State Highlights: Merck To Pay $31 Million To Settle States’ Medicaid Fraud Claims
A selection of health policy stories from California, Arkansas, Illinois and Colorado.
Reuters: Merck Unit To Pay $31M To Settle Fraud Claims By U.S. States
A subsidiary of Merck & Co has agreed to pay U.S. states $31 million to settle claims that it overcharged their Medicaid programs for an antidepressant it had sold at a discount to pharmacy companies, attorney generals from three states said on Wednesday. The officials from Idaho, New York and Florida said Organon USA Inc offered the drug, Remeron, to nursing home pharmacies at a discount to encourage its use over competitors. At the same time, the company reported the full cost of the drug when seeking reimbursements from state Medicaid programs, the states claimed. New Jersey-based Organon, which did not admit any wrongdoing, also was accused of improperly promoting use of the drug by children and teens (Wiessner, 10/15).
Kaiser Health News: Capsules: Spike in ER, Hospitalization Use Short-Lived After Medicaid Expansion
While the Medicaid expansion may lead to a dramatic rise in emergency room use and hospitalizations for previously uninsured people, that increase is largely temporary and should not lead to a dramatic impact on state budgets, according to an analysis from the UCLA Center for Health Policy Research released Wednesday (Aliferis, 10/15).
California Healthline: UCLA Study Shows Why One Of The Biggest Obamacare Fears May Not Come To Pass
Something like 10 million Americans -- give or take a few million -- have gained health coverage thanks to the Affordable Care Act. And here's one way to put that in perspective: In just six months between late 2013 and early 2014, the nation's persistently high uninsured rate fell by a staggering 25%. So does this mean that the nation's already busy emergency departments are about to bust at the seams, as some Obamacare critics suggest? That states still nixing the Medicaid expansion are right to worry it would overcrowd their hospitals? Not necessarily, says UCLA's Gerald Kominski (Diamond, 10/15).
The California Health Report: State Refuses To Identify Hospitals It Says Have Harmed Patients
California has been withholding money from 66 hospitals it holds culpable for medical errors, but state officials refuse to describe the mistakes or publicly identify the hospitals, all of which have allegedly harmed patients. California Department of Health Care Services spokesman Norman Williams said the agency is withholding disciplinary records to protect patients’ private medical information, but patient advocates are criticizing the lack of transparency (Richard, 10/15).
Los Angeles Times: Mission Hospital Halts Elective Surgeries After Patient Infections
One of Orange County's largest hospitals has halted all elective surgeries after its accreditation came under review following an outbreak of surgical infections. Mission Hospital performs about 7,000 surgeries a year, of which nearly 70% are elective (Jennings, 10/15).
The Wall Street Journal: Panel Backs Requiring Arkansas To Provide Drug
An advisory board recommended Wednesday that Arkansas’s Medicaid program eliminate restrictions on the use of an expensive cystic fibrosis drug made by Vertex Pharmaceuticals Inc. that are the subject of a legal battle in federal court. Members of the state’s Drug Utilization Review Board, which is made up of Arkansas doctors and pharmacists, recommended that the state adopt a revised set of criteria for prescribing the drug, called Kalydeco, that wouldn’t require that patients seeking the drug first prove their health worsened after taking two older, less-costly treatments (Walker, 10/15).
Chicago Post-Tribune: $4.2M Self-insurance Savings Projected For Lake County
The first year of a new network for the county’s health and workers compensation self-insurance pool has resulted in a savings of $3 million through the end of September. That figure is on pace to climb to $4.2 million by the end of the year, David Baker, president of Professional Claims Management Inc., the county’s insurance administrator. Plans are also in the works to see if a clinic for county employees can be built to promote wellness and better care and further reduce claims. Lake County commissioners on Wednesday said they were pleased with what they have seen so far this year and approved the contract with PCM for 2015. Baker said health insurance costs are continually on the rise. Both East Chicago and Hammond, two of PCM’s clients, are seeing slight increases this year. Health insurance medical claims costs are down 16 percent, prescription drug costs are down 15 percent and workman’s compensation costs are down 5 percent. Baker said while the health care costs are declined, employee claims rose slightly, 5 percent, this year. The savings is due to the switch by PCM to Cigna. Because Cigna is a larger network than previously used by the county, the amount it now pays for services is discounted more than it was under the smaller networks used in the past (Napoleon, 10/15).
The Associated Press: Arkansas Medicaid Vendor Wants Status Reinstated
The owner of two mental health companies wants an Arkansas agency to change its mind about the facilities' status as Medicaid providers. The state's Department of Human Services suspended Trinity Behavioral Health Care and Maxus Inc. a day after it identified owner Ted Suhl and accused him of giving bribes to an ex-deputy department director. The agency sent letters to the facilities Oct. 8, saying that they would no longer receive Medicaid payments for any new claims, citing a "credible allegation of fraud." It said Medicaid claims by the firms' existing patients would still be paid for up to 30 days to give them time to find new providers, the Arkansas Democrat-Gazette reported (10/15).
Denver Post: Homeless Housing Nonprofit Branches Into Health Care
Aurora Warms the Night has provided motel vouchers to hundreds of homeless men, women and children on nights when the temperature drops below 20 degrees since 2006. Now, the award-winning nonprofit is gearing up for its first winter in a bigger building at 1544 Elmira St. The new location just around the corner brings the total amount of space to just under 2,000 square feet. Thanks to the extra room, the organization has expanded many of its in-house services to help get clients off the streets. Most notable are an onsite health clinic provided once a week, HIV/AIDS testing, vocational coaching through Aurora Mental Health and guidance for enrolling in food stamp and Medicaid programs (Mitchell, 10/16).