Healthy Muse Healthcare News.
Rural healthcare fraud and drug shams.
In case you forgot, healthcare is rampant with fraud.
Federal prosecutors just charged Jorge Perez and nine others in a $1.4 billion (BILLION) rural healthcare billing fraud.
- Since certain rural hospitals can charge much higher rates for lab testing, the fraudsters ‘contracted’ with out of state labs and then proceeded to charge insurance at extremely high rates for lab tests. Most of the tests were conducted for people who had never even entered the hospital.
Here’s the crazy stat: according to KHN, Mr. Perez’s empire was affiliated with HALF of the nation’s rural hospital bankruptcies in 2019.
Over in the Big Pharma world, Novartis just paid the Feds around $700 mil to settle an illegal kickback scheme, where Novartis sales reps allegedly bribed docs with fancy food, gifts, etc. to get the physicians to prescribe Novartis meds.
Onto the Supreme Court…Abortion.
Last Monday, the Supreme Court struck down a Louisiana abortion law. The law in question restricted abortion providers from administering services in Louisiana unless that provider had admitting privileges at a local hospital.
- At the end of the day, SCOTUS says no abortion changes in its 5 – 4 ruling.
Accolade’s big day.
- Digital health benefits provider Accolade staged a hugely successful IPO this week. The stock was up over 30% in its first day of trading. Here’s a link to their website.
Drugs: made in America. & other policy stuff.
Marco Rubio and Elizabeth Warren plan to introduce legislation to conduct a review of the pharmaceutical supply chain.
- AKA, they want to produce more drugs in America since the pandemic exposed our dependence on manufacturing drugs in other countries.
Meanwhile, the House passed an infrastructure package that contains an additional $30 billion in funding for healthcare providers.
6 months into COVID. Here’s the latest.
Big Picture Stuff.
- The latest numbers: Over 11.4 million infected, 534k deaths globally. 3.0 million infected, 132k deaths in the U.S.
Here’s a great summary from Nature of what we’re still trying to understand about the coronavirus. HHS is extending its declared public health emergency for 90 more days past the July 25 expiration.
- States continue to reverse reopening as we’re now over 50k cases reported per day. Cases are especially worse in the South and Sunbelt (Texas, Arizona, Florida). More and more mask mandates are going into effect across the nation. And is the WHO downplaying the risk of an airborne virus?
Fauci says…
- Fauci is predicting 100k cases per day in the U.S. if the outbreaks can’t get under control. Hopefully these trends reverse as people get used to wearing masks.
What about deaths?
While cases are going in the wrong direction, deaths – at least for now – continue to trend downward, which is the most important statistic.
- One possibility – The coronavirus may have mutated to become more infectious. Still, hospitalizations are up, and deaths are a lagging statistic. Fingers crossed…
Vaccine stuff.
Moderna’s phase 3 trial was slated to start on July 9, but has since been delayed indefinitely according to Stat. A July start to the trial is still possible as Moderna adjusts its trial protocol.
- Meanwhile, Pfizer reported early – but encouraging – results from its vaccine trial. The vaccine caused immune results in patients and did not have serious side effects.
Drama over Gilead’s Remdesivir.
You might recall that biotech giant Gilead’s repurposed drug Remdesivir recently proved to be an effective treatment against the coronavirus.
- In an open letter from its CEO, Gilead set the price of a full round of treatment for the drug at a little over $3k.
This wasn’t the biggest news, though.
After readying its supply, Gilead agreed to sell all of July’s available supply of Remdesivir to the U.S.
- The U.S. decision to purchase not only July’s full supply, but 90% of August’s planned Remdesivir production, drew instant backlash.
I can’t help but ask why this is getting so much criticism:
- The U.S. is the epicenter of the pandemic currently
- The U.S. involvement was fundamental in the drug’s success, including tens of millions of $$ invested
- Gilead is a U.S.-based company
- Finally, Gilead is partnering with generic manufacturers in developing countries to make the drug affordable to those populations.
Of course, I’d love to hear differing viewpoints here.
Pediatricians want schools to reopen.
Big question: should schools reopen in the fall? U.S. pediatricians think the benefits outweigh the risks (AKA, kids need school for socialization and to have friends).
- Read the American Academy of Pediatrics’ full recommendations here. No mention of what teachers should do, though.
THE RETURN OF HYDROXYCHLOROQUINE?
A study published this week linked the now-very-famous drug to lower COVID death rates.
- Prior to this release, other studies indicated that the drug was not effective. The WHO even ended a recent trial early due to perceived lack of efficacy. Honestly, who even knows anymore.
Quick Hits
Biz Hits
- Telehealth startup Ro has been crushing it lately, achieving record growth during the pandemic. You might remember this better company by its previous name – Roman. Since its beginning focus on men’s health, the company has expanded into generic pharmaceuticals with a subscription model.
- CVS Health is launching its own group purchasing organization – known as a GPO in the healthcare community. CVS’ GPO will be called Zinc. What’s a GPO? Find out here.
- Lululemon’s $500 million Mirror purchase was super telling to me this week. Home gym forever, anyone?
- The healthcare sector added over 350k jobs in June. Hospitals added jobs for the first time in 2 months.
- Goldman Sachs estimates that implementing a national face mask mandate would be worth about 5% of U.S. GDP. Nuts.
- $1 billion antibiotic venture fund was launched this week.
- Quorum Health is expected to emerge from bankruptcy next month.
State Hits
- Voters in Oklahoma just narrowly approved Medicaid expansion in the state.
- A Texas merger may have created the largest radiology group in the country – RADNTX.
Other Hits
- Major insurers are planning to end expanded telehealth coverage as soon as next month.
- Usually in the background, public health officials are facing increasing pressure and backlash during the pandemic.
- Read the extensive KHN/AP analysis showing that public health spending per capita has decreased by ~15% over the past 10 years.
- Although some surprise billing elements made it into the CARES Act, groups are now calling for Congress to include more robust surprise billing language in its NEXT COVID-19 stimulus package.
Thought-Provoking Editorials
- A doctor confronts medical errors – and the flaws in the system that create mistakes. (NPR)
- America needs leadership on prescription drug prices (WSJ – Chuck Grassley) (context – Democrats pulled out of a previously-bipartisan drug pricing effort in the Senate. Lots of drama with this one).
- To be young, a doctor, and black: overcoming racial barriers in medical training.
Healthy Muse Top Picks
- I really enjoyed the profile on Ro this week. Really interesting stuff how these new healthcare platforms are entering their markets.
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