to postpone a cut in Medicare payments to physicians includes a provision that encourages electronic prescribing by physicians.
The administration of Illinois Governor Rod Blagojevich (D) has hidden its state budget problems by rolling over an average of $1.5 billion in Medicaid claims each year since 2005.
National Reports - A new Ohio mandate standardizes the credentialing process and promotes more contracting transparency and fairness in the managed care process.
Washington, D.C. - Government agencies and qualified researchers will be able to tap into Medicare Part D claims data to learn more about drug coverage and safety under a new policy issued by the Centers for Medicare and Medicaid Services (CMS).
Drug trend for 2007 was 2%, the lowest year-over-year trend since Medco began tracking it in 1999, according to the company. While the drug cost trend is small in terms of overall healthcare dollars spent, it was at one time rising at a rate more than double the rate of inflation, according to Lon Castle, MD, senior director, department of medical and analytical affairs at Medco.
Starting March 28, data on patient experiences in the hospital was added to the federal government's Hospital Compare Web site. Patients' feedback was drawn from a 27-question survey developed by the Agency for Healthcare Research and Quality (AHRQ), and reflects the issues of greatest concern to patients. Data about patients' experiences in 2,500 hospitals has already been uploaded to the site; by the end of the year, information from most of the nation's hospitals will be available.
According to results of Deloitte Consulting's 2008 Survey of Health Care Consumers, nearly 80% of consumers want their physicians to provide online access to medical records and test results. Thus, the cry has gone out for physicians, providers and purchasers to respond quickly. In the travel and banking industries, data moves freely between applications-and that's the current challenge for the healthcare industry.
Statin medications lower cholesterol levels and have an anti-inflammatory effect. They should be used in combination with lifestyle changes to reduce heart disease risk.
Methicillin-resistant Staphylococcus aureus (MRSA), a type of bacterium that is resistant to certain antibiotics, has become a national epidemic, with increasing numbers of serious infections, hospitalizations and deaths. Hospital stays for these infections tripled from 2000 to 2005.
While legislators and healthcare stakeholders across the country wrangle over the problem of the nation's 46.5 million uninsured, a grassroots movement called Project Access is having an impact on the health of thousands of uninsured Americans.
Your advertising campaign has officially become old-school. That stock image of pleasant patients and attractive doctors? You aren't catching anyone's attention with that approach anymore. Meet HealthPartners' new mascot: Petey P. Cup. Yes, that's right, a urine specimen cup is a walking, dancing, huggable mascot that makes appearances at clinics, health fairs and events around the Twin Cities. Petey also has a syringe sidekick named Pokey.
Genetic testing is used to predict or diagnose a disease for an individual. It also makes possible the use of pharmacogenetics-the study of genetic variation that translates to differing response to drugs-to align drug treatment for maximum effectiveness. The emerging field of pharmacogenetics has opened up a new world of personalized treatment and evidence-based medicine.
When Peter Lee stepped down in January from his eight-year tenure as president and CEO of the Pacific Business Group on Health (PBGH), he chose to stay close to home, taking over the new role of executive director of national health policy for this non-profit organization of large employers and other major purchasers. Although Lee wears a new hat, he is confident that he has left the CEO position in the hands of a competent and experienced healthcare thought leader: David Lansky. The duo has easily blended its expertise-Lansky as the information technology whiz and Lee as the national healthcare policy guru and patient advocate. Both share a passion for data and measurement.
Capitation and other risk-sharing arrangements have been pursued by provider organizations for the past two decades. Yet the law on whether such arrangements result in the provider organization being in the business of insurance has not fully evolved in all states.
Regardless of an insurer's composition - public or private, large or small, geographically diverse or regionally focused - reducing non-labor general and administrative (G&A) expenses can contribute greatly to margin improvement.
The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to expand the recommended ages for annual influenza vaccination to include all children from 6 months through 18 years of age.
The purpose of the attorney-client privilege is to encourage frank communications between attorneys and clients, which promotes dissemination of sound legal advice. Regarding the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), some courts have found that an ERISA plan fiduciary may not assert the attorney-client privilege against plan participants regarding matters of plan administration.
